The punchline.
You walk into a doctors office and the doctor says, ‘By looking at a couple numbers on your chart I’m concerned about you getting this condition that about 18% of people like you get.’
‘So,’ the doctor says, ‘I have this treatment I’d like to recommend.’
‘Now, to be fair,’ the doctor continues, ‘I have to tell you this treatment is 90% ineffective. And, for some reason, almost 50% of participants don’t even complete this treatment. And if you DON’T have the genetic mutations in your DNA that cause this condition, you’ll never get it.’
The doctor goes on to admit, ‘Also, if you end up getting the condition, we have ways to manage it. Really, the condition will probably just shave a couple year off the end of your life.’
And then he mumbles, “Oh, and, there’s this other treatment that isn’t widely adopted that could possibly work just as well as the treatment I’m recommending.”
The punchline : This treatment is weight loss, the condition is type II diabetes, and the numbers on your chart say you fit into the obese category of BMI.
SOME PERTINENT FACTS
The treatment of weight loss is infective becasue for 90-95% of people the weight comes back in five years.
In studies of dieting for weight loss, there is a higher than normal amount of people that simply drop out of the studies before completion. The same has been found to be true in commercial weight loss programs.
Studies of Identical twins show that type II diabetes is at least 80% based on DNA.
Most fat people will never get type II diabetes based on well known statistical facts.
The alternative treatment is HAES. Even small amounts of regular exercise and nutritional changes seem to be effective, in relation to the outcome of type II diabetes.
________________________________________________
Sources :
- Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S.
- Controversies in Management: Dietary treatments for obesity are ineffective
- Predictors of Attrition in a Large Clinic-Based Weight-Loss Program
- Systematic Review: An Evaluation of Major Commercial Weight Loss Programs in the United States
- You did NOT eat your way into Diabetes!
- Health at Every Size (HAES) Book Website
Edit : I’ve made two small changes in wording; “effectively manage” to just “manage” and “I don’t like talking about” to “isn’t widely adopted.”
Hi there;
Followed your links on Huffington Post. Am so tired of the weight-ism I encounter. Always good to know others who are unapologetically plus size.
Peace;
LaurieAnn
Welcome LaurieAnn! I just noticed your adorable avatar on HuffPo. I hope you enjoy your stay!
Peace,
Shannon
LaurieAnn -
It’s good to see you here! We try to be unapologetic but also thoughtful about our reactions to the world we live in.
Eliz
Great post! And can I just say that I love the alliterative day-of-the-week tags?
Thanks for the compliment on alliteration. I love alliteration.
Peace,
Shannon
Simone -
That is totally Shannon. He deserves the credit for the neat alliteration.
Eliz
Elizebeth,
In fairness, most doctor’s aren’t even aware of HAES. Weight loss is still the default recommendation for diabetes because of the cultural paradigms that have yet to shift. But I think they are shifting.
And thanks for the list of sources. That is awesome!
Peace,
Shannon
atchka -
You are correct, sir. Most doctors don’t even know about HAES or the research that support the HAES argument. Which is kinda sad in itself, that the medical establishment can be so caught up in the popular opinion that they aren’t skeptical with such contradictory facts.
This post is amazing! It is crazy how basically every health problem, from diabetes to cancer is associated to being plus-sized. I would love to see some studies on skinny people lol
This Supid Lamb -
Thanks!
I wouldn’t mind the association if it wasn’t such a catch-all. The declaration that “fat kills” or “all fat people are unhealthy” smarts of pseudo-science.
Fat people aren’t dropping off like flies and we aren’t all unhealthy. So the skeptic in me get’s a little ranty. Like, what the hell?
Eliz
Interesting facts, though I have doubts about how effective diabetes Type 2 management can be. Both my grandparents were dead by mid-60s from diabetes related heart problems. Their daughter, my mother, died at age 62 from the same, after five years on peritoneal dialysis. A few years later, my father had to begin hemodialysis due to many years of HBP. Are new drugs and new technologies sufficient to prolong a diabetic’s life to a normal life span? What if I lose my insurance and can’t buy insulin?
