A dozen doughnut holes. Growing up, that was a typical breakfast for Tassiana Willis, a 24-year-old African-American poet. In her family, moments of joy centered around sweets. Her grandfather, a man of few words, showed affection through weekend trips to McDonald’s.
Willis, who grew up in San Francisco, has harnessed the power of poetry to raise awareness about Type 2 diabetes, a preventable disease caused largely by poor dietary habits and lack of exercise. It once affected mostly adults but now is spreading at alarming rates among young people, especially ethnic minorities and youth from low-income households.
“Raise your voice and change the conversation,” urges the tagline on four new videos produced for an arts and public health campaign called The Bigger Picture. The videos, including one by Willis called “The Longest Mile,” show young poets telling deeply personal stories about the life circumstances that promote diabetes.
The videos challenge viewers to look at “the bigger picture” behind the startling rise of diabetes. Instead of highlighting poor individual choices, they expose the social and economic factors — everything from food pricing and marketing to unequal access to parks and playgrounds — that conspire to push young people of color into an unhealthy lifestyle.
“The way these stories are told … really calls for social change,” said Natasha Huey, who managed the campaign for Youth Speaks, one of four youth development organizations across California that partnered with the University of California-San Francisco’s Center for Vulnerable Populations to produce the poetry videos.
The Bigger Picture, which launched in 2011, has produced more than two dozen videos about diabetes, which together have been viewed more than 1.5 million times on YouTube. They have also been presented at school assemblies for thousands of Bay Area students.
The rise in Type 2 diabetes among youth goes hand in hand with rising obesity rates.
Willis said she is obese now because of the way her financially strapped family ate when she was young. “There are powerful emotions behind why we eat what we eat,” she said in an interview.
In “The Longest Mile,” Willis recalls the humiliation of being unable to run a mile during PE class in middle school. “I wasn’t slow / I was just fat.” Obesity is fueling the spread of Type 2 diabetes, and Willis knows she’s at high risk for the disease.
Unlike Type 2 diabetes, which is related to lifestyle choices and obesity, Type 1 diabetes typically develops in early childhood and is believed to be the result of genetic factors and environmental triggers, including viruses.
Over the past decade, rates of Type 2 diabetes have tripled among Native Americans, doubled among African-Americans and increased by as much as 50 percent in the Asian, Pacific Islander and Hispanic populations, according to the federal Centers for Disease Control and Prevention.
“We’re at the tipping point in this disease,” said Dr. Dean Schillinger, a professor of medicine at UCSF and director of health communications at Zuckerberg San Francisco General Hospital and Trauma Center, who co-created the Bigger Picture campaign. “The trajectory is very scary and the rate of increase, particularly in youth of color, is exponential.”
In a recent JAMA paper featuring the new videos, he stressed the importance of shifting the way diabetes is characterized in public health education.
“The overarching objective is to change the conversation about diabetes away from it being an individual ‘shame and blame’ message to approaching it as a societal problem,” Schillinger said.
In another video, “Empty Plate,” Anthony “Joker” Orosco, a 20-year old Chicano poet, depicts his farmworker relatives who can’t afford to buy the produce they pick.
Orosco, who grew up in Stockton, a city in California’s agricultural San Joaquin Valley, said he was inspired to honor the hard work of immigrants who sacrificed for his generation.
Low-income people often struggle to buy fresh vegetables, whole grains and other nutritious foods, because those choices are more expensive than the sugary, fat-laden processed foods widely available in many poor neighborhoods. In a 2013 study, researchers at Harvard and Brown universities found that a healthful diet costs about $550 a year more per person than an unhealthy one.
Schillinger said that, based on his earlier experience with the AIDS epidemic and anti-tobacco campaigns, he believes there needs to be a “groundswell of grass-roots activism” if the course of Type 2 diabetes is to be reversed.
“A young person getting diabetes is an injustice, and so the campaign features young people who are targets of diabetes risk but are now becoming agents of change,” he said.
In “Monster,” Rose Bergmann, 17, and Liliana Perez, 16, talk about fathers who relied on sugar-packed energy drinks to work double shifts to support their families.
The industry that makes sweetened drinks has taken notice. “We do agree that people need to manage their sugar intake,” said Lauren Kane, senior director of communications for the American Beverage Association in Washington, D.C. She said beverage makers are “aggressively working to innovate to offer more products with less sugar … and to create interest in access to those beverages.”
McDonald’s has also recently announced new nutritional standards to reduce the number of calories in its Happy Meals, which are marketed to children.
Los Angeles poet Edgar Tumbokon, 19, said nutritious food did not play a big role in his childhood. “I grew up in a food desert surrounded by a culture and kids who loved to eat junk food,” he said. “Eating healthy was considered ‘a white thing.’”
Tumbokon, who weighed 13 pounds at birth, said his poem, “Big Boy,” was inspired by his immigrant Filipino mother, who developed gestational diabetes, which now afflicts 1 in 11 pregnant women. He grew up watching her test her blood sugar and inject herself with insulin.