Weight, Prejudice, and Type 2 Diabetes

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Do you think overweight people bring Type 2 diabetes on themselves? It would be natural to think that, because doctors and other authorities have been blaming weight for years. Health "experts” call Type 2 a "lifestyle disease," implying that people choose it. Heavy people are called "obese," which comes from the Latin for "over/eating," as if that were the whole cause of overweight.

Heavy people are often pitied for being unhealthy and scorned for being unattractive. They can be turned down for jobs, refused insurance, even hounded out of stores. (“We don’t have anything your size, so why are you here?”) In my book, Diabetes: Sugar-coated Crisis, I point out that these attitudes are based on prejudice, not science or aesthetics. They are mostly about money, not health or beauty. Today’s blog entry starts to look at some of these issues.

Weight and Type 2 diabetes
So what is the relationship between weight and Type 2 diabetes? It’s true that excess weight (especially abdominal fat) is associated with Type 2, and that losing weight often makes it better. But that doesn’t mean overweight causes diabetes. Most overweight people do not have Type 2 diabetes. Other factors, chiefly genetic variation, stress, and lack of physical activity are probably responsible for both the weight and the diabetes.

It’s interesting to note that liposuction—draining fat from the body through a tube—does not seem to affect blood sugar levels much. But bariatric surgery, where some of the stomach and intestine are bypassed, sometimes (at least temporarily) halts diabetes immediately, even before weight loss occurs.

In other words, fat itself is not as damaging to health as the behaviors, conditions, and stresses that tend to make you fat. Those are what need to be changed. Heavy people who get themselves in condition, as shown by exercise tolerance and normal blood pressure, have little more health risk than lighter people. But the social stress of being fat, and the constant struggle to be thin and to deal with antifat attitudes, may add significantly to overall stress and help cause Type 2 diabetes.

If you’re very heavy, weight loss is definitely desirable. It takes pressure off your knees and hips, making it easier to be physically active. It often improves blood glucose control and cholesterol profiles and, in general, makes it easier to stay healthy, especially in our toxic food environment. Still, society’s negative attitudes toward overweight are far stronger than health concerns should dictate.

Class-based prejudice
Most social attitudes against weight have nothing to do with health. They’re about money. It used to be that only the rich could afford enough food to be heavy. Fat was associated with wealth, so fat was considered attractive. If you look at the sex symbols of 100 or even 50 years ago, they were much heavier than today’s media beauties. (Look at a picture of Mae West or Marilyn Monroe for example.) Now, when calories are easy to get, thinness is associated with wealth, fat is considered ugly, and the conventional model of beauty is way too thin to be healthy.

Overcoming fat prejudice
These prejudicial attitudes toward overweight people cause actual harm. Undeserved blame adds another burden to people who usually have hard lives already. Feeling guilty, ashamed, weak, or inadequate raises stress and blocks people from changing. Prejudice in social or job situations add to stress and economic difficulties.

In another blog entry, I’ll go into what we can do as individuals and communities to counter prejudice and discrimination against heavy people, perhaps including yourself. If you’re interested, you can check out, among others, these Web sites:

And don’t stop trying to get in shape. At any weight, fit is healthier than sedentary.

So what have been your experiences? Have you or someone you know been subjected to insulting or prejudiced behavior because of weight? Do you, loved ones, or friends blame yourselves for health conditions that are mainly environmental? Let us know what you think by commenting below.

Want to share your self-management story?
On another note, I’m working with the Institute for Healthcare Improvement on a Web site to help patients and health-care providers work together on self-management. I could use some stories about getting started with diabetes self-management, the problems you have overcome, and those you still have. If you’re willing to talk or correspond about your self-management story, send me an e-mail. People will benefit from your experience and wisdom.

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