www.roanoke.com

When Dr. Eric Williams talks to patients about changing their lifestyles to stave off heart disease, diabetes and stroke, he knows firsthand some of the challenges people face.

Williams grew up in inner-city Philadelphia and rose to become a cardiologist. In a recent interview, Williams said that while there are race-specific issues in health care, the overriding factor he sees crosses racial lines and is socioeconomic.

"When you grow up poor, you live for the day," he said. "You don't care about next week, you don't care about 30 years from now. It's really about survival.

"So when somebody says to you: 'Will you stop smoking?' or 'If you eat right, or if you exercise, then you'll be better off 10 years from now,' that's not really important to that person, because they're trying to figure out, 'How am I going to pay my mortgage -- today? How am I going to make my car payment? How am I going to get clothes on my children's back? How am I going to feed my children?' "

Here's more from Dr. Williams:

On the difficulty in making lasting lifestyle changes:

Williams said for a lot of people, "things are very cultural, the way they eat, the way they live on a regular basis. Even if an individual can change in one family, really, unless the whole family changes their habits, it's very difficult."

"I can remember growing up as a youngster and spending a lot of time at church. The older women in the church would make these great church dinners that you had on a pretty regular basis. But unfortunately, it typically consisted of mashed potatoes in butter and green beans cooked in ham, and fried chicken -- things that were very good to eat, but at the same time very bad for you. Those are the kinds of things that are very difficult for an individual to change because it's such a fabric of the way they live."

On specific race-based concerns:

Black people are twice as likely to develop type 2 diabetes, and blacks with diabetes and heart disease are three times more likely to die.

He said there appears to be a genetic predisposition to that.

"When I was in the inner city, it was not uncommon for young men my age or even younger to be on dialysis, or to be blind, to have had heart attacks already from having aggressive high blood pressure."

Hispanics and American Indians also have higher rates of some diseases, such as diabetes and hypertension, than whites, he said.

On some blacks and their mistrust of the health care system:

Williams said he thinks some blacks, particularly those who have lived in a predominantly black community, still have issues of distrust of the health care system, which is predominantly white.

"Trust is a huge part of the physician/patient relationship. ... As a physician, patients really bare their soul to me. They tell me things that they probably wouldn't even tell their spouse, their mother or their father."

He thinks it helps that he can empathize with some patients because of his own background.

"They know just from talking to me and knowing my background that I can understand them. Now I don't give them a break, I still challenge them to change. But I can say to them, 'Look, I lived this way, I know what you're going through.' "

On the importance of early screenings:

Many people don't seek out medical care until they are already sick. Williams advocates that people get early and regular health screenings, even before they think that something is wrong with them. That way, doctors might be able to catch early on a teenager with a cholesterol level of 300 or one who is morbidly obese and already has diabetes, but doesn't know it.

"There is something that can be done if you're willing to change your lifestyle. You don't have to be like your uncle, your aunt, your mother, your father, your grandparents. You can live a more productive and healthy life if you're able to intervene upon it now."

On the challenges of changing behavior:

"The key to treating heart disease is preventing it in the first place.

Unfortunately, we're really behind the eight ball as a medical community because a lot of people don't even become apparent to the medical community until they're in their 40s, 50s and 60s -- especially for men, who typically don't get routine medical follow-up. So the whole time we could be intervening and implementing preventative-type strategies, we don't have that opportunity. By the time they come to us, the disease a lot of times is full-blown."

As for people who can make lasting lifestyle changes, Williams said, "unfortunately, it's a minority. There are some people who really do have life-altering experiences who can radically change their lifestyle.

"If they survive a heart attack and can just across the board change their lifestyle, it's amazing how they'll feel better than they've ever felt."