Diabetes Disproportionately Impacts Black and Brown Women—Here’s What You Can Do About It

Why Black & Brown women are more likely to get diabetes–and what we can do about It

Diabetes Digital Podcast by Food Heaven

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Welcome back to another episode of the Diabetes Digital Podcast.

Today we want to talk about HealthEquity and why black and brown women are more likely to get

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diabetes and what we can do about it.

As dietitians of color, we see first hand the disproportionate impact that conditions like diabetes

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have on our communities.

And one of the most common questions we get asked in media interviews is why certain demographics

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are more likely to have diabetes.

And I know a lot of people tend to put the blame on us and our communities or the foods that we’re

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eating, and it’s actually way more complex than that.

So today we’re going to break down the health disparities, why they exist, and most importantly,

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what we can try to do about them.

Welcome to the Diabetes Digital Podcast.

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I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

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Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual

nutrition counseling for people with diabetes and pre diabetes.

1:02

Visit diabetesdigital.co that’s Co to book your first appointment.

We accept insurance and offer affordable self pay options.

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Now let’s get into today’s episode.

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Now on to the episode.

I wanted to share a statistic that I think really speaks to the difference and prevalence when it

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comes to diabetes.

According to the CDC, in 2021 the prevalence of diagnosed diabetes was 11 to 12% in black Hispanic

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adults, whereas about half of that for non Hispanic adults.

So a huge difference and you see that across the board when it comes to conditions like heart

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disease, pre diabetes.

It’s important to note that prevalence varies significantly by education level, which oftentimes is

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an indicator of socioeconomic status.

We know that quality education is also aligned with quality healthcare, the resources that you have

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in your community.

Specifically, 13% of adults with less than a high school education had diagnosed diabetes versus

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only 9% in those that had a high school education.

And what’s interesting is that adults with family income above 500% of the federal poverty level had

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the lowest prevalence of all, both for men and women.

And like I said, it’s not just about individual choices.

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We know that there are so many systems in place that make it harder for black and brown communities

to get things like quality education, quality healthcare, even nutritious foods, which we’re going

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to be talking about today, and seeing a dietitian that looks like them, like that’s something big.

And that’s one of the reasons why we decided to create Diabetes Digital is because even the

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nutrition recommendations that we’re getting from our dietitians may not be culturally competent.

And so people might be less likely to follow it because they don’t really see themselves being

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represented.

Yeah.

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And I think one place to start with this conversation is some of the systemic barriers to health,

because again, people want to blame the individual.

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And I’m so sick of that conversation.

And we want to just, you know, have an another conversation and just put some more information out

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there to get started.

Let’s talk about food access and nutrition inequality.

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And these are topics that we have talked about so much on the podcast, which you know, now it’s the

diabetes digital podcast.

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Formerly we were the Food Heaven podcast, but we want to specifically like look at these things as

they relate to diabetes and pre diabetes, which is what we focus on within diabetes digital.

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So when we’re talking about food access and nutrition inequality, I think we really have to look at

the poverty rate.

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So research suggests that for the past three decades, Black and Hispanic poverty rates have been

significantly and consistently two to three times higher than poverty rates of white Americans.

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So again, poverty rates within Black and Latinx communities have been significantly two to three

times higher than their white counterparts, which is huge.

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And in many black and brown communities, fresh produce and nutritious foods are harder to access and

can be more expensive than in wealthy or predominantly white neighborhoods.

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I’ll give an example.

I feel like I’ve probably given this example on this podcast like 50 times.

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I used to work in a clinic in East Oakland and I would do cooking demos and nutrition workshops for

many of the kids in the clinic.

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And what I found was there was one grocery store, but the produce options were just not up to par.

They weren’t great.

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And even when I tried to incorporate, you know, different foods like yogurt and things like I

remember opening up a yogurt and it was completely moldy inside.

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So I would have to drive all the way to another grocery store like a Trader Joe’s to get produce

that was more affordable even than in the community and also just fresh and more appetizing to get

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the kids excited to eat it.

Also, Wendy and I started our careers in nutrition working in underserved communities in places like

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Harlem, Brooklyn, the Bronx.

And the reason we were in those communities doing nutrition education was because they were in food

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desert.

