Tag Archives: depression

Diminishing Distress Dials Down Diabetes

First do no harm. Diabetes scare tactics just might kill you.

I recently ran across this article on Diabetes Hub which describes two important studies which correlate distress with poorer outcomes for people coping with diabetes.  The first of these studies involved a randomized trial of 150 women with uncontrolled diabetes.  What the study found is that those women in the study who were able to reduce their level of disease-related distress had significantly improved glycemic control.

Typical sources of disease related distress included fear of getting sicker and feelings of isolation or overwhelm in relation to disease management and treatment.  The EMPOWER study tested various forms of treatment interventions and found that regardless of treatment methodology, those people who were able to lower their distress were more compliant with treatment protocols:

HbA1c dropped much more substantially in those in whom distress was lowered, compared to those with whom distress was unchanged or increased,” Dr. Cummings said. “Medication adherence, self-care behaviors, and diabetes empowerment and self-efficacy were all substantially improved in the group with lower levels of distress at the end of the trial.

The doctors admit that they don’t quite know why lowering distress has such a significant effect on glycemic control among people with diabetes.  However it seems that working to lower distress among people with the disease is an important treatment goal.  According to Dr. Cummings:

We’re surprised at the number of these women caring for children, grandchildren, and other members of their families, often while working, and yet not finding time to care for themselves. It is clearly an important cultural phenomenon that we need to understand better.

The article went on to discuss data gathered from another important study: the national Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study.  Dr. Cummings noted that in this study which included 4,000 black and white adults 45 years and older with diabetes and nearly 18,000 adults without diabetes, those subjects with diabetes were more likely to suffer from depression or distress (26.7% vs. 23.2%, P < .001) or both (10.1% vs. 6.2%, P < .001), compared with those without diabetes.  Those people who had diabetes and also symptoms of distress or depression had higher risks for stroke and CV death than people with diabetes without depression or distress.

What all of this seems to make clear to me is the deep need for compassionate, blame-free, stigma-free, evidence-based health care for people coping with diabetes.  The notion of scaring people straight or using dire warnings to fuel completely unrealistic weight loss goals may be more than counterproductive–they might prove especially medically dangerous for this population.  Many forums for people with diabetes are filled with horror stories about how members were stigmatized, told their conditions were their fault and told that if they didn’t get thin, they wouldn’t live to see their children or grandchildren grow up.

But maybe what really needs to grow up is our approach to helping people with diabetes live better, longer and happier lives.  Maybe we need to spend a little less time pointing fingers and a little more time holding hands as we help people make small, incremental, manageable and realistic changes in their lives.  It’s just possible that fear tactics are doing more to harm people with diabetes than to help them.

That’s one of the reasons I’m so excited to be giving a presentation at the upcoming Take Control Of Your Diabetes Conference on September 26 in San Diego, CA  The event focuses on helping people with diabetes take positive, small and sustainable steps to better health.

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New study says weight stigma signficantly reduces Quality of Life–and water is wet.

Don’t get me wrong.  I am deeply glad that they are studying the negative effects of weight stigma.  But I am wondering when this will finally be considered obvious.  I am waiting for the moment when somebody says, “shaming fat people is bad” and the primary response is, “well, duh”.

I recently read this study which was released as an online precursor to publication in Obesity magazine.  The study seeks to understand the affect that weight stigma and discrimination on conditions like depression and overall quality of life.  As the study states:

Weight stigma is often cited as a potential mechanism leading from obesity to poorer psychological well-being [4, 5, 7, 9]. Prejudice against individuals with obesity is pervasive and rarely challenged in Western society [10]. As a result, many individuals with obesity, and particularly those with severe obesity, report being discriminated against because of their weight in their everyday lives [11, 12]. Given that weight stigma and discrimination have both been shown to have a negative impact on psychological health outcomes, including well-being [10], depression [13, 14], self-esteem and self-acceptance [13, 15], and body image dissatisfaction [13, 16], this might explain why people with obesity suffer psychologically.

You would think that this had been studied in depth before.  However, according to the introduction of the study, this hasn’t previously been explored in a lot of depth.  According to the study:

Only one study to our knowledge has tested the mediating effect of weight-related discrimination, showing a significant reduction in the association between obesity and self-acceptance after adjusting for perceived weight discrimination [15]. None have examined the role of discrimination in relation to more global indices of psychological well-being, such as quality of life or depression. The aim of the present study was therefore to investigate the extent to which perceived weight discrimination mediates associations between obesity and three markers of well-being: quality of life, life satisfaction, and depressive symptoms.

