Diabetes Self-Management Blog

My friend Jan has, she says, "horrible" varicose veins. "They look like ropes you tie a ship up with going down my legs. I have pooling around my ankles" that look like bruises to the extent that people ask her if she’s injured herself. On top of that, "they ache…especially if I’m on my feet all day," as she is when she watches her toddler granddaughter.

So why doesn’t she get them fixed?

“They will not consider any treatment at all until I lose weight,” she sighs. “I guess any problem I have, including the cold I’ve had for the last two weeks, is because of my weight.”

Maybe I should suggest she ask them why they insist on putting her at risk for leg ulcers and blood clots.

(If you’re curious about why my friend has to tell me what her varicose veins look like, it’s because I live in Indiana — and she doesn’t. But friends we have been since fifth grade.)

Nearly two years ago, I wrote a blog entry (“‘Fat and Lazy,’ or Type 2 Diabetes — Which Came First?”) telling about how I asked a local endocrinologist what he would tell me first if I were his patient. He then began to pontificate about how I needed to lose weight. Never once did he say he would help me get my blood glucose down.

It’s not — as I assume many of us know from experience — an uncommon problem. But a health-centered program called Health at Every Size (HAES) would like to change that.

“When heavy persons present with medical problems, HAES suggests that health professionals offer the same approaches that they would for a thin person presenting with similar problems,” writes Jonathan Robison, PhD, an assistant professor at Michigan State University who is involved with HAES.

“In the case of a thin person with essential hypertension, for example, conventional wisdom suggests dietary changes, increases in aerobic physical activity, and stress management followed by medication if necessary. Yet a heavy person presenting with the same diagnosis is told to lose weight, regardless of all that is known about the most likely consequences of this recommendation.” (Read Robison’s full article here.)

The HAES philosophy focuses on promoting a healthier lifestyle that should, over time, produce a healthy weight for each individual. “An appropriate, healthy weight for an individual cannot be determined by the numbers on a scale, by a height/weight chart, or by calculating body-mass index or body fat percentages,” says an article written by Robison in July 2005. “Rather, HAES defines a ‘healthy weight’ as the weight at which a person settles as they move toward a more fulfilling and meaningful lifestyle.”

Admittedly, say the HAES folks, everybody isn’t at a weight that’s healthy for them. However, they say, “movement toward a healthier lifestyle over time will produce a healthy weight for that person.”

Of course, there’s been research! A report published in the early 2000’s by the U.S. Department of Agriculture’s Agricultural Research Service detailed a study that pitted two teams of obese women against each other.

Facing off was one team that followed the health-centered HAES approach and another that did your run-of-the-mill diet stuff. Two years later…

  • The Every Size women kept their weight fairly stable; dieters lost weight by the sixth month, but had regained it by the end of two years.
  • Every Size volunteers lowered their cholesterol and systolic blood pressure and maintained it over the two-year period; dieters failed to lower cholesterol at any point, plus they were unable to maintain the decrease in systolic blood pressure they’d realized at the end of the six-month reducing-diet phase.
  • Exercise? The Every Size folks almost quadrupled their time in two years; dieters were more active at the one-year mark, but didn’t sustain that.

I could go on. Suffice it to say that the people in the Every Size group did better in both physical and emotional categories.

Weight is not a character flaw, any more than diabetes — either type — is. It is what we are; what we have programmed into us. Look at the results by those who followed a health-centered, rather than weight-centered, program.

What to do about the attitudes out there? Darned if I know. Oh, I do have some ideas: If your health-care professional starts out with “lose weight,” ask what they’d tell you if were a “normal” weight. Ask for a larger blood pressure cuff or a larger gown. Point out that the scales don’t go high enough or that it’s uncomfortable sitting in a chair with arms.

Point out that most of the people in this country are overweight, so surely you’re not the first one they’ve seen. If they’re telling everybody to lose weight and it isn’t working, then why not? What do the healthcare folks think THEY’RE doing wrong?

Ask why they think you cannot lose weight. My endocrinologist used to think I sat around and ate bonbons or something all day until I went over my insulin doses, basal rates, and insulin-to-carbohydrate ratios with him. The math showed him that I actually eat normal amounts most of the time. Besides, I don’t like bonbons, but you have to watch the chips and dip around me.

Can we tell ourselves to just eat as healthy as we can, get in more physical activity than we are now, and stop beating ourselves up if we fall off the horse? Just climb back on and keep on riding.


  1. I think this has many truths in it. As someone who has gained and lost so many pounds so many times and who is now a Type II diabetic, I think I’ve seen both sides of this. Yes, losing weight and keeping it off would solve many health problems, but look around — very few people ever achieve this. It’s certainly not because we enjoy carrying extra weight around and wearing large size clothes. No one gets up in the morning thinking, “I’ll overeat today.” Every day is a struggle for most overweight people. When a doctor (or other health professional)ever so very cavalierly demands that a patient lose weight and get down to some ideal weight (which the patient may not have been since he/she was a teenager) as a first step, they’re missing a big part of the picture and doing the patient and his/her health a real disservice. Treating the patient first and encouraging the patient to work toward a healthier lifestyle - slowly - with their disease under some kind of control has to be a better way.

    Posted by buckigirl |
  2. Dear Jan.

    We should go back and weight everything we put in our mouths and log exercise. I did this 2 years ago and lost 10 lb in 85 days. One would think great not so. My body deceided it was starving and all hell broke loose not only did I regain the 10 but another 10 to prepare for the next famine. So now I weight 250 instead of 240 lb. Would have been better to leave 240 be body was happy then at that weight. And my insulin resistance has gone up.

    I also hate bonbons and never ate them before diabetes.

    What would be your opinion on this. I am rationing the insulin to a maximum of 75 units per day in the belief that this will at least keep the weight from increasing more. And adjust the diet and up exercise to keep BG reasonable. Is this a mistake should one try to keep the BG in the normal range or as low as possible to loose weight? The problem is lows which will convince the body that you are starving.

    Posted by Calgarydiabetic |
  3. Jan,
    Thanks for letting us know about HAES and Dr. Robision. Their focus on wellness is what I’m promoting in my new book, if I ever finish it.

    Posted by David Spero RN |

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