Wednesday, February 15, 2012

Losing the Overweight Stigma with Type 2 Diabetes

For lots of people the hardest question is, “What are you doing to control your diabetes?” That’s what a leader of some new focus groups tells me.

“If they have type 2 diabetes, they feel guilty about it,” she tells me. “So they won’t open up about their diet, exercise, testing, and how they take their prescribed medication.”

Feeling guilty is bad enough when you done wrong. But when it’s not your fault, it’s doubly awful.

If you have type 2 diabetes, it is not your fault, although it seems that many of us don’t know that. On the other hand, everybody knows that when people get type 1 diabetes it is not their fault. Type 1 diabetes is an autoimmune disease that we still don’t know how to prevent. But much of the world goes around telling us that our type 2 diabetes is “a lifestyle disease.”

That lumps it together with lung cancer from smoking and cirrhosis of the liver from alcoholism. The message – usually hidden but sometimes explicit – is that we are lazy, we eat too much sugar, and especially that we get fat because we stuff our faces with bonbons and jelly beans.
 
But the numbers just don’t add up. More than one-third of all American adults are overweight. Plus, nearly one-third of us are obese.

Many people think that being heavy causes diabetes. But since a lot more people are overweight or obese than have diabetes, weight can’t be its cause.

Government data show that 34.1 percent of adults are overweight. These people have a body mass index of 25 to 29.9. Another 32.2 percent are obese, meaning a body mass index of more than 30. Together, almost exactly two-thirds of us are carrying more weight around than is good for our health.

By comparison to the two-thirds of Americans who are overweight or obese with a body mass index of 25 or more, 7 percent of us have diabetes. So being heavy can’t be the cause of diabetes. Even when we consider the one-fourth of Americans with pre-diabetes, there’s got to be more to causing diabetes than being well-upholstered.

Still, more than 85 percent of people with diabetes are overweight or obese. That means there must be some connection between diabetes and weight.

While being overweight can’t be the cause of diabetes, weight and diabetes are linked. They probably have a common cause. This strong correlation is why you will often see type 2 diabetes described as a “lifestyle disease.” This implies that diabetes results from a choice, just as other lifestyle choices like cigarette smoking and heavy alcohol consumption lead to other diseases. It’s blame-the-victim time.

Even the government’s Centers for Disease Control and Prevention buys into this argument. “We know obesity causes about two-thirds of diabetes,” the agency told state health agencies in 2005. In fact, no one has ever demonstrated that obesity causes diabetes or even insulin resistance.

On the other hand, maybe insulin resistance or diabetes makes us overweight. That’s certainly possible, but even if it is there has to be something else that causes us to carry more weight than we should.