Diabetes Faces a New Sheriff in Town: Lifestyle Change

Health officials take action as diabetes reaches epidemic proportions in New York City

Long Island has something to teach New York City. It is the 21-Day Challenge, which puts flesh on the old adage “you are what you eat.” The program is aimed at people living with obesity or having one of the three highs–high cholesterol, high blood pressure, or high sugar.

Lillian Kuo, a full-time volunteer at the Buddhist Tzu Chi Foundation in Nassau County, works to “help people create a healthy new lifestyle” by changing their eating habits to consuming more beans, multi-grains, and a rainbow of fruits and vegetables. The biggest obstacle, said Kuo to the 21-Day Challenge is “that people like to eat meat.”

Lifestyle changes are getting a second look as type-2 diabetes reaches epidemic proportions in Black and Brown communities throughout the metropolitan area. In a city that spends next to nothing on prevention, but billions on hospital surgeries and expensive medications, New York City officials are now under pressure reduce chronic diseases such as diabetes. How much progress they can make is uncertain as “budget gaps” loom precipitously over city finances.  

The 21-Day Challenge, nonetheless, checks off a number of healthy habits: eating a more plant-based diet, avoiding sugary beverages, drinking plenty of water, and exercising regularly. Most of all, the program offers hope: hope that a person could take the initiative themselves and ward off diabetes.

Chris Norwood, executive director of Health People, a community health agency based in the South Bronx, said that fighting diabetes is key to fighting chronic diseases.  

Diabetes “makes everything worse: heart disease, kidney disease, high blood pressure,” said Norwood, “diabetes is the one that is not only causing wreckage in itself, it fuels these other diseases.”

Type-2 diabetes is a largely preventable disease which affects people as they get older. It is a leading cause of adult blindness and lower limb amputations in New York City. Studies show that individuals with obesity have a higher risk of developing diabetes than those with a normal BMI.

According to the World Health Organization, a person living with diabetes thinks about their disease, on average, every 20 minutes for the rest of their lives.

Hard to Change

City records show that neighborhoods with large Black and Latino populations are bearing the brunt of the diabetes epidemic. In East New York and Morris Park, low-income communities in Brooklyn and the Bronx respectively, twenty-three percent of all adults have been diagnosed with the disease, the most of any place in the city.

By comparison, only two percent of the adults have been diagnosed with diabetes in Greenwich Village, a largely white enclave in lower Manhattan.

Public health advocates say that lifestyle changes, such as exercising more and eating more nutritious foods, can help stave off both obesity and diabetes and lead to a healthier body. Making these changes though, is more difficult in disadvantaged communities.

Kelebohile Nkhereanye, a food justice advocate diagnosed with prediabetes and with a home in East New York, said about people’s lifestyle, “Like where they live. It is not like here [Astor Place in Manhattan] where you can go to the parks over here, Union Square, Thompson Square. It is beautiful here. You can sit right now in the sun. Nobody cares. You are just doing whatever you are doing.”

“In other neighborhoods like East New York,” said Nkhereanye, “you have to worry about ‘When I go out, where am I going? Who is watching? What is possible?’ To me that is not a fair system.”

Rashaun Buchanan, 23, a department coordinator for the Mary Mitchell Center near Tremont Avenue in the Bronx, who oversees a teen program that teaches younger students about healthy eating, said that he thinks many local teenagers after school would probably go to Kennedy Fried Chicken to satisfy their hunger needs and purchase $1.50 slices of pizza. “It’s a quick meal, [and] it is cheap,” he said.

Bodegas are not really for healthy foods, said Buchanan, but for snacks like Honey Buns, Zebra Cakes, chips and candy. “There is one on every corner.”

Records show that nearly 40% of City elementary school children are at an unhealthy weight, putting them at a higher risk of developing type-2 diabetes.

Maria Lugo, Senior Director for Health Initiatives at the Hispanic Foundation, worries that there is a lack of culturally competent providers who can speak the language and connect with patients.

Lugo said about changing food habits, a provider may mention to a person living with diabetes, “‘Or you can try a Mediterranean Diet, or try eating more fresh fruits and vegetables’, but our community, they do not understand what Mediterranean diet is.”  

