By Jerry Mitchell
Mississippi Center for Investigative Reporting
Bombs are exploding across the nation, with injuries and casualties reaching the millions, but few recognize the war that is taking place, experts say.
That war is diabetes, and Mississippi is ground zero, the only state in the nation where every county is in what researchers call the diabetes belt.
Over the past three years, diabetes has contributed to the deaths of nearly 900,000 Americans —more than died in World War I, World War II, the Korean War, the Vietnam War, the Gulf War, the Afghanistan War and the Iraq War combined.
“If we don’t do something, our national health system will collapse,” said Dr. Stephen Farrow, executive director of the Biloxi-based National Diabetes and Obesity Research Institute. “There will be too much blindness, too many people on dialysis. Our country will go broke.”
The cost to society? More than $327 billion a year, or more than the cost for cigarette smoking. Unless something changes, Medicare’s trust fund (where $1 out of every $3 is spent on diabetes) is expected to go broke by 2026.
Dan Hurley, author of Diabetes Rising: How a Rare Disease Became a Modern Pandemic and What to Do About It, said the nation needs to respond to the ravages of this war. “Kidney failure has skyrocketed,” he said. “People are losing limbs and going blind. It’s horrific.”
Diabetes can cause kidney failure, something nearly 1 million Americans suffered last year, needing dialysis or a kidney transplant to survive. More than a half million remain on dialysis, costing the nation more than $37 billion a year.
More than 200,000 Americans have lower-limb amputations each year, 60% of them due to diabetes. Overall, more than 2 million Americans are living with limb loss.
Diabetes is the primary cause of blindness in adult Americans, because elevated blood sugars damage blood vessels in the eye. The National Eye Institute projects that by 2050, 14 million Americans will be battling the sight-stealing diabetic retinopathy.
Diabetes is closely linked to high blood pressure, which increases the risk for heart attacks, strokes and similar events. Heart disease alone kills more than 650,000 Americans a year, or 1 in every 4 deaths.
In 2007, $1 out of every $5 spent on health care was spent on diabetes care. Today that number is $1 out of every $4.
Hurley recalled Ralph Nader’s campaign in the mid-1960s that led to seatbelts. At the time, he said car manufacturers were declaring, “People don’t care about seatbelts. We are giving the consumer what you want.”
Nader responded that car manufacturers were killing people and had to stop. Congress agreed and passed laws that led to a dramatic reduction in injuries and deaths in vehicle accidents.
Hurley said the nation faces the same crisis with diabetes. Until changes come in the law and in the American diet, diabetes will continue to ravage the population, he said.
“We all want to blame the people and say that they overeat, that they’re not taking care of themselves, that they’re not following doctors’ orders,” he said.
“Blaming people makes people hide their behavior, and they do worse,” he said. “Compare that to Alcoholics Anonymous, where they say, ‘I am powerless.’ It’s up to a greater power. In this case, the greater power might be health officials, grocery stores and the doctors.”
CHEAP PROCESSED FOODS FUEL OBESITY
Over the past half-century, obesity has gone from rare to common. In 1962, less than half of the adults in the U.S. were considered overweight or obese. Now that number is almost three-fourths.
In Mississippi, the adult obesity rate is nearly 41%. Unless something changes, more than half the adults will be obese before the decade ends.
One reason? Processed foods, said Dr. Richard deShazo, distinguished professor emeritus at the University of Mississippi Medical Center and adjunct professor of medicine at the University of Alabama School of Medicine in Birmingham.
“We are eating large quantities of food that are manufactured by corporations, which like all other American corporations, their business is making money,” he said. “Over the last 50 years, the food industry has gotten very sophisticated in the way they develop processed foods.”
Highly trained scientists work in labs to create food to activate the pleasure centers in the brain, he said. “That’s why you can’t eat just one of them. They are, in effect, addictive.”
Ultra-processed foods now make up most of the calories consumed in the U.S. What makes them more attractive is how much cheaper they are in comparison to unprocessed food, deShazo said.
That problem is even more acute in places like Mississippi, where nearly 1 in 5 residents don’t have access to enough healthy food.
In the diabetes belt, the percentage of those with the disease went up as the county’s levels of poverty and obesity increased, according to an MCIR statistical analysis. Mississippi, which has the nation’s highest poverty rate, also has the nation’s highest adult obesity rate, one of a dozen states topping 35%.
Chiquikta Fountain, who runs the Delta Hands for Hope in Shaw, said locals must travel a dozen miles to Cleveland to buy fresh fruits and vegetables. The problem, she said, is many locals, including senior citizens, lack transportation.
To help overcome this problem, she operates an emergency food pantry. Sometimes she is unable to get fresh fruits and vegetables to share, she said. “Hopefully we can get a spotlight on what’s going on so that we can do something about it.”
‘WE’RE TRYING TO PUT A BAND-AID ON AN ARTERIAL BLEED.’
The devastation of diabetes has become clearer during the COVID-19 pandemic, which has stolen the lives of more than 639,000 Americans. Studies show that 40% of those who died of the virus were already battling diabetes. Mississippi is leading the nation in these diabetes deaths.
Mississippi and the nation keep responding reactively to diabetes when they should be fighting proactively, said Brandon pharmacist Ryan Harper, a longtime witness to the war. “We’re trying to put a Band-Aid on an arterial bleed.”
