The purpose of this research study is to study linear and nonlinear relationships of dietary habits in terms of minimal caloric intake and health outcomes in medical underserved communities in Chicago. Using a mixed-methodology approach, we were able to analyze structured data sets from a survey, which served as our primary source of data, and conducted in-depth interviews in a clinical setting and non-clinical setting with Chicago neighborhood residents that may have been diagnosed with Type 2 Diabetes. Our findings showed that a lack of access to care for nutritious food is a statistical significant factor influencing health outcomes related to targeting Type 2 Diabetes, particularly among low income Chicagoans. While educational parameters or variables play a role in measurable health outcomes, socioeconomic disparities and limited access to healthcare resources also contribute to health disparities in medically indigent communities of Chicago.
WHY ARE THE PIMA INDIANS SICK? STUDIES ON ARIZONA TRIBE SHOW EXCESSIVE RATES OF DIABETES, OBESITY AND KIDNEY DISEASE
Why do I want to know about the Pima Indians, when I live in Chicago and they are from Arizona?
Previously, in part 1 of “Modeling and Quantification of Medically Underserved Populations’ Obesity Intervention Outcomes”, we started to create a curricula framework for obesity intervention, according to Giachello, et. al. from the University of Illinois at Chicago, Jane Addams College of Social Work, Midwest Latino Health Research, Training, and Policy Center, because health outcomes data for minorities is quite sparse and unavailable. Since data in relationship to the social aspects of poor health among minorities is so sparse, and in part 2, the purpose of this paper is to begin to characterize, define, and explore one medically indigent group as an example of needing an accurate obesity intervention model. For example, a Washington Post article that was published in 1993 stated the following, “preliminary data from the study of a genetically similar group of Pima, living in the Sierra Madre in Mexico, have shown that the Arizona Pimas are sicker than their Mexican relatives, with higher rates of diabetes, obesity and kidney disease.” And, again in 1996, the National Institutes of Health provided in update on Native American Health by saying the following, “ Some idea of prevalence (the proportion of the population is affected by the disease at any given point in time) of the diabetes among Native Americans can be obtained from case registries held at Indian Health Service facilities. The prevalence rates of diagnosed diabetes among Native Americans vary across tribes and are generally higher than in the U.S. population as a whole.” Also, in the spring semester of 1999, the University of Illinois at Chicago, Jane Addams College of Social Work, Midwest Latino Health Research, Training, and Policy Center, and along with myself had begin to confront high prevalence rates among Native Americans, but all minorities that are living with risk factors of Type 2 Diabetes.
Now, more recently, the larger story about the Pima Indians is that Indians or Native Americans are a smaller subset of the minority communities that live in the United States, particularly here in the city of Chicago. Not only Pima Indians are living with complications related to diabetes, but other minorities in Chicago maybe living with similar complications. The reason why Pima Indians maybe showing excessive rates of diabetes, obesity, and kidney disease, because of unhealthy food choices in their communities. Unhealthy food choices may cause significant increases in the glycemic load and glycemic index, which affect increases in blood glucose levels.
This discovery with the Pima Indians diabetes complications are not new, but have a sociohistorical background in the western part of the United States. Also, Wendy Mellilo stated in the Washington Post article that, "after studying the Pima Indians of Arizona for nearly 30 years, researchers are certain of one thing: The switch to a high-fat diet common among most [U.S.] whites and to a sedentary lifestyle is making the Native American group sick at a faster rate than other Americans." Why did the Pima Indians switch from a Native American diet to a westernized high-fat diet? And, also in terms of social aspects of poor health, D'Adamo stated, "Agricultural advances in the Americas were late in coming, because the new American homeland was abundantly populated with game and fish, which discouraged agriculture. Even corn, which was a staple grain, didn't appear to be domesticated until 4500 B.C., and common beans appear to be an even more recent addition, first being cultivated around 2200 B.C. So, as with the Basques culture, meats and not grains were the primary staple of the Native American diet." Late advances to agriculture in the United States caused a lot of health consequences among ancient minorities, such as the early development of food deserts.
Early on, ancient minorities had problems accessing healthy foods in the early development of food deserts. Within these ancient food deserts, nonessential foods like red meats, corn, pinto, navy, and kidney beans were not beneficial to the native american at the time. D'Adamo goes on to mention, "The scarcity of a primary food source led to a widespread migration in search of new and fertile hunting grounds...Hunger began to take its toll on the previously successful tribes. The young, old, and weak fell by the wayside, succumbing to disease and starvation. Bands of hunters began warring with each other for the limited food supply." Not only Native Americans were confronted by early food deserts, but Africans as well were faced with illness and disease due to resource depletion on the dark continent. Also, during ancient periods through colonial Africa, and in the early Americas, scarcity of the four major food groups was the etiology of modern world diseases and illnesses.
Investopedia defines, "Scarcity refers to a basic economics problem—the gap between limited resources and theoretically limitless wants. This situation requires people to make decisions about how to allocate resources efficiently, in order to satisfy basic needs and as many additional wants as possible. And, even free natural resources can become scarce if costs arise in obtaining or consuming them, or if consumer demand for previously unwanted resources increases due to changing preferences or newly discovered uses." Not only during colonial Africa, dynasties of Asia, and monarchy rule in Spain, but still today in modern times, scarcity is an ongoing situation on the south and west sides of Chicago. Currently, in Chicago, disinvestment plagues the south and west sides, where most dense numbers of minorities live, according to Mayor Lori Lightfoot. Also, disinvestment is the cause of food deserts throughout the south and west sides of Chicago.
