HAES and Disease
I recently saw this question posed in an online forum.
I got the results back from my blood panel and aside from the high blood pressure, I also have high cholesterol (250, whatever that means).
I’ve sort of known this was coming for a while now. I have a family history of high cholesterol, hypertension and heart disease.
So my question is, what the hell do I do now? Is HAES irrelevant for me now? Is there a HAES approach to lowering cholesterol? It makes me wonder if HAES is best for maintaining health, rather than treating specific metabolic disorders, like high cholesterol or diabetes. Thoughts?
This is a really interesting question. Before I answer it let me be super clear that I’m not a doctor or nutritionist. I’m just a girl with a blog and I encourage people to find practitioners they like and trust. I’m not trying to give any kind of medical advice here.
The first question I always ask when someone blames something on my weight is “Do thin people get this thing?” The answer is always “yes” so my next question is then “How do you treat it in thin people?” I want to try that before I try a risky prescription that has a 95% failure rate (which is what dieting is).
Fat doesn’t cause disease and weight loss doesn’t cure it. Health is multi-dimensional and includes behaviors, access, environment, stress and genetics. We can only control some of these and so my understanding of the Health at Every Size® (HAES) approach is that healthy behaviors, while they don’t guarantee health, are our best chance, especially if we can’t reduce our stress or change our socioeconomic conditions to give us that best possible change for access to healthy foods, movement and healthcare.
If you have a disease and it is to be managed, my understanding is that it’s managed through behaviors as well. And it seems to me that the recommended behaviors should be the same regardless of the size of the person with the disease. Even if weight loss weren’t statistically impossible for the vast majority of people, if thin people and fat people both get a disease, then it doesn’t stand to reason that being thin is the cure.
To me, following food recommendations to manage a health condition is at the very core of a Health at Every Size practice. You eat in ways that nurture you and, in some cases, that may mean eating less of certain types of foods. It can be difficult because it can be triggering to restrict, but eating to manage a disease and eating to make your body smaller are two different things for me, and so eating to manage a disease falls well within my HAES practice, while trying to lose weight to manage a disease does not.
I do think that we have to be careful of the information that is out there. In recent years what was considered “healthy” blood pressure has been lowered several times with the help of the pharmaceutical industry and “healthy” blood glucose levels have also been lowered. Also, it has been my observation that people test extreme diets to mitigate and manage disease, but do NOT test moderate ones. Recently, a study looked at managing type 2 diabetes with a 600-calories-per-day liquid diet. I wonder what would have happened if they had done things like eat regular small meals through the day and eat more whole grains? People seem to want to discover a “Break Through!” solution, not just “eat a little differently and move your body.”
In the end I think that we all have to decide for ourselves if, and how, we will use HAES to support us, and what health really means. I am a fan of the definition that Michelle at The Fat Nutritionist uses: the best life you can live in the body you have, with the situation you are in.
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This makes total sense. HAES is so flexible and so individual that it can sometimes be difficult to know whether you’re doing it “right” or not. But there really isn’t a “right” or “wrong” way to pursue health… only more or less effective and plausible means for any given individual. It’s so complicated! So thanks for helping to clarify.
Peace,
Shannon
One of the diabetes lists I belong to advocates weight loss and strict control of carbs/administration of meds to control blood sugar (most are aiming for an A1c that is close to what is considered “normal” in someone who doesn’t have type 2 diabetes, which is right around 4.4 - 4.5).
That means they’re counting calories/carbs and calculating med dosages at every meal/snack and doing quite a bit of exercise in order to control a disease that’s progressive and that tight control hasn’t been shown to help (in fact, tight control has been shown to be worse, for some reason - can’t recall the study right off-hand that showed those results).
Thankfully, DH’s doctor says that as long as his A1c is in the 6.8 to 7 range, he’ll be fine as far as complications are concerned. That means as long as his blood sugar runs between 86 and 200, with nothing higher or lower, he’s controlling his t2d just fine without having to count calories/carbs as tightly as those who are aiming for a lower A1c - and it’s much easier for him to stick to that plan because he doesn’t have to do without as many foods or eat less of the ones he really likes. But some doctors advocate going for the lower A1c, and I’ve seen the members of the list who report their numbers complain about their A1c’s going up and down from test to test - I think it’s because they’re too strict with their eating plan and it’s one that’s not sustainable long-term.
This is just an example of how HAES (TM) can work in managing one disease. It can work the same way for someone who’s trying to manage their cholesterol - figure out what target you want to hit that’s reasonable for you and what changes you need to make that you can sustain over a lifetime. Same thing goes for hypertension, etc.
Oh, and it’s very much a matter of trial and error to see what works. I had to make a spreadsheet that tracked what DH ate, when he ate it, what his BGs were before and after he ate each meal, and then figure out what foods raised his BGs the most. The foods that raise his BGs the most are the ones he eats the least of (or if he insists on eating more of them, he gets more insulin to cover them). I did a lot of research and reading to learn about carbs, blood glucose, insulin, the whole nine yards (thank Maude I don’t work, it was a full time job learning all that crap). Oh yeah, exercise also affects his BGs, if he’s worked hard, his BG is lower than on a day that he hasn’t worked at all, so that has to be taken into consideration too.