Right now, I think that one can choose to somewhat mitigate genetics, if desired. I wear glasses to correct my inherited bad vision instead of falling down stairs or crashing my car - I behave in other ways to avoid becoming a diabetic.
If by “mitigate genetics” and “avoid becoming” you mean delay onset by maybe two or three years, while making yourself and everyone around you miserable… then yeah, I guess restrictive dieting is totally a viable choice.
Key word being *choice* — you choose to spend your life dieting to try and avoid diabetes. You don’t get to make that choice for anyone else, and yet that is exactly what public policy and societal pressure are attempting to do.
Erin S. -
I think you make a good point here. There is animal research that shows if monkeys never get fat they will never get diabetes, but it also shows that the animals act like they’re starving for the length of their lives.
But, far as I know, there is no research that shows loosing the weight (and keeping it off) will STOP someone from EVER getting diabetes. The point being that there is no research that shows a more than just statistical outliers keeping off the weight for an extended period of time.
The theory that “getting thin” will make you healthy doesn’t hold up when you examine the “in the long run” part of the question.
And really, there is something to be said for quality of life versus quantity — if I have the choice of living only until 70 and remaining overall content or even happy with my life in general, or living until 90 but spending every waking moment feeling like I’m starving and constantly denying myself every scrap of enjoyment because it might make me fat or fatter… I’ll lose the extra 20 years thanks.
@ Erin S.
I didn’t say I was dieting and I didn’t say I was miserable. I didn’t specify my choices because they are just that, mine. No where did I recommend dieting , or indeed any behaviors, to any others. My life is quite excellent - thank you very much for thinking otherwise.
I’m not aware of any studies, but have known individuals who after making various changes (including but no limited to weight loss), blood sugar levels return to normal and medication is no longer needed. (type 2 only)
And I know people who, in spite of following to the letter your “healthy changes” and other buzz words for lose weight and exercise more… were still diabetic, still had uncontrolled blood sugar, and required ever increasing amounts of medication to control symptoms.
There is no one right answer for everyone, but your response just smacks of “well fine, but since you totally can do this that and the other thing to mitigate the genetics, if you don’t it’s your own damn fault”.
Maybe you didn’t intend to come across as a typical concern troll but that IS how it came across.
I’m too polite to say how you came across.
Wait, how in the word did you get ‘restrictive dieting’ from Karen’s post? Why is it that someone coming into an FA space and insisting that they knew fat people’s lifestyles consisted of (insert ugly stereotype here) would rightfully get their ass handed to them, but you feel free to make a fair amount of ugly assumptions about this woman’s lifestyle and her intent in posting here?
I know people who can only control their diabetes with medication and I know people who’ve greatly reduced or eliminated their need for medication with weight loss and/or other lifestyle changes. I won’t deny that our culture treats the former group as if they’re irresponsible slackers (despite management of the disease being the goal) but I’m not sure the scales are balanced by anyone assuming the latter group are a bunch of starving purveyors of misery.
If you’re going to make a point to use the same language that the diet lobby uses to make health into a moral imperative, then you should expect people to react to it the same way they would react to the more overt kinds of fat shaming. In over 30 years I have never heard even a doctor suggest that there is anything OTHER THAN weight loss dieting and restricting your diet to only a very very small list of moral foods. Therefore, of course I am going to assume that her “other things” she does to avoid diabetes involves either weight loss dieting or eating only “good” foods that have societies moral stamp of approval (this week anyway).
The entire problem is her last paragraph and it’s comparison of “mitigating” genetics that cause diabetes with something as simple and external as wearing glasses to compensate for vision problems.
She wears glasses to avoid crashing her car… and “does other things” to avoid becoming diabetic. It’s just entirely that simple y’all, and I don’t know why you just won’t simply do these “other things” that I guess are totally 100% as effective at avoiding diabetes as wearing glasses is at correcting some kinds of vision defects. And if you don’t do these other things, I guess you’re as stupid and to blame as someone who crashes their car because they didn’t simply put on a completely painless external device.