According to an article published on PBS WTTW Channel 11 - Chicago, "The United States Department of Agriculture defines a food desert as an area with poverty rate of at least a third of the population lives more than a mile from a supermarket or a large grocery store. Research shows that Chicagoans live in food deserts, though exactly how many is unclear. According to a 2006 report on the public health effects of food deserts in the city, most of those in Chicago were made up entirely of African - American residents." African - American, Asians, and Latino residents in Chicago are unable to access grocery stores like Mariano's, Jewels Osco, or Whole Foods. The problem is that supermarkets and large grocery store chains healthy foods cost a lot of money. Cost may be a predictor and health response variables among minorities in Chicago that live in food deserts.
However, "Individuals determine what is appropriate in terms of eating behaviors by looking to social and environmental cues (Wisbett and Storms, 1974). Cues such as the intake of others or portion sizes indicate what is normative consumption and people adjust their eating to align with the norm, which is known as modeling (Roth, et al,. 2001; Herman et al., 2003)." For example, environmental cues are based on the general locus or location of the individual, such as, economy, society, and culture. Also, social cues are belief, convenience, price, prestige, familiarity, taste, tolerance, and satiety. However, environmental and social cues maybe affected in untreated individuals that may not have SNAP benefits, and also are not current recipients of Illinois Medicaid and Medicare live in food deserts on the south and west sides of Chicago. Untreated minorities are immunocompromised to obesity and type 2 diabetes through the lack of environmental and social cues related to food intake. Poor eating behaviors are the leading cause of obesity and other complications related to type 2 diabetes symptoms, according to the CDC and NIH.
Poor eating behaviors are caused by food cravings. Kemps and Tiggemann states, "Food cravings refer to a motivational state whereby an individual feels compelled to seek and ingest a particular food. It is the intensity of this state and the specificity of the craved food, which distinguishes food cravings from ordinary food choices or general hunger. Although food cravings are normative everyday experiences, most research has addressed their potential maladaptive nature. For example, food cravings have been associated with binge eating, which in turn contributes to both obesity and eating disorders. Food cravings are associated with guilt and depression." An individual human that may weigh less than or greater than 70 kg ingests particular foods from the U.S. Food Pyramid. For example, if we look at the original chart, it was designed in a circular unifying format that it segmented into seven food groups with different serving size amounts. The first segment is leafy green and yellow vegetables; the second segment is related to citrus fruit, tomatoes, and raw cabbage; the third segment is potatoes, vegetables, fruits, and others; the fourth segment is milk, cheese, and ice cream; the fifth segment is meat, poultry, fish, eggs, dried peas, and beans; the sixth segment is bread, flour, cereals, whole - grain, or enriched; and the last segment of the circular food continuum is butter and fortified margarine.
However, there is a problem for a person weighing less than or greater than 70 kg to follow the public health slogan, "The basic seven...eat this everyday. In addition to the basic 7...eat any other foods.", because reflecting earlier on Kemps and Tiggemann point, "Although food cravings are normative everyday experiences, most research has addressed their potential maladaptive nature." The original food model is not inclusive of these normative everyday experiences. These normative everyday experiences are quite visual or based on pictures or images from these basic seven food groups. For example, according Dresler, et. al., "Environmental factors such as the visual exposure to food are claimed to influence eating behavior in humans. Sight of hedonic food enhanced the desire to eat and calorie intake, even when subjects were satiated. The specific psychological mechanisms, which trigger motivation for food consumption independent of metabolic energy status, are far unclear." Also, visual exposure can come from any source such as the internet, magazines, mobile, newspapers, and even tv that can influence choices from the basic seven food groups. The stronger the influence from tv, newspapers, mobile, magazines, and internet, caloric intake may increase or decrease the weight of a 70 kg individual living in Chicago.
And, but also, trigger motivations with specific psychological mechanisms can be interrupted by environmental and social cues. For example, Wikipedia defines again, "In economics, a poverty trap or cycle of poverty are caused by self-enforcing mechanisms that cause poverty, once it exists, to persist unless there is outside intervention. Families trapped in the vicious cycle of poverty, have limited or no resources. There are many disadvantages that collectively work in a circular process making it virtually impossible for individuals to break a cycle." This circular process collectively works against the basic seven food groups that triggers motivation for high caloric intake, which may increase the glycemic load and glycemic index, according to a replicated dataset. This increase in the glycemic load and glycemic index of the same basic seven foods may lead to further health consequences. For example Dresler, et. al. goes on further to say in the same article, "In normal human subjects, ghrelin administration increases self - rated appetite and caloric intake and prompts the imagination of favorite meals. Ghrelin levels increase in humans before meals and decrease after meals regardless if meal times were fixed or meals were initially voluntarily." Voluntary food choice may lead to ghrelin levels increasing in humans weighing less than or more than 70 kgs are based on health belief.