In other words, many studies have suggested that fat people experience a lesser Quality of Life (QOL) than thin people.  However, this study seeks to determine whether that reduction in Quality of Life is simply because of person’s body size or whether it is caused by the world’s reaction to their body size.  I won’t keep you hanging too long.  The study determines that 40% of the person’s reduction in QOL is from perceived discrimination.

We used mediation models with bootstrapping to test the proposition that associations between obesity and well-being are mediated by weight discrimination and found that approximately 40% of the total effect of obesity on psychological well-being could be explained by perceptions of weight discrimination.

This is I think an important distinction.  So much in the “War on Obesity” suggests that the solution is for all fat people to simply lose weight.  The study suggests that the reason fat people are depressed might be–in large part–the “War on Obesity”.  As Ragen Chastain frequently states in her blog, Dances with Fat, “The way to deal with oppression is not to remove people from the oppressed group.  The way to deal with oppression is to fight the oppression.”  And I have to wonder to what extent this 40 percent takes into account the internalized oppression experienced by people of size.

I hope that this, along with so many other studies regarding the harm caused by weight stigma will finally convince some of the folks in the Obesity War to consider the harm they are causing–the millions of lives ruined by “friendly fire” in this war that makes people sadder and sicker rather than healthier or happier.  And  I hope that those proponents of “tough love” and “the ends justify the means” will reconsider their stance.  Because in the case of weight stigma, love is indeed very tough to come by.  And when the ends are actually worse that the starts, it’s time to carefully consider some new means.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S.  Want to hear me speak about weight stigma at your school or organization?  Learn more about me here.

What Happens When We “Let Ourselves Go”…

TheFatChick

After I tell people that I support Health At Every Size (R) and after I explain what Health At Every Size is, people often share with me their fear that if they ever stopped strictly policing their body size, their food intake and their calories burned, they will grow “big as a house” and they will “never stop eating”.  Now this fear is natural.  We’ve been conditioned to believe that we are just one chocolate chip cookie away from total body apocalypse and that only constant, fierce and consistent vigilance will keep us from serious medical harm.  There’s a $60 billion dollar diet industry as well as an unbelievably huge system of bariatric surgery and drugs and research grants and public health initiatives to support the notion that if we take our eyes off the thin body prize for even a moment, all hell will break loose.

Except, in my experience, it kind of doesn’t.

Some recent research coming out of Australia, seems to support the notion that Health At Every Size and Size Acceptance does NOT generally lead to giving up on health altogether.  “The Role of the Fatosphere in Fat Adults’ Responses to Obesity Stigma: A Model of Empowerment Without a Focus on Weight Loss” details interviews with 44 bloggers in the “Fatosphere”.  The subjects of these interviews often talked about moving from a reactive response to stigma (attempting weight loss to conform to societal norms) towards a proactive approach to stigma (recognizing stigma, reframing fat, and focus on self-acceptance).  These bloggers described significant improvements in well being as a result of being associated with the size acceptance community and taking a direct approach to dealing with shame and stigma.

Granted, we’re only talking about 44 bloggers here.  This is hardly a representative sample of fat people all over the world. But it does seem to map to my experience.  For a short time after I declared all foods legal and nothing off limits I ate a LOT of cookies and chips and pizza.  But after not very long, the bloom was off the rose.  I found I really didn’t want another candy bar.  I wanted broccoli.  I wanted chicken.  I wanted whole wheat bread and peanut butter.  I wanted real food.  Once the “forbidden” label was removed from foods, I found I could often take them or leave them.  I could eat one cookie.  I could eat 3 potato chips.  Because you know what?  I knew I could have them again whenever I wanted them.

Once I removed the notion of punishment from my physical activities and started focusing on finding exercise that was fun, I started enjoying my workouts a whole lot more.  Rather than dragging myself up onto the treadmill and burning an arbitrary number of calories, I called the dog and we went outside for walkies.  I got my heart pumping.  I bumped up my Vitamin D levels.  And I HAD FUN.  When I accepted that I no longer had to do exercise that I hated, I found myself free to focus on fitness that I loved.  I learned to look forward to workouts again.

