Jeremy Pomeroy is onto something that, years from now, we may all be thankful for.
In the nearby Gila River Indian Community, Pomeroy has been working with American Indians, helping to control type 2 diabetes.
His observations reinforce a concept new to diabetes control — that exercise, not necessarily weight loss, is key to managing the disease.
Pomeroy works with 55 people regularly; all but two have their blood sugar under control. That control has come despite the fact that medical "weight loss" prescriptions haven’t been met. These individuals, around age 46, have an average weight of 270 pounds and a body mass index (BMI) of 40. The normal BMI range is 18.5 to 24.9. Overweight is considered 25 to 29.9. Obese is 30 and above.
"When diabetes doesn’t end up killing us all, it will be because of the work of this tribe," said Pomeroy, a Tempe resident and an exercise physiologist at Su Pu Kum Ke Wellness Center in Sacaton.
Dr. Michaela Tong works at Hu Hu Kam Memorial Hospital, which is affiliated with the wellness center, and said movement seems to effect change at the molecular level. It improves blood supply throughout the body, which reduces stress on the vascular system.
"There is also a certain amount of depression associated with a chronic disease, and exercise helps with that," Tong said.
As people begin exercising, other lifestyle changes follow. "They start focusing in on their diet. There is a greater compliance with medication," Pomeroy said.
Within the community, just south of Chandler, half the residents 35 and older have type 2 diabetes. That compares with 4.4 percent of the general U.S. population, according to self-report figures from the Centers for Disease Control and Prevention. That same office also projects that incidence of diabetes in the general public will increase 165 percent by 2050.
Gila River tribal leaders recognized the health problem within their own community 35 years ago. But, as little was known about treatment, they worked then toward prevention. Now, exercise strategies, combined with diet, are giving hope that a diabetes diagnosis is not a death sentence.
Gila River community members now have some control over their health. Instead of focusing on illness, they focus on wellness.
"I think a lot of what we provide here is hope," Pomeroy said.
Some Gila River community members are skeptical of this "hope." They’ve seen parents, grandparents, friends and neighbors spiral from insulin dependence to dialysis to the grave.
Mark Talas didn’t want that to be his future. So he worked with Pomeroy and started exercising. Then he cut out high-fat, processed foods.
What he got in return was his health.
A NEW AGE
Talas grew up with his grandparents in Keams Canon, about 60 miles east of Winslow, where he was active and ate healthy foods.
"There were springs, oh, five to 10 miles away, and we used to run there and back," Talas said.
And meals: There were melons, squash, beans, piki bread, mutton, rabbit and prairie dog. "My grandfather had a lot of peach trees, so we had dried fruit," Talas said.
For the most part, the family only ate fast food on periodic trips to Holbrook, 80 miles away. On those trips, before returning home, the Talases purchased eclairs at a bakery, boxed chicken at the Chuckwagon diner and a jug of apple cider.
Now highly processed foods are everywhere, including Keams Canon and the Gila River Indian Community.
As far as exercise goes, children don’t run the trails any longer. "They play video games," Talas said.
Now 57, Talas lives in Florence, with access to the Gila River Health Care facilities in Sacaton. At 238 pounds, he wasn’t running, either — he ambled through the door at the Su Pu Kum Ke Wellness Center. He was drinking beer. He was making bad food choices. He was stressed. With retirement two years away, this wasn’t the shape he wanted to be in.
But what really motivated him to make changes was knowing he’d soon be in size 42 pants.
Today, Talas is 50 pounds lighter and a peer fitness leader at the Su Pu Kum Ke, which means "house of wellness."
In some ways, he’s not a typical client, as he did lose a large amount of weight. But in other ways, he is like Pomeroy’s other clients. He is moving and feels good. His blood sugars are under control. He takes only one pill a day.
"If a 57-year-old man can get in better shape than he was in his 30s, anybody else can do it," Talas said. "I’m going to be the only 92-yearold man with a six-pack. I’m going to live to be at least 120."
TIME FOR A CHANGE
In April 2001, Su Pu Kum Ke Wellness Center opened at Hu Hu Kam Memorial Hospital in Sacaton. The center facilitates physical therapy and weight loss directives handed down by doctors.
Pomeroy, who has a background in exercise physiology, exercise psychology and exercise science and wellness, was hired to help with the weight loss component. It is within this community that he saw the greatest opportunity to have a public health impact, due both to the size of the problem and the commitment of leaders to improve the quality of life.
"There are a lot of people who, for one reason or another, cannot or will not walk into a typical (gym) and start working out," Pomeroy said.
They may have had a bad experience with exercise. They may see no point to it. Others might be uncomfortable with the setting.
Pomeroy works with all of the above, with a goal of controlling blood sugar levels and increasing quality of life. To do this, he listens to what clients want. There is no set series of exercises, days per week or weight loss goal to reach.
"Someone may not be ready to make a change," he said. But they may be ready to start thinking about getting ready to exercise. He lets those people know he’ll be there for them.
For clients who are ready, Pomeroy puts their needs at the center of the fitness program, tapping into what they want to do.
And then, "we try to make it fun," Pomeroy said. "We try to demonstrate that their efforts will be rewarded."
Those rewards are proven through hemoglobin (A1C) levels, the measurement of overall diabetes control. After three months, Pomeroy’s clients have an average hemoglobin (A1C) level of 6.5, well within the controlled range of 5.2 and 9.
"I have worked with people who were coming in with a walker or cane and now no longer need them," Pomeroy said.
And it all started with regular exercise, not weight loss.
Soon, Pomeroy will be moving to a new job within the community, that of physical activity coordinator for the Gila River Health Corporation. In his new capacity, Pomeroy will be the hospital point person responsible for community-based physical activity programs assisting in diabetes prevention for people with health conditions.
"I am honored to have been given the opportunity to work here and develop the relationships with the people," Pomeroy said. "I honestly feel that what I have gotten back from this re lationship equals or exceeds the efforts that I have made. Most people don’t get that kind of opportunity in a career."
Type 2 diabetes
Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it causes problems, including damage to the eyes, kidneys, nerves or heart.
American Diabetes Association —
National Institute of Diabetes & Digestive & Kidney Diseases —
American Dietetic Association —
Diabetes Action Research and Education Foundation —
Diabetes Exercise and Sports Association —
Juvenile Diabetes Research Foundation International —