I don't mean to keep coming back to issues around obesity since I am focused on diabetes, but there's no way around it. No matter where I look in my research I am no more than one step away from obesity--as a cause of diabetes, barrier to effective diabetes treatment, or a moral failure of the patient.
A couple of posts ago, I wrote about the problem with "diabesity," and I got a few high-fives for it. The thing people who are heavy talk about most with me is their frustration that doctors think that because they're heavy they are necessarily sick and that their weight will absolutely lead to diabetes and other conditions later on. I know many healthy people who carry a lot of weight; they are still fully functional in terms of their ability to move and work. Even into their 40s, they don't have issues with blood pressure, cholesterol or diabetes. Some people are just bigger than others. There are a lot of activists working to change the way the general public and the medical field see fat people because it just isn't so simple.
Since I spend so much time looking at the scientific research on obesity, I can see where doctors and other practitioners get the idea that having significant extra weight makes people sick (a lot of the time it actually does), but like so many other things that are driven by supposedly objective science, it is only part of the story. I don't know how many times I have experienced unwanted discussion of my weight (since, despite a few decades of effort, I'm still a little fat) at a medical appointment when I was there for a sinus infection. My experience is not unique. I regularly hear from people how much that specific conversation keeps them from making an appointment even when they know that they need to go to the doctor.
The thing is, doctors are not the enemy; they are trained to behave with less compassion and it is only recently that any real attention has been paid to bedside manner around obesity. In fact, the topic of obesity has been controversial for the American Medical Association, the main authority over the practice of medicine in the U.S. The shift in thinking about obesity as a disease means that now doctors have an obligation to bring it up in medical visits with patients, something they are woefully unskilled at as a whole.
I've been dreading what this means for people who already don't want to go to the doctor because they don't want to be lectured about their weight and was delighted to hear a talk at the American Association of Diabetes Educators (AADE) conference a few weeks ago that gave me hope that doctors can do so much better. Dr. Arya Sharma of the Canadian Obesity Network presented a set of tools that they have put together to help physicians have productive, respectful conversations about obesity: The 5 As of Obesity Management. In this model, they start with asking the patient's permission to have the conversation and then proceed to assess the degree to which obesity is actually causing illness or disability, moving far beyond the BMI measure that most practitioners use, the Edmonton Obesity Staging System. In this video, Dr. Sharma talks about the stuff that got me most excited at the conference.
So all of that is to say I'm excited that there are researchers and clinicians trying to make it easier for us to get medical and other professional help for losing weight when we need it. I'm also hopeful that doctors and their staff will become more compassionate and will have better tools for having these sorts of difficult conversations in respectful ways.
After all, if we don't feel respected by our doctors, there's no way we're going to listen to them--even when they might have something relevant to say.
Love,
Mel
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