The cost of medicine to battle diabetes has multiplied over the past decade and a half, he said. “It’s three to five times higher, if not more.”
Some of the latest long-acting insulins cost those suffering from diabetes more than $1,000 a month, he said.
He is open to the expansion of Medicaid, which would bring about $1 billion more a year in healthcare funding to the state. Such a move, he said, could help reduce the brain drain in Mississippi, one of only three states to see a reduction in its population over the past decade.
He admits that tackling diabetes can be difficult in a land where breakfast may be two donuts and a Mountain Dew, where macaroni and cheese may get counted as a vegetable, and where sweet tea comes in foam tubs.
But he believes that attacking these issues head on, instead of ignoring them, can move Mississippi toward a solution.
“How do you eat a whale?” he said. “One bite at a time.”
‘THE ENTIRE COUNTRY IS MOVING TOWARD INCREASED PREVALENCE OF OBESITY AND DIABETES’
At the National Diabetes and Obesity Research Institute, the walls are covered with drawings of the peregrine falcon, the world’s fastest animal.
It’s a reminder, Farrow said, of how quickly Mississippi needs to move.
“The entire country is moving toward increased prevalence of obesity and diabetes,” the endocrinologist said. “Mississippi and its neighbors are leading that advance.”
The U.S. Centers for Disease Control and Prevention named the “diabetes belt” for the areas of the country where the rates of diabetes are much higher than the general population.
The belt is comprised of two swaths through the Southeast. The first swath extends from Virginia to east Texas, mirroring the “stroke belt” and the nation’s highest concentrations of obesity. The second swath tracks the Appalachian Mountains from the lower parts of Ohio and Pennsylvania to Mississippi.
The diabetes belt matches some of the nation’s highest poverty regions. MCIR analyzed federal data on health, income and demographics and found the higher the rates of poverty, the higher the rates of diabetes.
MCIR also found a significant correlation between poverty and obesity. Mississippi, which has the nation’s highest poverty rate, also has the nation’s highest adult obesity rate, one of a dozen states topping 35%.
“We’re the first state to break the 40% level in obesity,” Farrow said, “and signs point toward higher numbers.”
Annual costs for obesity in the U.S. already top $342 billion, according to one study.
If obesity surpasses more than half the adult population and diabetes continues to climb, Mississippi and other states will no longer be able to afford the price tag, Farrow said. “State budgets will suffer. Fewer people will qualify for military service, so national security will be at risk.”
Despite such dire forecasts, Farrow pointed to areas of hope:
■ A host of new medicines and insulin innovations for those with diabetes.
■ Remote patient monitoring, where information regarding blood pressure, diabetes and weight can be transmitted to a database that patients and health care providers can check. “It’s helping the patient adhere to the treatment recommendations they agreed to,” Farrow said.
The information enables doctors to not only look at the data for each patient, but as a whole for outliers, he said. “It doesn’t replace face to face care, but it’s an important tool you’re going to see more and more.”
Mississippi ranks second in the nation in the obesity of children 10 to 17, affecting more than 22% of students. Many of them are now developing Type 2 diabetes.
“Prevention is imperative, and we need to start as early as possible,” Farrow said. “By the time you’re an adult, it’s much more difficult to reverse diabetes than if you had prevented it in the first place.”
Studies show the younger that people develop Type 2 diabetes, the higher their risk of complications and death.
The U.S. Department of Agriculture pushed a healthy food program that the Mississippi Department of Education embraced, leading schools to remove unhealthy items from vending machines and replacing fast-food fare with fresh fruits and vegetables. The changes played a role in the leveling off of the childhood obesity rate in the state.
“It’s a positive thing,” Farrow said. “Time will tell whether or not that’s a durable direction.”
Diabetes is a disease that touches almost every family, he said. Almost half the adults in the U.S. have been diagnosed with diabetes (34 million) or prediabetes (88 million).
A fasting blood sugar level of less than 100 milligrams is considered normal. Anything from 100 to 125 milligrams is prediabetes. Anything 126 milligrams or higher is diagnosed as diabetes.
“Prediabetes means you are on a trajectory where, if nothing changes, you will develop diabetes,” Farrow said. “It’s important to intervene early.”
That intervention should include education, exercise and a healthier diet, he said.
“We want to make sure our medical colleagues all have the best information to take care of their patients,” Farrow said.
The institute works with clinical research partners, tests new drugs, and consults with patients and industry. Plans include a five-story research center that will attract researchers around the globe to study obesity and diabetes.
Despite the odds stacked against him, Farrow gushes optimism.
“Finding a cure for diabetes and obesity would be a holy grail,” he said. “Mississippi is first in these diseases. Mississippi is working aggressively to cure them. There’s no reason a cure can’t be found.”
Email Jerry.Mitchell@MississippiCIR.org. You can follow him on Facebook, Twitter or Instagram.
This story was produced by the Mississippi Center for Investigative Reporting and funded in part by the Fund for Investigative Journalism. It was also produced in partnership with the Community Foundation for Mississippi’s local news collaborative, which is independently funded in part by Microsoft Corp. The collaborative includes MCIR, the Clarion Ledger, the Jackson Advocate, Jackson State University, Mississippi Public Broadcasting, and Mississippi Today.
Mississippi Center for Investigative Reporting is a nonprofit news organization that is exposing wrongdoing, educating and empowering Mississippians, and raising up the next generation of investigative reporters. Sign up for our newsletter at www.mississippicir.org.