Guilty of bad analogy - that’s me! for I am NOT dieting so stop making assumptions and insulting me. I am NOT asking or recommending that anyone diet. Or do anything else for that matter.
Karen -
“sufficient to prolong a diabetic’s life to a normal life span?”
I do admit in the post that we’re talking about some loss of lifespan in relation to diabetes. The studies I’ve seen say about an average of 10 years less of life. And, as I understand it, the scare about diabetes is that it makes you twice as likely to die of heart problems.
My point is that if your going to try and “mitigate genetics” it should be through a proven route. There are sources, like The Aerobics Center Longitudinal Study (ACLS), that show fitness, not fatness, is a better indicator of longevity.
My other point is that a treatment that is relevant to the few is being recommended to the many. If a person has no other metabolic indicators (high blood pressure, high cholesterol, or insulin resistance) and no family history of diabetes, why are they being told to loose weight? That just doesn’t make any sense to me.
Kudos elizebeth. Clear, concise, snappy. A voice of reason.
My husband has type 2 diabetes (as did both of his parents and so do 3 or 4 of his 5 brothers) and his doctor at the VA is always after him to lose weight. He has large bones - his orthopedic surgeon told us that after replacing his left knee, and said that DH isn’t really fat for his bone structure, no matter what his VA doctor thinks. DH refuses to diet for weight loss, and his weight has stayed the same (within 10 - 20 lbs) ever since he retired from the Navy 16 years ago. He does count carbs, takes his Metformin and insulin, and takes the cholesterol and BP medication prescribed by his doctor. So far, his cholesterol and BP numbers are good, his BG numbers, well - those aren’t as low as mine (I don’t have diabetes of any kind), but they satisfy his doctor most of the time. He knows that he could have a shortened life because of the type 2 diabetes, but at 54, he doesn’t have many of the complications yet (other than glaucoma, and that is under control). He said if he dies earlier than normal because of his diabetes, at least he will die happy and well-fed, not starved and miserable.
Life is a balancing act, and you balance doctors’ advice against what you know/have researched and how you want to live your life. There are no guarantees that even if you do everything “right”, according to your doctor, that you still won’t die of some disease anyway.
Vesta, thank you for giving a positive example of Type 2 diabetes control.
Wow, feisty weekend, eh?
Erin, I understand your frustration and how what Karen wrote made you think that she was recommending weight loss. She said that a person could choose to mitigate the possibility of diabetes onset. As Elizebeth said, research shows that fitness could play a significant role in preventing insulin resistance. I’ve also read that HAES could help significantly as well. But you’re right in that losing weight alone does not prevent or solve diabetes. For all the talk about how WLS reverses diabetes, the research shows that it isn’t the weight loss itself that causes these changes (as the positive effects are seen prior to any significant weight loss). So, it could be the starvation that helps or some other aspect of nutritional malabsorbtion, but it looks like the amount of fat you have on your body is not a causal factor.
That being said, I would ask that you try to give a person the chance to answer your concerns before making an assumption about their intent. Karen’s first comment said nothing about restrictive dieting, but you thought that’s what she meant. I would suggest asking her first what she meant by choosing to mitigate diabetes. She may have access to some research or personal experience that you aren’t aware of and could help further the dialogue.
Karen, that was a bad analogy.
If a person has bad vision, of course they’re going to wear glasses because you couldn’t function without them. But how a person responds to diabetes is more challenging because we’re talking about lifestyles. Be careful in how you discuss choices in the context of weight because it is a triggering phrase for a lot of people who have heard that their weight, their health, their diabetes is completely their choice and that failure to make the necessary choices is somehow a reflection on their character. Talking about weight and health is a semantic minefield, so you really have to choose your words carefully when you comment on something so personal to so many people.
Peace,
Shannon