I have hypertension. Without medication my blood pressure runs in the 150′s to 160′s over upper 80′s to 90′s. For me, it is not “silent.” I become anxious and develop tinnitus when it is elevated.
I developed the condition last year while doing an unpaid internship for nursing, which led to having to take out several of those wretched payday loans, which I am still paying back. It also followed the last year of my father’s life, which was very stressful.
Plus, elevated blood pressure runs in my family. I developed it at 46. My brother, who is not considered obese, developed it at 35. It is unknown how long my father had it, but after he had his stroke, we came to the conclusion that he’d had several smaller strokes previously.
It is my opinion that the so called “obesity diseases” are in reality diseases of aging. I do not at this time present with heart disease, and I do not have diabetes, though people assume that I have it because of my build.
I take medication to treat my blood pressure. I would do so no matter what size I was, and in my opinion, doing so is in keeping with HAES as it is doing what is right for my health no matter what my size.
Ah, Fat Marcia, you have no reading comprehension skills at all, do you? Where in my comment did I say I had diabetes? I didn’t. I said MY HUSBAND has it and I belong to the list so I can educate myself about diabetes in order to help HIM. As a matter of fact (not that I have to justify myself to a fucking troll), I don’t have diabetes and never have had it. My blood sugar has always been normal, so eat shit and bark at the fucking moon, moron.
Will someone shovel Fat Bastard off this coil already? There has to be a way to ban him from WordPress or something. It’s just pathetic at this point.
CC,
He’s been using multiple IP addresses, so we’ve basically been playing Whack-a-Mole with the asshole. Seriously, somebody needs to intervene on this dumbass’s behalf. It can’t be good trolling at the computer all day.
Peace,
Shannon
His mommy needs to stop being so permissive. If he’s a 13 year old pimple faced kid, she needs to take away his computer. If he’s a 40 year old loser, she needs to kick him out of her basement!
I keep track of my low blood sugar (not diabetic, just naturally low my doc says) by eating regularly and not too much sugary stuff. My blood sugar will jump then crash, which is easier to do because it’s naturally low. I’m trying to avoid developing actual diabetes later in life by taking care of myself *now*. Health at every size and intuitive eating have been so helpful to me in learning to do that.
I just had a thought (and damn me for falling into stereotypical thinking, but it is what it is) - I wonder if Fat Bastard really is fat? What do you want to bet that he’s some thin, young, ne’er-do-well who lives in his parents’ basement, can’t get a job, and has nothing better to do all day long than troll the internet making trouble for people he hates because they have lives while he sits in the dark, mouldering his life away? If so, that’s really sad and I have nothing but pity for him (and believe me, pity is not a good thing, not at all, it’s not something of which you want to be on the receiving end).
My mother’s side of the family has the diabetic gene. My grandfather has Type II which is controlled with medication. My mom is hypoglycemic, as is an aunt. I have PCOS, which spikes my blood sugar if I don’t take birth control pills. When I’m on the hormones, my blood sugar is in the excellent range. But I try to get in exercise when I can, so that may affect my levels, as is drinking more water and less soda, which was not a weight loss choice. I can look back on it now and say it was a HAES choice. I just wanted to see if I could drink less soda.
What the morons like Fat Bastard Marcia and what other multiple personalities he uses to
troll don’t get is that diabetes is not a fatty disease. Because the levels were lowered, along with the BMI, suddenly everyone who is visually large will either be told they will get it or be at risk for it. Genetic and family history goes out the window in the panic over fat.
My maternal grandmother developed type II diabetes when she was around 70. She wasn’t heavy. My mother is now 72 and so far has managed to dodge the bullet. I’m 46 and so far my blood sugar readings are pretty much rock steady, so I’ve been lucky.
I’ve been working with the geriatric population since 1988, and I’ve never seen the so-called “truism” that fat people are more prone to these diseases. They affect people of all body types. Age, not size, makes them more likely.
The one “truism” I’ve seen is that heavier people tend to develop osteoarthritis in the lower extremities at a younger age if they’re prone to it, but don’t tend to develop osteoporosis. More slender body types tend to be vulnerable to osteoporosis, and at a certain age the osteoarthritis thing evens out. However, doctors don’t go around telling thin people with osteoporosis that “this is your fault. If you’d just eaten more you wouldn’t have had this happen!” So why they feel justified in blaming fat people for-well, pretty much everything that happens to us-I’ll never know.
Hi Bree,
Actually the BMI levels were raised in the US and lowered in Singapore. You may find the his article interesting. BMI is not the best indicator of risk for cardio vascular problems.
Japan and Hong Kong definition
Category BMI range – kg/m2
Normal from 18.5 to 22.9
Overweight from 23.0 to 24.9
Obese 25.0 and above
In Singapore, the BMI cut-off figures were revised in 2005 with an emphasis on health risks instead of weight. Adults whose BMI is between 18.5 and 22.9 have a low risk of developing heart disease and other health problems such as diabetes. Those with a BMI between 23 and 27.4 are at moderate risk while those with a BMI of 27.5 and above are at high risk of heart disease and other types of health problems.