So they didn’t have grocery stores that most they might have a bodega, things like that.

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So we were with a program that brought kind of more fresh produce from the farmers market into the

community.

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So that’s number one.

And it’s not just grocery stores, it’s also types of restaurants, right?

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Like I grew up in a place that was in the hood and we didn’t have anything besides fast food chains.

Like we had a McDonald’s.

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That’s the main thing that I would go to as a kid.

And I remember I would get like, because I didn’t eat meat at that time, I’d get like a cheeseburger

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with no meat and a small fry.

And that was like my main meal in high school.

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And it was also like cheap and, and honestly, that’s like the only place I can think of that we had

around.

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It was like a couple blocks away.

It’s also convenience stores.

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They, like I said, the bodegas, they tend to dominate low income areas and there’s not that much

access.

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And the sad thing is that once those neighborhoods become more gentrified and you do have more white

people moving into those neighborhoods, that’s when you finally start getting like the grocery

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stores, the better produce.

And this happened to my neighborhood in Brooklyn where we had nothing but the bodega and then all of

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a sudden it became a gentrified neighborhood.

And then we had a fresh, you know, juicery and all these little shops and stores.

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So I think when your choices are limited, it’s not about willpower.

It’s about what’s available and what’s affordable and and I think that is the main reason why there

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is that food access and nutrition inequality within our country.

Yeah, and a lot of people might say, well, why don’t you open up a healthy food spot?

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It’s like, you know, just some of the things that I’ve heard, I’m like, OK, I guess you don’t, you

don’t know how it works for people who are struggling to make ends meet.

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Like their priority is surviving, not opening up a healthy food restaurant or something like that.

It just doesn’t work that way.

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And there’s just like so many other stressors that are in play, one of them being healthcare, like

healthcare in low income communities is a huge obstacle.

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I can’t tell you how difficult it is to get an appointment with a primary care provider in some

neighborhoods that are very low access.

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I mean, like, let alone an endocrinologist, like if you’re trying to see a specialist, thinking

about like an ophthalmologist, a podiatrist, if you have diabetes, a kidney specialist, like, Oh my

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God, you have to wait months and months on end.

And if you already have like so much going on and you have so many stressors, you’re not going to

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have that persistence to try to chase down a clinic to secure an appointment that’s six months down

the line.

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And those are all obstacles that are created and that get in the way of you getting quality care,

especially for things like pre diabetes, because if you don’t catch pre diabetes early, then what

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happens is that it can develop into uncontrolled diabetes and you might have gone years and years

without even knowing.

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And so it’s really important and it plays a huge role just like the lack of quality healthcare that

we have.

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And there’s actually some research that has shown that there does tend to be fewer primary care

physicians, trauma centers, pharmacies, even vaccine centers.

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When COVID was up and running, it was really hard to find like COVID vaccine centers near Black and

brown communities.

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So it’s not as simple as like, Oh yeah, just go to the doctor, eat healthier.

Like, we really have to push back on that narrative because there are real challenges that I think

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people that are disconnected from that, even Black and Brown people who might be affluent, who maybe

grew up in these conditions, but they haven’t been around it in a really long time.

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And they’re like, oh, but you can do this.

And it’s all about mindset over matter.

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I see that all the time now on Instagram.

It like makes me cringe.

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I’m like, OK, clearly, like it’s been a while since you’ve been in the hood.

It doesn’t work that way.

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Like, there’s so many different things going on.

And we need to fight for more resources instead of blaming people that are marginalized.

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Yeah, absolutely.

Another thing to talk about along the same lines is medical bias in diabetes care.

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And I know that it’s, it’s all just crazy times right now because I feel it just feels like there’s

a lot of censorship going on.

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Like people are saying DEI doesn’t matter and talking about these things don’t matter.

And but they do matter and they are real and there are studies to show that they exist.

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And black and brown women often report experiencing medical bias in healthcare.

I for one, have experienced medical bias in healthcare many, many, many, many times.

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I’m sure any black or brown woman you talk to you.

I, I know like almost all of my patients who I’ve worked with over the years have had similar issues

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with medical bias and also weight stigma as well, which we talked about a lot on this podcast.

Because you might be going to the doctor for certain symptoms, right?

