Type 2 diabetes. A comparison of the awareness in the Asian Indian Culture and the USA

Inhaltsverzeichnis

1. Theoretical and cultural Background
1.1. Main risk factors for developing Type 2 Diabetes
1.2. Awareness of influencing factors for developing and preventing Type 2 Diabetes
1.3. Awareness and use of alternative medicine for treating Diabetes

2. Leading question and presumptions

3. Method and corpus

4. Approach and results
4.1. Frequency of Type 2 Diabetes in Indian English and U.S. English
4.2. Frequency of overweight and obesity
4.3. Type 2 Diabetes and its correlation with overweight and obesity
4.4. Awareness of different forms of treatment for Type 2 Diabetes

5. Summary and discussion

6. References

1. Theoretical and cultural Background

For some time India is undergoing a nutrition transition which boosts the devel- opment of overweight and obesity leading to chronic diseases such as type 2 dia- betes (cf. Shetty 2002: 175/181, Chacko 2003: 1087f., Gujral 2015: 5). Due to industrialisation and modernization, the diet of Indians living in urbanised areas changes from traditional diets to excessive intake of western fast food (cf. Shetty 2002: 177f./181). Besides these dietary factors the rising lack of physical activity is highly associated with the rising emergence of the aforementioned disease (cf. Shetty 2002: 175/177f., Lawton et al. 2006: 44). According to the Asian Diabetes Prevention Initiative (website, “Facts and Figures”), in the year 2013 60% of dia- betics lived in Asia, whereby India was home to the second largest population of individuals with type 2 diabetes worldwide, with 65.1 million diabetics. In con- trast, the American Diabetes Association (website, “Statistics About Diabetes”) reported 21.9 million diabetics for the year 2012. As a result, the awareness of influencing factors for the development respectively prevention of type 2 diabetes should be quite high for both countries, and even higher for the Asian Indian pop- ulation. To see if this is the case, in this paper I am going to examine the English language of both cultures with the help of corpus-linguistic analysis.

1.1. Main risk factors for developing Type 2 Diabetes

Some factors influencing the emergence of type 2 diabetes were already men- tioned before. Overweight and obesity are clearly the main risk factors for devel- oping type 2 diabetes (cf. Gujral 2015: 5). Asian Indians have a higher percentage of abdominal body fat compared to Europeans, which leads to a higher insulin resistance associated with type 2 diabetes (cf. Asian Diabetes Prevention Initiative (website, “Why are Asians at Higher Risk?”)). Therefore, Asian Indians have a higher prevalence for developing type 2 diabetes than other ethnic groups, even at a lower Body Mass Index (BMI¹ ) (cf. Gujral 2015: 5, Shetty 2002: 178, Chacko 2003: 1087f., Lawton et. al. 2006: 44). Of course, body weight is highly depend- ent on nutritional factors (cf. Gujral 2015: 5). In addition to the traditional con- sumption of already unhealthy white rice, refined grains and saturated fats from palm oil, especially the increased consumption of western fast food raises the intake of fat, sugar and calories (cf. Asian Diabetes Prevention Initiative (website, “Why are Asians at Higher Risk?”)). Furthermore, the rising lack of daily physical activity in Asian Indians promotes the emergence of overweight, obesity and lastly type 2 diabetes (cf. Asian Diabetes Prevention Initiative (Ibid.)).

1.2. Awareness of influencing factors for developing and preventing Type 2 Diabetes

The awareness of influencing factors can help Asian Indians to prevent them- selves from gaining type 2 diabetes. Affected Individuals can improve or even cure their disease by applying this knowledge to their everyday lifestyle. Muruge- san et al. (cf. 2007: 434f.) show that the awareness of influencing factors of diabe- tes among Asian Indians is generally low. At a total score of 65 - which would reflect a high awareness - 50% of the participants scored below 15 points. Partici- pants were examined for their knowledge of various factors associated with diabe- tes - such as causes, symptoms and complications, physical activity, unhealthy body size and shape, healthy and unhealthy food and so on. Especially, partici- pants knew very little about the importance of physical activity and healthy diets for preventing and improving type 2 diabetes (cf. 2007: 434f.). By many, over- weight and obesity were not seen as risk factors for provoking type 2 diabetes (cf. 2007: 436).