Category BMI range – kg/m2
Emaciation less than 14.9
Underweight from 15 to 18.4
Normal from 18.5 to 22.9
Overweight from 23 to 27.5
Obese from 27.6 to 40
Morbidly Obese greater than 40
http://en.wikipedia.org/wiki/Body_mass_index
In the US 24.9 is considered overweight. In the US a healthy weight range for a person 5’5″ 111 - 150
A study published by JAMA in 2005 showed that “overweight” people had a similar relative risk of mortality to “normal” weight people as defined by BMI, while “underweight” and “obese” people had a higher death rate.
In an analysis of 40 studies involving 250,000 people, patients with coronary artery disease with “normal” BMIs were at higher risk of death from cardiovascular disease than people whose BMIs put them in the “overweight” range (BMI 25–29.9). In the “overweight”, or intermediate, range of BMI (25–29.9), the study found that BMI failed to discriminate between bodyfat percentage and lean mass. The study concluded that “the accuracy of BMI in diagnosing obesity is limited, particularly for individuals in the intermediate BMI ranges, in men and in the elderly. … These results may help to explain the unexpected better survival in overweight/mild obese patients.
A 2010 study that followed 11,000 subjects for up to eight years concluded that BMI is not a good measure for the risk of heart attack, stroke or death. A better measure was found to be the waist-to-height ratio.
The WHR has been used as an indicator or measure of the health of a person, and the risk of developing serious health conditions. Research shows that people with “apple-shaped” bodies (with more weight around the waist) face more health risks than those with “pear-shaped” bodies who carry more weight around the hips.
WHR is used as a measurement of obesity, which in turn is a possible indicator of other more serious health conditions.
The National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) states that women with waist-to-hip ratios of more than 0.8 are at increased health risk because of their fat distribution. And that men with waist-to-hip ratios of more than 1.0 are at increased health risk because of their fat distribution.[4]
The Centers for Disease Control and Prevention (CDC) states that women with a ratio of .80 or less is considered safe. And that men with a ratio of .90 or less is considered safe.[5]
A WHR of 0.7 for women and 0.9 for men have been shown to correlate strongly with general health and fertility. Women within the 0.7 range have optimal levels of estrogen and are less susceptible to major diseases such as diabetes, cardiovascular disorders and ovarian cancers (tenuous).[6] Men with WHRs around 0.9, similarly, have been shown to be more healthy and fertile with less prostate cancer and testicular cancer
SkinnyBastard,
I have to warn you that you smell like a troll to me. Your post is almost entirely cut and pasted, and your previous comment reeks of the kind of reconnaissance done by previous Fat Bastard trolls.
I don’t believe for a minute that Fat Bastard has an international fan club, let alone “friends.” In order to troll us hard, he once had to turn to 4chan for help. Now, I believe he has found a way to use multiple IP addresses to continue harassing us. He has posted a URL with several of these “anonymous” troll accounts that lead to blogs which he is listed as the admin of. I’ve seen at least five blogs so far.
I’ve deleted your last comment because we’re not interested in musical parodies of fat people and we’re still enforcing martial law (meaning, I’m deleting anything that even remotely resembles trolling). Your current comment starts out factually incorrect (BMI levels were not raised in the US, they were lowered from around 28 for men, and 27 for women to 25 for all), then you proceed to cut and paste this article from Wikipedia.
Regarding your comments on waist-to-hip ratio, the author of the JAMA study you cited on the mortality rates of overweight being better than normal, Dr. Katherine Flegal, told me in my interview with her that they looked at waist-to-hip ratio and found similar mortality rates. In other words, waist-to-hip is no better indicator of health than BMI.
You’re welcome to comment, Skinny Bastard, but you’re on a short leash until I’m certain you’re not here to stir the pot. Keep that in mind.
Peace,
Shannon
It is true that the standards for various health measures have been lowered in the last several years. However, it is also my understanding that the lowering of the high blood pressure cutoff is backed by solid research. Ignoring “borderline” high blood pressure is not to be recommended.
Quiltluver,
Welcome to Fierce Fatties.
I can’t speak to the reasons for lowering the HBP cutoff, but the BMI reduction had absolutely nothing to do with health. Even C. Everett Koop, no shrinking violet when it comes to obesity, was vocally opposed to the BMI change in 1998:
Peace,
Shannon
I started HAES about a year ago. I’ve been fat for a decade, but with no indicators of any of the diseases I’m “supposed” to have because I’m fat. I just had my bloodwork done and a few of my metabolic indicators improved. I’m heavier than I was at the last round, yet functioning much better thanks to taking better care of my body. I wish doctors would pay less attention to the scale and more attention to every other metric that says I’m doing just fine.
Congratulations, Ann! And welcome to Fierce Fatties.
Just keep doing what you’re doing. If you’re healthy and happy, then you’re doing it right!
Peace,
Shannon