CHARLESTON, W.Va. -- "West Virginia patients come into my office," Dr. Frank Schwartz said, "and they'll say, 'Yep, Mom had diabetes, and it caused her to go blind when she was 63. So when do you think I'll get diabetes?'
"And I'll say, 'You don't have to get diabetes. You can prevent it.'
"But it's like they didn't hear me. They'll say, 'But when do you think I'll get it? When do you think I'll go blind?'"
"And I'll say, 'You can cut your risk of diabetes in half if you exercise for a half hour three times a week and eat a reasonable diet,' and they'll say, 'I hope I won't lose my leg.'
"It happens again and again," he said. "There's this very powerful cultural story line in Appalachia that says, if your grandma and your dad had sugar, you're going to have it, and there's not a thing you can do to stop it, and you'll go blind and your leg will be amputated, and your kidneys will shut down.
"It's completely untrue, but that doesn't seem to stop it. Before we can start preventing diabetes on a wide scale, we need to deal with that story. If people believe there's nothing they can do, they won't try to prevent it."
Frank Schwartz, M.D., is an endocrinologist. He treats diabetes. He grew up in Parkersburg at a time when a kid "left the house in the morning and played all over town and didn't come back till supper. We walked two miles to school, so very few of us were heavy."
Now he directs the diabetes/endocrine program at the Appalachian Rural Health Institute at Ohio University in Athens, where he treats a lot of West Virginians.
He thinks a lot about the myths surrounding diabetes: Why is it so hard to convince people they can keep themselves from getting diabetes, even if their grandmother and mom had it?
He also obsesses over a second question: "Why does Appalachia have a higher diabetes rate than most of the rest of the country?" The two questions are somehow connected, he thinks.
Myth: Black people get diabetes because they're black
In 2010, Marshall University professors Richard Crespo, Lawrence Barker and colleagues found, through analysis of Appalachian Regional Commission data, that people in distressed Appalachian counties get diabetes two years earlier than the national average.
"Distressed" means the average income and education levels are low, and services are scarce.
Six years earlier, in 2004, Schwartz and his students basically found the same thing. They surveyed people in the 11 "Appalachian" Ohio counties located next to the West Virginia border. In those eleven counties, all of which qualify as "distressed," 11.3 percent of the people were diabetic, compared to the overall Ohio rate at the time of 7.2 percent. "They were in line with West Virginia, not Ohio," he said.
Schwartz and students asked diabetics how old they were when they were diagnosed. Thirteen percent said they were under 21. "That's more than twice the national rate estimated by CDC," Schwartz said.
How many West Virginia young people were diagnosed at a similar early age? "Nobody's ever asked, as far as I know," Schwartz said, "but it stands to reason that it would be happening.