Native American Diabetes: Healthy Lives Goal of Project

She does not drool, but she says the weekly experience always reminds her how difficult it is to do the right thing.

"It is not easy to eat healthy in this country, even when you're really trying to," she sighed, smiling.

Bates, who grew up on Navajo reservations in Arizona and New Mexico, is part of a $300,000 program funded by the National Institutes of Health that aims to help blunt Type 2 diabetes in an expanding urban Native American population, a demographic that suffers from the disease at a rate roughly twice the national average.

Called Life in Balance and directed by University of Nevada, Las Vegas professors and graduate public health students, the program requires participants to exercise at least 150 minutes per week and meet with lifestyle coaches regularly to discuss proper nutrition and fitness -- initiatives that researchers say are making inroads against diabetes on reservations.

"Though nearly 60 percent of Native Americans nationwide live in urban areas, they face the same risks of developing Type 2 diabetes like that of Native Americans living on reservations, yet community outreach to urban Native Americans has been minimal," said Michelle Chino, an associate professor in the UNLV School of Community Health Sciences and Life in Balance lead investigator.

Crystal Lee, who plans on becoming a medical doctor after finishing her studies for a doctorate in public health, serves as Bates' lifestyle coach.

On a recent August day, the pair sat inside the Las Vegas Indian Center and discussed how stress can affect diet.

"I don't think I eat more when I get stressed out at work, but maybe I do," said Bates, a 56-year-old clerk at a medical clinic. "I know I want to eat right. I don't want to get my leg amputated from diabetes the way my dad did."

Bates is one of 17 Native Americans who have signed up for the 16-week program, in which UNLV researchers regularly measure participants' body mass index, cholesterol and blood sugar, blood pressure and heart rate and waist size.

Even though sociological surveys now place the number of Native Americans at about 35,000 in Southern Nevada, it has been difficult for UNLV researchers to fill all 30 slots in the program, which began last spring.

"It's hard to get the word out," said Lee, a Navajo from Arizona. "Native Americans aren't used to people caring about them."

The more Lee and other UNLV researchers talk about why Native Americans suffer from diabetes at such at alarming rate, the more the conversation shifts from strictly a health condition to a disturbing part of American history.

Whenever statistics are reeled off about the disease, it's clear Native Americans suffer from it far more, with some Indian tribes having as many as half of their populations dealing with diabetes, particularly Type 2.

Nearly 24 million people in the United States, about 8 percent of the population, have the disease, which is the seventh leading cause of death in the country and a leading reason for kidney failure and amputations.

Each year an estimated 13,000 youngsters develop what is known as Type 1 or juvenile diabetes. They comprise about 10 percent of all diabetes cases in the United States.

This type occurs when the pancreas stops making insulin, which normally helps keep the amount of sugar in the blood at a stable level. It is a lifelong disease that requires a highly structured regimen of diet modification, exercise and insulin injections to manage.

But what has caught the most media attention in recent years is the type of diabetes that is hitting Native Americans at even higher levels than the population at large -- Type 2, in which the body still produces adequate amounts of insulin but tissues in the body are insensitive to it.

Known as insulin resistance, this condition is seen increasingly in people whose physical activity is low and have high body fat levels.

Twenty years ago, Type 2 diabetes was referred to as "adult onset diabetes." Only 2 percent of new cases were among children.

But today about 20 percent of those diagnosed with Type 2 diabetes are between the ages 9 and 19, with virtually all of them very obese and with a family history of the disease.

"A huge factor in Indians having so much Type 2 diabetes isn't that hard to understand," Lee said. "We were placed on reservations where we could no longer hunt or grow our food and then when the government gave us food, it was heavily processed with too much salt and sugar and fat. In the past we had always been people that loved fruits and vegetables and that was all taken away from us."

UNLV medical anthropologist Danielo Benyshek also refers to history for the high incidence of Type 2 diabetes among Native Americans.

He said that Native Americans placed on reservations late in the 19th century and early 20th century were subjected to severe hardships on their reservations.

"There simply wasn't enough food," he said.

Babies with low birth weights were commonplace.

"Research has shown that low birth weight babies are at far greater risk for insulin resistance and Type 2 diabetes," Benyshek said.

When public criticism of government treatment of Native Americans grew loud, Benyshek said government officials started sending to reservations highly processed food that also can cause Type 2 diabetes when it is the mainstay of diet.

"The problem wasn't calories at that point," Benyshek said. "There are feast and famine pathways to Type 2."

Lee, whose work with Indians has even taken her to the United Nations for ways to correct problems, said it is unfortunate that urban Native Americans continue to eat the same kind of foods that the government long provided on reservations.

Old habits, she noted, are hard to break.

"But we must break them," she said.

Bates, who was a borderline Type 2 diabetic when she entered the Life Balance Program, said she plans on doing just that. She has lost about 10 pounds during her three months on the Life Balance Program and her blood sugar level is lower. She exercises at least three times a week and will never again cook with lard.

"For the first time in my life I'm really beginning to understand what role nutrition plays in health," Bates said. "I'm going to pass that on as much as I can. We can be healthy. In so many different ways, people tried to kill us off for years. Why should we do that to ourselves?"