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Maybe you have symptoms related to diabetes, but they are not investigating them because they’re

just like, Oh well, you just need to lose some weight.

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You know, you’re often given this generic advice or dismissed, but as we know, and we, we, I

mentioned, we’ve talked about so much on this podcast, weight loss is not the only or even the best

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approach to diabetes care.

And research also shows that black patients are less likely to be prescribed newer, more effective

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diabetes medications than white patients, which is absolutely insane because research also suggests

that we tend to have a harder time with like our glycemic control when we do have diabetes and tend

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to have more complications.

And there’s many reasons why we are prescribed less effective medications.

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One of them is also cost and access, right?

When it comes to black and brown people, as we mentioned, we sometimes are, you know, below the

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poverty line and maybe we don’t have like, that extra income to be able to afford some of these

newer medications.

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But I also think a lot of it is just the medical bias and maybe overlooking us for some of these

drugs and medications.

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And we’re often told to just watch our diet or, you know, we’re given older, less effective drugs

for these conditions like diabetes.

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Yeah.

And also insurance coverage, because people who are lower income, like usually they’re on Medicaid

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and there’s not too many options with Medicaid.

They’re not really trying to pay for much, including nutrition counseling, which is a whole other

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thing.

And so that affects things as well, the kind of insurance coverage that you have, which if you have

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a commercial plan, that means that you’re probably working, making a somewhat stable income.

And so that affects things as well, but it’s really important when it comes to diabetes care.

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We’re really big on individualizing care and taking into account all of these different things that

impact someone’s health status.

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We have to look at socioeconomic factors.

We have to look at family dynamics.

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We have to look at housing.

Like these are all things that should be considered versus being like, Oh yeah, cut down on carbs.

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Oh yeah, you can’t eat rice.

Oh yeah, just add more vegetables to your diet because it’s not that simple.

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And so as dietitians, we’re really big on assessing like, what is going on?

What is your culture like?

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What does your current day look like?

Are there certain barriers that are in the way that are affecting your access to food?

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Saying that someone is not motivated or someone is lazy is really harmful and also disrespectful.

And I hear a lot of providers saying this like I remember when I would work in clinical settings and

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like we would do our rounds and we would have our meetings.

Like the things that some of these providers were saying about the patients, I would be like, this

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is bizarre.

Like this is how y’all feel about y’all patients who are paying y’all bills.

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Like, yeah, culturally competent healthcare really does matter.

And we need more doctors.

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We need more dietitians who understand our background, our food, our experiences, and who don’t

disregard that.

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And even with diabetes digital, like we really make an effort to collaborate with the doctors that

our patients have because sometimes doctors just don’t know, like, you know, and, and it’s really

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important to have those conversations and advocate for people who are affected the most and being

like, well, actually, like, have you thought about this?

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Or why don’t we try taking on this approach?

And we, we even did a webinar with one of the physicians that we collaborate with, doctor Lauren

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Powell, who’s amazing.

She’s based in Georgia.

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And just like I think having more of those conversations within the healthcare community is going to

be really important to change the narrative.

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Yeah, and just seeing people as individuals with their barriers, understanding what those barriers

are, not making assumptions.

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I also probably have mentioned this on the podcast too.

I used to work at Kings County Hospital Center in Brooklyn and I was on the Congestive Heart Failure

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Task Force, which was a new task force that ended up being kind of like a best practice task force.

And, and what our Doctor Who was a black woman, she was like the leader of the task force.

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What she really like instilled for me was we never use the term non compliant.

She’s like, we just don’t use that because that is often like used in clinical settings to kind of

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take the ownership off of like us in the system and put it on the patient.

So anytime someone would be like, oh, they’re non compliant, she’s like, no, like we’re not saying

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that.

What is actually going on?

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What are you doing wrong?

What could you do better?

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What can we as a system do better?

We we have like a dietitian in the room.

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We also would have like a social worker in the room.

We would have the doctor in the room, like the pharmacist.

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And so we all could work together to figure out how to improve this patient’s outcome.

And that’s why we need diversity.

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And that’s why we need providers of color because sometimes, yeah, it’s very easy to just like

again, put the blame on patients or act like it’s all patients fault and and not see some of these

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challenges and barriers to get in the way.

