What Is Type 2 Diabetes
Head Start Is Implementing Prevention
HS Diabetes Prevention Program Successes & Possibilities
References

Head Start and the Indian Health Service have launched an initiative to promote healthy habits and lifestyle changes.

An estimated 17 million Americans currently have it, but over a third are not even aware they have it. What is it? It is Type 2 diabetes, a disease whose prevalence is increasing rapidly in the United States. Type 2 diabetes is on the increase primarily due to our lifestyle—poor eating habits and lack of exercise are the main culprits. An unhealthy lifestyle can lead to obesity—a condition occurring in epidemic proportions in America—which can pose many health risks, including Type 2 diabetes. Most at risk for diabetes are certain population groups including, African Americans, Hispanic Americans, Asian Americans, Pacific Islanders, and American Indians.

Diabetes is dangerous. It is the main cause of kidney failure, limb amputations, blindness in adults, and a major contributor to heart disease and stroke (National Institute of Diabetes & Digestive & Kidney Diseases 2002). Other health concerns related to the occurrence of Type 2 diabetes include high blood pressure, nervous system disease, periodontal or gum disease, and complications of pregnancy (Centers for Disease Control and Prevention 2002).

The American Diabetes Association (ADA) defines Type 2 diabetes as “a metabolic disorder resulting from the body’s inability to make enough, or properly use, insulin” (2002). Insulin is a hormone that is needed to convert sugar, starches, and other foods into energy necessary for daily life.

What Head Start is Doing

Head Start programs offer a unique opportunity to implement obesity and diabetes prevention programs that are culturally oriented, family-centered, and community-based. “Healthy Children, Healthy Families, and Healthy Communities” is a program created by the Indian Health Service (IHS) Head Start Obesity and Diabetes Prevention Initiative. The initiative promotes healthy habits, physical activity, healthful eating behaviors, and self-esteem among American Indian/Alaska Native Head Start children, families, staff, and communities. The goal is to prevent or delay Type 2 diabetes and obesity.

In 2000, the initiative began with five tribal Head Start pilot sites:

• Eastern Band of Cherokee Indians–Cherokee, NC
• Northern Cheyenne Head Start–Lame Deer, UT
• Red Cliff Early Head Start–Bayfield, WI
• San Felipe Pueblo Head Start–Pueblo of San Felipe, NM
• Winnebago Head Start–Winnebago, NE

The sites receive training and technical assistance, including the latest scientific information, through quarterly meetings and on-site consultation visits by health experts. Each site has developed specific initiatives based on their respective community needs. The pilot models are shared with the wider Head Start community and health professionals through public presentations, workshops, and other dissemination activities. Evaluation is ongoing, allowing for continuous program improvement.

According to Cheryl Wilson, Diabetes Prevention Consultant for IHS, the initiative is progressing beautifully. She attributes much of the success to the programs’ roots in the communities they serve. Each pilot site is required to work with a community health partner that is committed to the initiative for its duration and provides consistent support. Most sites selected their local Special Diabetes Program for Indians grant program as their partner. Other partners include Women, Infants, and Children (WIC), and Residential Energy Assistance Challenge Option Program (REACH). New resources for the Head Start community can and do develop out of these community partnerships.

The pilot sites are conducting many exciting and innovative interventions that reflect the needs of the community—

• San Felipe Pueblo Head Start, in conjunction with the local Health and Wellness Department, has a diabetes prevention program that emphasizes physical activity for Head Start children, parents, and staff. The program offers free aerobics classes for community women, Alpha Fit (weekly classroom exercise sessions for children set to music), and monthly fun runs and walks for families.
• The Northern Cheyenne Head Start Program has created the “Eat Healthy Campaign” in which the tribal symbol “morning star” is placed on the labels of healthy foods in local grocery stores.
• At the Winnebago Head Start in Nebraska, monthly family fun nights include a healthy meal, education for parents, fun fitness and reading games for children, and door prizes and books for those attending. The staff are involved in weekly fitness activities with a theme: March Madness (basketball), Up with the Birds (early morning exercise), Tae-Bo (kick-boxing aerobics), Husker (for Nebraska) football, country line-dancing, and many more.
• At the Red Cliff Early Head Start, a registered dietician makes presentations about nutrition for staff and parents.

Success Already

Those involved in the Diabetes Prevention Initiative are enthusiastic about its successes and future possibilities. Pam Potter, Program Director for Winnebago Head Start, reports that the staff has felt results in their overall well-being, herself included. Cynthia Cheykaychi, Director of the San Felipe Head Start, believes their program has been especially successful in creating awareness of how dangerous diabetes is and the complications that can result. She says the program really makes a difference by helping to create healthy lifestyle habits and awareness of the dangers of diabetes in young children. The result is a “continuum of prevention,” the effects of which will be apparent in years to come.

Although results of the pilot program will not be disseminated until the program’s end in 2004, the number of participants is growing fast. The Eastern Band of Cherokee Indians Tribal Care Healthy Journeys Initiative reports a “ripple effect” in its 50-mile walking club, which started with only a handful of members. Family members of the staff and Head Start children and parents, as well as others in the community, are getting active. But this does not happen overnight. Virginia Johnson-Shell, Health Services Manager for the Cherokee Indians Initiative, advises programs “to have patience” in gaining participation for their activities.

Wilson hopes that other Head Start and Early Head Start programs will follow the examples of the pilot sites—they, too, can become involved in the fight to prevent Type 2 diabetes, especially with the help of a community partner. Interested programs can start their own diabetes and obesity prevention activities at any time without extra funding—it is as easy as planning a regular walking program!

References

American Diabetes Association. 26 June 2002
www.diabetes.org.

Centers for Disease Control and Prevention. 26 June 2002
http://www.cdc.gov.

National Institute of Diabetes & Digestive & Kidney Diseases. “Diet and Exercise Dramatically Delay Type 2 Diabetes: Diabetes Medication Metformin Also Effective.” 26 June 2002
http://www.niddk.nih.gov/welcome/releases/8_8_01.htm.

Special thanks to Cheryl Wilson, Diabetes Prevention Consultant for the IHS National Diabetes Program, for contributing to this article. The Head Start Bureau also extends its appreciation to all the programs for sharing their experiences.

See also: 
      Adult Health, Head Start Bulletin #75 [PDF, 6.5MB]