“They may not understand, ‘Okay, well, I am going to eat more salad, but what happens to my rice and beans? What happens to my tortillas?’ How do you eat healthy with the culture that you are in? And I think that is a big key to reducing the risk of diabetes,” said Lugo.

New York City’s Health Department estimates that as of 2020, about one in eight New Yorkers reported having diabetes and that systemic racism, poverty, and housing volatility have all been associated with premature mortality in communities of color.

Diabetes is also taking a financial toll. According to the American Diabetes Association, in 2022, the economic costs of diabetes nationwide was $306.6 billion in direct medical costs and another $106.3 billion in indirect costs. Those costs included dying prematurely, working fewer hours, and reporting to work sick.

NYC Takes Action

In response, the department of health issued its Citywide Diabetes Reduction Plan in April, emphasizing disease management over preventive screenings for prediabetes and early diagnosis. The report was the first of its kind in the United States.

The health department’s main goal under the plan is to train more Peer Leaders and Community Health Workers on using lifestyle interventions with high risk populations as a way to help people with diabetes lower their blood glucose levels. Any new funding for the plan comes from grant money and not increased public spending.

Kelebohile Nkhereanye said that instead, the City should be making “sure people get jobs,” so that “they can buy high quality food.”

Baptiste Nicholas, a social worker at a Manhattan clinic who works with individuals suffering from chronic diseases, said “It is one thing to teach a patient about diabetes management, but many patients benefit from a hands-on approach, especially in the beginning of managing diabetes, and there just aren’t enough resources.”

Chris Norwood, whose organization works with Peer Leaders, is more upbeat. She said, “You’re recruiting people who themselves have diabetes or their family members had diabetes, so they have a great mission and dedication to try and improve their community.”

City residents enrolled in either Medicaid or Medicare have access to the National Diabetes Prevention Program, a lifestyle change program put out by the CDC and approved for use by the City to prevent the onset of type 2 diabetes. Participants in the National Diabetes Prevention Plan work with a lifestyle coach on how to eat better, stay active, and reduce stress while also joining a support group that encourages participants to cheer one another on. 

Completing the year-long course can reduce a person’s chances of developing type-2 diabetes by 58% and lower their risk of heart attack or stroke.

Prof. Venkat Narayan, executive director of the Emory Global Diabetes Research Center in Atlanta, Georgia, said that “shifting as much of the responsibility for management to the individual self” works tremendously.

What also works tremendously, said Narayan, is “having good data systems that measure quality of care” and “incentives for providers” to have a high proportion of their patients with their blood glucose levels under control.

Yet hurdles remain. By the health department’s own accounting, the City will only be able to offer 8,750 adults living with diabetes lifestyle intervention programs over the next five years. In comparison, approximately 98,000 New Yorkers alone do not have their diabetes under control; 775,000 city residents in total have diabetes.

Additionally, the City did not set aside money for preventive screenings, despite listing it as a domain that requires further investment. Individuals with prediabetes have slightly elevated glucose levels and therefore are at a higher risk of developing diabetes.

“About 90% of people with prediabetes go undetected, and even those that get detected, action is not initiated,” said Narayan.

“Identifying those people at high risk, those with prediabetes and referring them to these lifestyle management programs is a very smart thing to do,” said Narayan. “And by that, you can delay diabetes onset by 12 to 15 years.”

The City’s Department of Health and Mental Hygiene did not respond directly to questions about doing more preventive screenings or offering only a small number of residents living with diabetes a lifestyle intervention program. Instead, it said it has introduced other programs such as Plant-Powered Fridays in public schools. 

From the City’s perspective, money is tight. The most recent budget allocated zero dollars for diabetes prevention. Money to lower class size, expand housing vouchers, and funds to help out asylum seekers are budget priorities for the next two to three years.

Lillian Kuo, when asked whether she thought New York City’s healthcare system was up to task in the fight against diabetes, talked about Mayor Eric Adams instead and how he changed his eating habits and lifestyle to become a vegetarian as a way to cure his diabetes.

“You know the mayor is trying very hard to promote healthy eating,” said Kuo, “If everyone listens to him, everyone can be healthy.”