Is Type 2 Diabetes Your Fault?

I recently got an irate letter (yes, an actual letter that was delivered by a mail carrier) from a man who said his wife had recently been diagnosed with diabetes and it's all her fault.

He said he's been telling her for years that she had to lose weight and exercise more but she didn't do what he told her to do, so getting diabetes is all her fault. And he complained that I said in my book The First  Year: Type 2 Diabetes that getting diabetes is not your fault.

I tried to explain what I meant, to no avail. But just in case some other people are confused about this issue, let me explain.

First, it is true that losing weight and exercising more will reduce your risk of getting diabetes. But it's no guarantee. Sometimes people who aren't overweight and who exercise a lot still get type 2 diabetes. Other people can be very overweight, even obese, and not get any exercise and they'll never get diabetes.

In order to get type 2 diabetes, you need two different things. First, you must have insulin resistance (IR). Second, you must have beta cells with a genetic defect that won't allow them to overcome the IR.

Some of your IR is genetic, some people estimate up to 50%. It's not your fault if you have a lot of genetic IR. But even if you inherit a lot of IR, if you have strong beta cells that are able to grind out a lot of insulin to compensate for the IR, you won't become diabetic, although you may put on a lot of weight because of the IR.

(Whether weight gain causes IR or IR causes weight gain is controversial. I think both are true, causing a vicious circle. You put on a little weight and your IR increases. The increased IR makes you put on more weight, and this increases the IR even more.)

If you've inherited beta cells that can't cope with increased IR, this is not your fault.

Finally, many people who have weight problems, especially lifelong weight problems, seem to have defects in their appetite controls. Normally, when you've eaten enough food, you feel full. Some people never feel full.

The most extreme examples of this are the few people in the world who don't produce any leptin, a hormone that is supposed to turn off your appetite when you've eaten enough. Little babies and toddlers with this condition are constantly ravenously hungry and will eat anything they can get their hands on. They become grossly obese as toddlers.

But if you give these children leptin, they immediately stop eating a lot and lose weight with no effort. Clearly, their overeating was not caused by some kind of moral failure or low self-esteem. They inherited a biochemical defect.

Now, if you've inherited a milder form of a defective appetite control, it is true that if you ate less all your life, you wouldn't gain as much weight. But you'd spend your life feeling as if you were starving. And not eating food that is available when you're starving is considered a form of torture. In fact, it's often used to torture people.