BBDC Member Profile

Ananya Banerjee, PhD

January 5, 2021
By Krista Lamb

Growing up, Dr. Ananya Banerjee often heard that those from the South Asian community were at a higher risk for type 2 diabetes. This rang true, as her own family history included a number of people who lived with the disease.

Knowing about this predisposition led her parents to be careful about what they ate, to remain active. They were professionals, well-educated, they came from a relatively privileged background, surely if they took all the suggested precautions they could avoid a disease many consider to be associated with lifestyle.

When her father was diagnosed with type 2 diabetes, they were shocked. They had done everything they were supposed to do to avoid developing the condition. When years later, her mother was diagnosed with prediabetes, the family was equally stunned. But Banerjee had started to think about the connection between the family’s ethnicity and their diagnosis—what if it was not necessarily about diet and exercise, but something much deeper.

At the time her father was diagnosed, his family doctor asked about his stress levels, about how hard he had worked since immigrating to Canada in order to create the lifestyle their family enjoyed. It had been a challenging experience. Maybe that contributed. When Banerjee’s mother received her diagnosis, it was shortly after her father’s death. She was under enormous emotional stress. Was that a connection?

“I started thinking about the pressures of my mom losing my dad, her life partner for 40 years. They came to Canada in their 20s. She left her whole family, had to start from scratch,” says Banerjee. “There was something in the back of my mind, wondering is it more than just behavioral factors that are influencing diabetes in the South Asian community?”

It was this that inspired her graduate and postdoctoral studies. Banerjee wanted to look at diabetes in South Asian communities through an epidemiological lens. She began reading studies that consistently showed those of South Asian decent were at higher type 2 diabetes risk, but she was bothered that the studies often seemed to fall back on stereotypes when considering the reasons for this.

“In the discussion section it always alluded back to this notion that in the South Asian culture physical activity is not the norm and the ways South Asians eat is conducive to diabetes. And at one point, I started to get really offended, because if that was a true narrative, then my parents shouldn’t have gotten diabetes, I shouldn’t be at risk for diabetes,” she says. “And then I started to think of all the immigrants in South Asian communities—what is their risk factor profile when they actually experience more barriers to lifestyle changes and in access to the health care system?”

This led to Banerjee, now an Assistant Professor at the University of Toronto’s Dalla Lana School of Public Health, working on a research study with Dr. Baiju Shah at ICES. They looked at the seemingly one-size-fits-all approach to diabetes in South Asian communities. “Is it because we’re just stigmatized and known not to be active? And our diets are just filled with ghee and sugar? If this is the case, then we should be able to look at all South Asians collectively, no matter how long they’ve been in Canada, what region they came from, what socioeconomic status they’re part of, and it should just be uniform,” she says.

Yet, when she and Shah looked at the data, stratifying South Asians in Canada according to where they had immigrated from in South Asia and considering socioeconomic status, whether they came as a refugee, and looking at other social indicators, they saw the prevalence of diabetes was in fact very different depending on your social circumstances.

In many ways, this makes sense. South Asia encompasses a wide range of countries and a diverse and complex range of communities, cultures and people. That simply because of being descended from a geographical region your diabetes risk was higher seemed too, well, simplistic.

This study showed there was much more to it. Of particular interest were the results illustrating that those who had immigrated from Sri Lanka in the 1980s, escaping the civil war and often coming to Canada as refugees, had the highest rates of diabetes in Ontario: 27% compared to someone from India, where the rate was 18%, very close to Canada’s national average.

“Once we started to dig deeper, we saw those who are most vulnerable were low income South Asians. That migration piece really started to hit home for me,” says Banerjee, who felt a deep connection to this research. “I’m trying to make sure we stop blaming South Asians for having diabetes because of our culture, instead of looking at these structural contracts and understanding migration itself and how the stressors can often create hormonal imbalances to produce stress-induced metabolic complications within us and within anyone.”

DR. ANANYA BANERJEE AT WORK WITH HER TEAM OF RESEARCH COORDINATORS AND ANALYSTS

Banerjee’s work continues to focus on this—showing that, yes, there is a higher diabetes risk in some South Asian populations, but this risk differs depending on where you are from and your social conditions. She is also looking at how she can use this information to change the ways people think about this risk. “As South Asians we have internalized this fact and we are blaming ourselves. We’re being blamed from the broader society, but then within our communities we’re also blaming ourselves, and I think that’s not helpful,” she says. “I don’t want diabetes in South Asian communities to be normalized, and I don’t want us to have a fatalistic attitude. We have this data, and it’s important to bring the data back to the South Asian communities and ask them to really have more of a critical eye as to why this is happening.”

Banerjee has also been exploring the unique migration experiences of Tamil migrants to Ontario from Sri Lanka, inviting  those from the community to discuss their experiences and play a role in the research. She brought in students who identify as Tamil and the team engaged with stakeholders throughout the Tamil community, working to ensure participants felt empowered by the process. “It’s been really nice is to take these mixed methods approaches that are very community-based, very participatory, really enabling the community to take charge and investigate their own research inquiries and seeing myself as a facilitator, not really the expert,” she says.

Another study looks at why those of South Asian descent are often diagnosed at much younger ages than, for example, the Caucasian population. Banerjee is working with the next generation on the South Asian Adolescent Diabetes Awareness Program (SAADAP), looking at opportunities to change perceptions and break the cycle. “It’s about enabling South Asian youth who have a family history, to understand it’s not their fault, it’s not their parents fault,” she says. “And to start advocating for real systemic change and creating social policies for migrants.”

Moving forward, Banerjee is dedicated to using her own experiences with diabetes, and those of the community around her, to advocate for and enact change.

For more information on Dr. Banerjee’s work, visit the South Asian Research Hub.