This article first appeared in the St. Louis Beacon, Nov. 10, 2010 - There have been times when Tracy Blue's mood was a perfect match for her last name. She was often irritable and occasionally depressed as she coped with Type 2 diabetes and the burden of carrying as much as 254 pounds on her 5'4" frame.
During the past year, however, her health has improved and her weight has dropped, thanks in part to an exercise and counseling program tailored to African Americans like herself. Called BODDY, the program operates out of the Monsanto YMCA in north St. Louis and is run by Washington University's Health and Nutrition Center.
"No, never, no way, nada are words that automatically come to mind when people with diabetes see or think about delicious food," McGinnis says. "Food of all types, flavors and kinds is part of the treatment for diabetes. Food is not the enemy."
The exercise, diet and counseling allowed Blue to discontinue some medications, including those to treat her diabetes. She now believes the various medications were affecting her mood. Blue's approach to diabetes may be the exception instead of the rule. In addition to diet and exercise, many diabetics also need insulin and other medication to control their blood sugar.
"I've lost weight. I feel better. I'm off the medicine and I'm happier," Blue says.
BODDY shows one consequence of offering overweight people a place to focus on fitness and exercise in safe environments. Researchers are discovering that a neighborhood's environment not only affects health but also influences the extent to which people engage in healthy activities. Those principles seem to play out when Blue is on her way to work some mornings and sees women like her trying to take brisk walks in O'Fallon Park.
"They walk with sticks in their hands, afraid of the dogs, I guess," Blue says.
That image evoked apprehension in Blue. It's not that such predatory behavior occurs frequently, but the perception that the park is unsafe influences whether and how often residents such as Blue are willing to use it for brisk walks, jogs and other forms of exercise.
Obesity Is All Too Common
Blue's weight and health problems are common among black women. Federal studies show that about 80 percent of them are overweight or obese, the highest percentage of any U.S. group. Michelle Obama's Let's Move program has tried to call attention to the fact that Americans of all ages are getting fatter and suffering preventable health problems -- such as Type 2 diabetes -- that are thought to be triggered by or complicated by being overweight.
Blue adds that outsiders might not understand some cultural reasons black women don't exercise as much as they should. For some women, she says, it boils down to deciding whether to exercise and watch their curls wilt from the sweat or avoid exercise to protect their permanents. White women might be able to simply shower, shampoo and use a blow dryer to look great, but she says it isn't as easy for black women to work with their hair.
A Brutal Self-assessment
Now that Blue sees improvements in her health and weight, she talks more freely about incidents that used to cause painful embarrassment. Take, for example, vacation pictures that usually trigger wish-I-were-there-now memories in most people. But not Blue. Certainly not the snapshots with girlfriends, all smiles and in color outfits, looking into a camera during a trip a few years ago to Jamaica. Blue hadn't thought much about the pictures until the day a relative saw one and spoke before catching her tongue. With unintended cruelty, the relative said, "Look at those fat-ass women in that picture!"
That was about two years ago. Recalling that moment this summer, Blue lets out a giggle, a deep one that lasts so long she puts a hand to her throat to constrain herself. Then she talks about photos from another trip, this one to Des Moines to take in an opera. Those photos led Blue to make a brutal assessment of her physique.
"I was in plaid shorts," she recalls, "and I was huge. I was like, 'Wow, am I fat!' "
If she hadn't conceded as much, her body would have. Whenever she stood up, her body kept reminding her how difficult it was to support her weight.
"I'd have to wait before I could start walking. My knees would hurt, my clothes weren't fitting me, and I decided it was time to start losing weight because things had gotten really, really bad."
It helped that an ad in the St. Louis American, a black weekly newspaper, caught her eye more than a year ago. In addition to offering help to African Americans coping with weight problems, diabetes and bouts of depression, the ad offered a year's membership in the Y. The membership is $40 a month for individuals, a price that wasn't too steep for Blue, a woman with two college degrees and work experience in fields ranging from business to social services.
Hard Work Pays Dividends
BODDY turned out to be a good fit for Blue. Its catchy title stands for Beating Obesity, Diabetes and Depression at the YMCA. The principal investigator, Rick Stein, wanted to find out whether attacking weight, diabetes and depression in a controlled setting such as the Y would have a positive impact on the lives of the participants. He says that BODDY has the potential to alleviate depression, improve a person's quality of life, decrease body weight and reduce the risk of chronic heart disease in obese African Americans with Type 2 diabetes.
Stein believes the Y-based program holds much promise. Judging from Blue's results, the program certainly raises the question of whether some obese diabetics with other physical ailments might benefit as much from counseling, dieting and a free membership in a gym as they might from taking medicine.
"I knew it was going to be hard," Blue says. "They don't hold your hand and force you, but they give you all the tools to lose weight -- meal plans and what to eat. It's really an intensive program. When I started losing weight, I didn't have problems with my knees anymore."
Blue was quite familiar with diabetes long before she was diagnosed about a decade ago. Both her parents are diabetics, and her maternal grandmother had both legs amputated because of the illness.
"She died of breast cancer," Blue says of her grandmother. "But I didn't want to be like her with both legs amputated. I told myself, 'No way.' "
That's another incentive, Blue says, to lose pounds and take better care of herself.
The challenge, says Stein, is to convince patients not to gain back the pounds, which can harm their health. Blue says she doesn't expect that to happen. In fact, after she completed BODDY's program last month, she bought her own membership to keep up her exercise routine.
That's another reason Tracy is no longer blue.
This story was written with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communcation and Journalism. Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.