Clearly I’m citing anecdotal evidence here.  But there is plenty of other research by amazing people like Linda Bacon and Lucy Aphramor that explains what happens when people lose their obsession with weight loss and start focusing on the Health At Every Size approach to wellness.  What happens is that folks get happier and generally healthier all without the nasty side effects of disordered eating, weight cycling and depression so common to the traditional diet-based approach.

So after I tell people about Health At Every Size and after people tell me that they can’t support HAES because they would lose all control and would wind up desperately unhappy and unhealthy, I still have an ace up my sleeve.

I share the overwhelming evidence that the HAES (R) approach typically leaves people at a weight that is natural for them with a body that is healthier and with a mind that is happier than ever before.

Seems like a safe bet to me.

Love,

The Fat Chick

 

I want to be the chubby mouse with the big fat brain.

Isn’t it interesting how so many people who have never met us are nevertheless quite sure they know exactly what we want? I have been inspired by a number of amazing posts by fellow HAES experts this week that talk about the notion that no matter what the cost, we all want to be thin.

It all started with Ragen Chastain’s amazing post about the notion of having a “fat brain”.  She talks about the various “experts” she’s run into who promise that being fat is simply a state of mind.  These experts tell us that if we just get our mind right, we’ll be thin.  And I have to state, I’ve run into a fair share of folk who have suggested the same thing to me.  I remember sitting through a lecture during one of my fitness certifications where the leaders decided to go off book.  They drew a stick person on the board with a hole in the center.  They said that fat people eat because they have a hole in their lives that they need to fill with food.  They suggested that once these poor fat folks figured out where the “empty spot” was and learned to fill it with something other than food, they would be thin.  I wish I could say that I stood up at that moment and asked the leaders where the “hole” was in my fat body, because I sure couldn’t see it.  I think I was too angry and freaked out to stand up at that moment.  (And in retrospect, maybe asking a fitness instructor to help me find my “hole” wasn’t such a good idea after all.  And in light of the proposed medicalized bulimia apparatus a new “hole” may wind up in the future of quite a few fat folk.)  I seethed the entire weekend and ultimately wrote a scathingly bad review and called the district supervisor.  But the message of these misguided teachers was nevertheless quite clear.  I had a fat body because I had a fat brain.  And nobody wants a fat brain, right?

Except, I kinda do.  Because you know what? Brains are made up of mostly water and fat.  And we can argue on and on about the type of fat that is in our brains.  But no matter how you slice it, a scrawny, skinny brain is not the very best for thinkin’. I like my fat brain.  In fact, I might even want to plump that bad boy up a little.  So score 0 for the folks who felt quite confident they could read my chubby little mind.

On to the next cyberbump on this topic, this time delivered by the always amazing Dr. Deah Schwartz.  It seems she was pretty upset about the last line found in this article discussing how endocrine disruptors have been shown to cause obesity in mice.  The article begins with a picture of two mice–one skinny and one fat and ends with the line, “After all, which mouse would we rather look like?”  Clearly the author believes that no one would rather look like the more rotund rodent.  Just like nobody could possibly want a fat brain.  Except, I’m not so sure.  I think the tubby mouse actually looks a little cuter.  And since this mouse study seems to indicate that mice who are on a diet seem to be depressed all the time, I think I’d prefer to look like the fluffier little fella.

Look. If you wanna be my lover (or friend or collegue), don’t assume you know what I want.  Don’t assume that I am eager to meet your aesthetic standards for the way I look or what I eat or how I hope to be.  If you want to know, ask.  Then I’ll tell you what I want what I really, really want.  The answer just might be something completely different than you originally thought.

Love,

The Fat Chick.

P.S. Tune in to the blog tomorrow for the next episode of my new YouTube show: “Right Now! with Jeanette DePatie (AKA The Fat Chick).  And don’t miss the telesummit I”m doing with Anne Cuthbert tomorrow about setting safe, healthy and happy exercise goals.  And finally don’t forget to add your minutes and miles to the Fit Fatties Across America form.  Help us get all the way to San Jose in time for A Fatty Affair on Saturday!  We’ve got 1,300 miles to go, so enter your time and your miles today!