Things continue to be busy with working on my dissertation, but the good news is I'm learning things that I can pass along.
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| Even health care providers and researchers don't take the stairs. |
Something I heard a lot when I first started doing diabetes research was "diabesity." The way that people said it just bothered me because it seemed like they were dismissing the seriousness of diabetes because a person was also obese and they were clearly less sympathetic, calling it a "lifestyle disease." So I looked into it and found that the way most folks are using it comes from Francine R. Kaufman's book, which you can take a peek at here. Originally, though, “diabesity” was a diagnostic category for type 2 diabetes that was directly caused by obesity in laboratory studies of animals (see this and this if you're curious). The way it is used now is much more generic, a shorthand for talking about fat people who have diabetes or prediabetes--and it doesn't matter which came first.
The more I learn about diabetes and the more scientists I get to hear talk about this issue, the more I'm convinced that there's some underlying metabolic disorder that causes both diabetes and obesity independently of each other. This explains why weight loss helps both issues, but is not enough to cure either. The problem with "diabesity" is that there's a lot of cultural stigma in our society around obesity and to lump the problems together into a single word oversimplifies the causes of diabetes. We tend to blame fat people for all of their health problems and they are treated poorly as a result.
Blaming obesity for type 2 diabetes hides the fact that it is possible for diabetes to be a cause of obesity (not the other way around) and that weight loss alone does not actually cure diabetes. If the issue were as simple as balancing energy consumed with the energy expended (“don’t eat more than you’ll burn off with activity”), then reducing carbohydrates would cure both diabetes and obesity.
In a recent TED Talk, Dr. Peter Attia did an excellent job of laying this out and describing how his belief that type 2 diabetes was the patient's fault affected the care he gave a patient and how his own experience with metabolic syndrome changed the way he sees diabetes. Please watch this.
I wish every doctor who ever wrote off my bigger health problems because I was fat could have this awakening so that they would know how they hurt people and they wouldn't keep doing it.
Many people with diabetes are able to live with high blood sugars for their entire lives without complications and no matter what medications and lifestyle changes are made, they never achieve an A1C below 7.5. There are others who have known genetic mutations within their families that create a condition that looks a lot like type 1 diabetes, but doesn't respond to conventional treatments. There aren't any conclusions just yet and there aren't any changes being made to the way that diabetes care happens (like new tests and treatment plans), but I was glad to know that the research is happening.
Language matters in how we understand the world and how we relate to each other. I hope that as people who do diabetes care learn just how much they don't know, their language will change. Diabesity is inaccurate and it hurts people. It is great for marketing and media soudbytes, but it is not a human diagnostic category.
So when it comes to weight loss, diet, exercise, and controlling type 2 diabetes, here's the jist of what I learned at ADA:
"We don't really understand the relationships just yet, but we're working on it.
In the mean time, please eat some salad because it can't hurt."
I'm glad you're doing so great with weight loss and managing your blood sugar, but if that stops working so well, I want you to know you're not the only one. It's so frustrating that the one behavior that is pushed over and over again for managing diabetes is not always under your control. I'm looking forward to when the scientists figure it out and they come up with new ways to treat it. For now, though, keep eating what you've been eating since it's working for you. Also, never take that kind of abuse from a health care provider. Just because you're overweight doesn't give anybody the right to bully you about it, least of all the people you trust with your health care.
Love,
Mel