Another thing, yeah, that I want to add is oftentimes people of color, I feel like we get really bad

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care, not always, but often because we can have diabetes or pre diabetes and the doctors don’t even

tell us.

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I can’t tell you how many times.

Like so of course you’re going to have bad outcomes if you don’t even know like.

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This is like a.

Thing that comes up in our meetings with the dietitians all the time too, where it’s like, well,

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they clearly have diabetes per their labs because it’s very clear what the diabetes cut off is, but

yet the doctor’s like not telling them or saying you’re fine don’t don’t worry about it.

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And it’s like what world are we living in?

Even one of my best friend’s moms like her A1C, which is the average measure of your blood glucose

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over three months and we use it to diagnose diabetes like it was in the diabetes range.

And they didn’t even tell her.

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She just happens to know these things.

So it’s just baffles my mind.

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I feel like even when I’ve had pre diabetes, like they don’t even there, there’s been no no talk of

like counseling, no talk of checking in with me, no nothing.

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So of course that’s going to be another reason why we have more issues.

Now let’s get into diet culture and weight stigma.

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So I’ve already mentioned this a little bit and if you listen to our podcast episode with Delina

Soto two weeks ago, our last episode, we talked about this as well.

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Definitely check that one out if you haven’t.

Black and brown women are often told that their weight is the problem when it comes to diabetes or

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pre diabetes.

But if you’ve listened to our pod, you know that BMI is outdated.

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It’s also based on measurements of white men and it doesn’t actually measure health.

And we cover this a lot more in our podcast episode with Sabrina Strings, which we’ll include in

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this show.

Note, she has an incredible book called Fearing the Black Body that goes into this history.

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Like I’ll use myself as an example, I was diagnosed with pre diabetes and I did a lot of not a lot,

but like moderate amount of some lifestyle changes trying to like balance my meals a little bit

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more, add more vegetables, just things we need to tell our patients to do.

And also physical activity like strength training, things like that.

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And my BMI did not change at all, but my A1C significantly went down and got out of that pre

diabetes range.

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But my BMI is still like bordering the quote overweight slash obese category.

And so I say that to say that there’s so many patients like this where we’re so focused on BMI,

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sometimes to our own detriment because then we end up losing muscle mass, which is so important for

blood glucose regulation.

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And I also feel like people of color, especially black and brown people, sometimes we tend to have

more muscle mass, right?

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And it might make our BMI look higher.

And you know, that can in turn, people might try to counsel us on like, we need to focus on weight

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loss when really that is not what we need to be focusing on.

We need to focus on preserving that muscle mass, if not adding more muscle, trying to incorporate

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physical activity and all of those things.

So weight is not the only factor that determines diabetes risk.

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Other things we want to look at in addition to nutrition is sleep, stress, systemic racism that

plays a role in just like us having inflammation, right?

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Access to healthcare.

And another thing I want to point out is like in communities of color, traditional foods often get

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demonized.

And this is something that we talked about in our episode with Selena, who just wrote a book about

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diet culture in the Latin X community.

And you guys definitely want to get a copy of that book.

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It just came out.

But she talks a lot about this and how people are told to cut out rice, beans, plantains, even

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though they’re staples of balance and healthy meals.

And this can make healthy eating feel really out of reach because a lot of these ideals and Wellness

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ideals are very, very unrealistic for our communities.

All right.

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So now that we’ve covered some of the barriers, we do want to present some solutions, of course.

So this episode is not going to solve food insecurity and, you know, poor healthcare.

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Yeah, it would be great if it did, but it’s a lot more complicated than that.

But here are some potential things, suggestions that might help to navigate the very complicated

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world of healthcare and food access.

One is trying to look for providers who are culturally competent.

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I say culturally competent because sometimes you’re not going to find a provider that looks like you

or that completely understands your cultural background.

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But are they making an effort to be curious, to ask questions?

Are they interested in where you’re from and how that might impact the foods that you’re eating or

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how you see healthcare?

Like all of that I think is really important to find in a provider.

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All of our dietitians are from diverse backgrounds.

They make an effort to understand where our clients are from because of course, we’re not going to

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know every culture from every place in the world, But it’s about making that effort and being

curious.

