Sweetened syndemics: diabetes, obesity, and politics in Puerto Rico.

Aim: Obesity is prevalent in Puerto Rico due to intersecting structural inequalities such as poverty and unemployment. At the same time, type 2 diabetes mellitus is also highly prevalent on the island due to similar structural factors. The role of food access and identity contributes to the ways in which the illnesses interact. The two illnesses furthermore form part of a syndemic in Puerto Rico. The island's status as a US territory leaves Puerto Rico with limited economic resources from the US government for necessary programs like Medicare. As such, this paper proposes that obesity and diabetes form a syndemic in Puerto Rico. Subject and methods: Interviews were conducted with 75 Puerto Ricans, recruited from the Centro de Diabetes Para Puerto Rico. Results: Thirty-six participants had obesity, and an additional 14 were overweight. Sixty-five participants had type 2 diabetes. Study participants perceived that Puerto Rico's subaltern status deleteriously affected obesity rates due to limited US federal assistance for health insurance and for imported fresh foods and vegetables. Diabetes was due to both weight mismanagement and a lack of healthcare providers. Conclusions: Obesity and diabetes form a syndemic in Puerto Rico through multiple and interacting structural factors, such as crime, unemployment, and a broken healthcare system. Puerto Rico's economic and healthcare crises leave the island in a difficult situation, unable to support itself and without the resources to improve its situation. [ABSTRACT FROM AUTHOR]