Diabetes is a serious problem in Bermuda. Our food culture (which is heavily affected and informed by food insecurity), increasingly sedentary lifestyles, high rates of obesity, and stress inducing habits make Bermuda the perfect environment for diabetes to thrive, and it does.
Bermudians contract diabetes at a higher rate than the global average, and questions about food insecurity are still difficult to answer here, but we’re going to try to shed some light on the topic.
Bermuda Diabetes Association Diabetes Educator Sara Bosch de Noya says, “Although there is little data directly on the rates of food insecurity as it relates to diabetes here in Bermuda, it is a known fact that we have a high incidence of overweight and obese people, and the prevalence of diabetes here on the island is higher than the global prevalence of diabetes.
“Bermuda is estimated to have a diabetes prevalence of approximately 13%, while the global prevalence of diabetes now stands at around 10% of the world’s population.”
Speaking specifically on the topic of food insecurity in Bermuda, Ms Bosch de Noya asserts: “Food insecurity refers to a situation in which households lack access to healthy, nutritional foods because of limited money or other resources. Limited finances in food insecure households often result in the purchase of cheaper and high caloric density foods, which contribute to higher rates of obesity. Obesity …is linked to, and carries an associated increased risk of chronic illness, including type 2 diabetes, depression, and many other medical conditions.
“This, perhaps, is one of the major concerns with food insecurity: the potential to see an increased risk of developing diabetes, as further exacerbated by the pandemic. Many countries are seeing a significant rise in obesity rates because of physical, mental, and economic constraints and changes in lifestyle habits.”
In Bermuda, we generally consume diets that are comprised of imported, processed foods that arrive in cans, boxes, bottles, bags, and crates. We do not, generally, consume a lot of organically grown local produce. Yes, we do consume local fish, as a preference (for most Bermudians), but our national dish is Cod Fish and Potatoes – cod is not a local fish and is preserved in a lot of salt.
Sugar is another favorite for Bermudians. We put sugar in everything! Sugar intake, of course, is the single biggest factor in any diabetes diagnosis; indeed, we all have a relative who is from a generation which never used the word diabetes at all, referring to the dreaded affliction as the folksier, “Sugar.”
On how to prevent diabetes through dietary consumption, Ms Bosch de Noya advises: “It is key to understand the elements of what we eat and why; foods that contain carbohydrates, such as starches, fruits, dairy foods, and sweet foods are all broken down into sugar in our body. Therefore, sensible portions of carbohydrate containing foods, selecting less refined sources, e.g., whole wheat grains, rice, and pasta whenever possible and limiting sweet foods and avoiding sweet beverages are all key dietary recommendations.
“Increasing consumption of vegetables and fresh fruit is important to get adequate micronutrients (vitamins and minerals) while helping to fill up on less calorie dense foods. Healthy proteins, chicken, fish, eggs, nuts, and beans are recommended to incorporate with meals to maintain good blood sugar patterns. Healthy fats such as olive oil, nuts and avocados help to keep cholesterol levels in check and decrease the risk of cardiovascular disease which is prevalent in diabetes patients.”
With this in mind, we can see how factors such as socio-economic status, clean food access, and disparate food cultures can inform food insecurity in Bermuda. Let’s face it: eating healthy in Bermuda is not cheap!
Anything with the word “Organic” on the label is sure to come with a premium on the price tag; and even local produce is very expensive due to local farmers having to live and pay bills in Bermuda, just like the rest of us.
These factors make food insecurity a huge problem for many Bermudian families, so the high prevalence of diabetes in Bermuda is just a logical byproduct of how we’ve historically fed ourselves.
Ms Bosch de Noya extols the economically sound virtues of frozen vegetables and farmer’s markets, while breaking down the notable shortcomings of canned fruits and dried products: “Many associate healthy eating to be a challenge because of the cost of fresh produce. While this is true for many fresh vegetables and fruits which must be imported to Bermuda, it is important to remember that frozen vegetables and frozen fruits, have just as many micronutrients if not more than their fresh counterparts and are by no means a nutritionally inferior choice.
“Canned foods are significantly higher in sodium and owing to the salted water in canned vegetables, this compromises the micronutrient content. Canned fruits are often dense in sugar content so bulk buying of fresh fruits in bags, oranges, small apples and frozen fruit are healthier economical options than tinned fruits.
“Dried fruits such as raisins and cranberries, apricots and prunes are dense in sugar and carbohydrate content and best avoided for people with diabetes. Looking to follow recommendations for healthy eating with financial constraints and diabetes, opt for local fresh produce (often farmer’s markets are well priced), and stock your freezer with frozen vegetables and frozen fruits and berries.”
Unfortunately, according to Ms Bosch de Noya, food insecurity puts our children at risk too: “Most of the research into food insecurity and health outcomes traditionally has been concentrated on children, particularly where it relates to food scarcity and malnutrition associated with nutritionally inadequate diets.
“However, in the context of diabetes risk, when discussing food insecurity and diabetes (both prevention and management), all segments of our population are at risk. The increasing trend of obesity seen in children, if this may occur more in households affected by food insecurity, puts them more at risk of developing type 2 diabetes as adults particularly in families with a history of diabetes.”
Our seniors are especially affected as well, Ms Bosch de Noya continues: “In our senior population, food insecurity is real and contributes to detrimental diabetes care by compromising both the ability to afford recommended foods and their access to diabetes medication.
“In the working age adult group, there is evidence to show that food insecurity contributes to increased risk of diabetes, high blood pressure and high cholesterol, mental health problems and depression. All age groups of adults affected by food insecurity, if also living with a diagnosis of diabetes, would be challenged to adhere to many aspects of medical recommendations, pertaining to recommended dietary intake, medications, and scheduled health care appointments; all vital components of good diabetes care.”
In closing, Ms Bosch de Noya warns against the lingering specter of food insecurity and its impact on diabetes in Bermuda: “Food insecurity is widespread and prevalent, probably even more so since the pandemic started and likely to be experienced by many in our community for some time in the future. It is hugely detrimental on a personal health level and on the economic health of our community. It is a challenging problem to tackle effectively. It is important for all health care organizations, GP’s and health professionals to look at ways to address the issue by screening for food insecurity and connecting at risk patients to resources and interventions.”