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So if you want to work with a dietitian that is covered by insurance, you can go to our website.

We have so many providers on there that you can choose from.

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And then when it comes to, you know, endocrinologist, physicians, mental health professionals, the

same applies like really trying to have a solid healthcare team because when you build that trust,

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they’re likely to be more invested in you and to want to advocate for you and care about you as a

person and your health outcomes.

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And if you find that a provider is dismissing your concerns, they’re not really listening to you,

you can push back.

23:34

You can ask for better testing, but that can be really stressful and nerve wracking.

So you can always just find a new provider if you’re able to.

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I know sometimes there’s limited options, but I do think that people sometimes forget like you don’t

have to stick with the provider if that provider is not working well for you.

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As long as you have an alternative.

We don’t recommend just like not seeing anyone at all.

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But as long as you, if there is an alternative, do a little bit of research.

You can also if we have a whole directory for weight inclusive providers in different states.

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So if you want some insight on that, you can e-mail us info@diabetesdigital.com and we can help you

with that.

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And also, if you find that you really like your provider, but they’re just like super focused on the

number on the scale and they keep pushing weight loss on you, You can ask them like what, what

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approach would you take if I was a thin person?

What, what would be your recommendations?

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And you can tell them like, I don’t feel comfortable talking about my weight.

Like I really want to focus on all the other things that I can do.

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Just remember, like your health is a lot more than your weight, but also food, like, food is one

role of course.

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And as dietitians, we focus on that.

But you also have to look at things like stress management because when you’re chronically stressed,

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that can increase your blood sugar levels.

It can increase your risk for diabetes and under other conditions.

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Quality sleep.

Are you able to get consistent sleep every night, 7 to 9 hours?

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Because that can also disrupt blood sugar levels.

Having positive relationships in your life moving, like, are you able to do an enjoyable movement

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routine, whether that’s walking or, you know, stretching, dancing, like whatever it is that feels

good to you, It doesn’t have to be tied with weight loss or going to the gym.

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In terms of building strong relationships and support systems, one thing that we are going to start

doing at Diabetes Digital are support groups because we’re getting a lot of people who are asking us

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about, you know, support groups or they want to have people who have a similar condition that they

can relate to.

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So we’re thinking of doing and you can let us know, e-mail us at Diabetes Digital at info.co or DMS

and let us know like which one you’d be into, what we’re thinking of doing like a PCOS and pre

25:54

diabetes Group, A perimenopause and diabetes group.

We’re thinking of so many different ones, a BIPOC and diabetes support group.

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So if you’re interested, feel free to send us an e-mail and we’ll let you know what what’s on the

radar or what’s currently available and they will be covered by insurance as well.

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OK, so in closing, we just want everybody to remember that diabetes care isn’t just about diet and

exercise.

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It is not your fault if you get diabetes.

There are so many systems at play, access and advocacy and that we’re trying to do just one part in

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making diabetes and pre diabetes care more accessible.

Also, you deserve high quality healthcare.

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So definitely push for it.

If you feel like people are not listening to you or they’re not seeing you as a full person than

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human being, then if possible, maybe it’s time to find a new provider.

And if you need again, like when you said a list of weight inclusive providers, send us an e-mail.

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We will share that list with you.

Also, start small with sustainable changes that work for you.

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There’s no need to overhaul everything overnight.

You do not have to cut out carbs.

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You do not have to cut out your favorite cultural foods.

Like that is just not the case at all.

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And think about things that you can do for the rest of your life, not just like a quick fix diet.

All right, so if you learned something new today, share this episode with a friend or loved one,

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make sure that you follow us online.

We’re at Diabetes Digital Co on Instagram and you can always go to our website, diabetesdigital.co

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to stay up to date with our latest recipes and articles and all of that.

And thank you so much for tuning in.

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We will see y’all in a couple weeks.

Bye.

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Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your

27:45

pre diabetes or diabetes, visit us at diabetesdigital.co.

Also, if you found our conversation helpful, do us a favor and rate and review this podcast on

27:56

iTunes, plus share with someone who might find this helpful.

You can also connect with us on Instagram at Diabetes Digital.

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Dot Co and TuneIn every Wednesday for practical, inclusive, and culturally humble diabetes insights.

We’ll catch you later.