1.3. Awareness and use of alternative medicine for treating Diabetes

I want to take a closer look at the awareness and use of alternative treatments for type 2 diabetes. Since India has a long tradition of ayurvedic medicine, one could assume that Asian Indians have a better knowledge of herbal medicine and other alternative treatments compared to the U.S. Americans for instance. Kumar et al. (cf. 2006: 705) show that the awareness and use of alternative medicine among Indian diabetics was high.² In comparison, in the USA only about 40% of the population use alternative medicine (cf. 2006: 706).

2. Leading question and presumptions

Cultural beliefs can affect the perception of various aspects of everyday life, even the mindset towards a disease like type 2 diabetes:

“Culture (…) is a complex system in which traditions, attitudes, beliefs, and values are acquired, shared and held by a group of people. It affects every aspect of people’s lives, including their attitudes toward illness, health status and healthrelated behaviours.” (Chacko 2003: 1088)

Cultural beliefs and attitudes reflect on the language of any society, which can then be seen as a mirror for the awareness of a concept, even medical conditions like diabetes (cf. Geeraerts 2003 : 2). In this paper, the Indian and U.S. American cultural model (cf. 2003: 2ff.) of type 2 diabetes will be described through a cor- pus-linguistic analysis of the two English varieties. In particular, I want to exam- ine the general awareness of type 2 diabetes and its correlating factors among the Asian Indian culture in comparison to the USA. Furthermore, I want to check, whether the Indian English shows a higher awareness for alternative treatments due to the ayurvedic background.

It could be assumed, that Asian Indians have an even higher awareness for the causes of type 2 diabetes than the U.S. population, since Asian Indians are known to have a genetically high prevalence. It could also be assumed, that the Asian Indian culture shows an increased awareness of alternative treatment due to its traditional ayurvedic knowledge.

3. Method and corpus

For reviewing my own assumptions, which are also based on the theoretical back- ground I gave in the Introduction, I will make use of the corpus-linguistic method to examine the Indian English variety and compare the findings with the U.S. English. The Corpus of Global Web-Based English, or short GloWbE, includes 1.9 billion words from web pages in twenty countries speaking different English varieties.³ It allows the examination of different linguistic information in each of these variations, such as the frequency and use of words, synonyms, grammatical constructions and collocates. Furthermore, it is possible to compare a specific lin- guistic feature in two selected varieties, e.g. the Indian English and the U.S. Eng- lish. In the GloWbE -Corpus the U.S. English has a total number of 386,809,355 words. The corpus of the Indian English is 4 times as small as the U.S. English corpus, with only 96,430,888 words. This fact has to be kept in mind in while analysing the output of the search requests.

4. Approach and results

At first I am going to take a look at the general awareness of type 2 diabetes and additionally overweight/obesity in both English varieties. Furthermore, I will ex- amine the correlation between these two aspects, to get an idea of the extent of awareness of overweight/obesity being a causing factor for type 2 diabetes. In the last part I want to check the awareness of different kinds of treatments associated with the disease, such as special diets, exercise and lastly alternative, i.e. ay- urvedic, herbal medicine.

4.1. Frequency of Type 2 Diabetes in Indian English and U.S. English

When searching for the keyword “type 2 diabetes” in the GloWbE -Corpus the U.S. English shows a seven to eight times higher total frequency of the token (USA: 812 - India: 119):

illustration not visible in this excerpt

Fig. 1: Excerpt from the frequency chart for the word “type 2 diabetes”

But in relation to the total number of words in each variety⁴, the absolute fre- quency in Indian English is above half of the U.S. frequency of tokens (USA: 0,00021% - India: 0,00012%). This seems to reflect the awareness of the rising prevalence of type 2 diabetes in India. But still, the numbers for both English varieties are very low in general.

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¹ The BMI is defined by the World Health Organization: Normal weight is classified as BMI 18.5–24.99 kg/m², overweight is classified as BMI 25–29.99 kg/m², and obese is classified as BMI ≥ 30 kg/m².

² 71% of the diabetic participants showed awareness of alternative medicine and treatments, from which 67.7% actually used these methods.

³ Introductory facts on the GloWbE -Corpus can be found on: http://corpus.byu.edu/glowbe/ .

⁴ Remember that the Indian English corpus is four times as small as the U.S. English corpus. Therefore the total number of tokens has to be divided by the total number of words in each corpus.