Tag Archives: diabetes

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:

HbA_1c 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.

Paradoxically(?!) Fatter Diabetics Live Longer

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A few days ago a new study was released which indicates that of people living with type-2 diabetes, those in the overweight category live the longest. They even live longer than those in the “healthy weight” category. Newspaper articles like these (TRIGGER WARNING FOR UBIQUITOUS HEADLESS FATTY SHOT) are quick to cite this as another example of the “obesity paradox”. In case you are unfamiliar with this term, the obesity paradox refers to the fact that despite the fact scientists arbitrarily chose to name a lower weight category “healthy weight” or “normal weight”, the pesky fact remains that those of a higher weight on average live longer. And while people in the “overweight” category are more likely to contract certain diseases than those in the “healthy weight” category (such as cardiovascular disease) they are more likely to survive these diseases for a longer time. It’s vexing. Because, not only does this mess up the whole color scheme of the pretty BMI charts, it also means that we’ve been telling people to slim down to a weight that just might not be in their best interest.

One wonders how long the medical establishment is going to cling to this description of the “obesity paradox”, when the solution is so very simple. Change your labels. Change your definition of “healthy weight”. In fact stop saying “healthy weight” altogether. Because while certain weights have some advantages over others in some arenas, they are more dangerous than others. For example recent research indicates that the fattest people are the least likely to suffer from dementia at an early age.

The medical establishment and world at large are unlikely to change these labels any time soon however. The reason? Cash. Money. Cabbage. Moolah. Being able to charge over and over again for obesity treatments that don’t work is big money. Adding the word “obesity” to your research proposal increases the chances of getting funding and increases the amount of funding you are likely to get. Heck, as Harriet Brown’s excellent article in the Atlantic states–even mentioning the word “obesity” in a medical exam might mean you are able to collect more money for that patient. That’s why we classify obesity as a disease, even when expert panels in the medical establishment recommended against it.

I wonder when we are going to publicly accept the real obesity paradox. That we have a situation that occurs naturally in a certain segment of the population, that in some cases is potentially harmful and in some cases is potentially beneficial. Yet we label it a disease and focus billions of dollars towards trying (unsuccessfully) to change it, without any evidence that changing it will in fact, make people healthier, happier or live longer. That, to me, is the quintessential definition of a paradox.

Love,

Jeanette DePatie (AKA The Fat Chick)

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Fat Chick Rages: Don’t Teach Exercisers to Ignore Body Signals!

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My dear friend Ragen Chastain mentioned on Facebook that she had gone to an enjoyable Zumba class the night before, but was dismayed the next day when she checked out the Zumba studio’s facebook page. Apparently they posted an image stating: “Are You Feeling Dizzy, Sweating, Tired, Breathless? … Good, Great Workout!!!” I’ve posted my modified version below:

Not even going to take a chance this will get reposted without a little alteration on my part…

Okay, so let’s get started on how wrong this is. Not a little bit wrong. Not even a medium amount of wrong. A Carl Sagan, galaxy-filled COSMOS of wrong. This is not inspiring. This is not cool. This is irresponsible and dangerous.

This sign to me represents a culture where we learn to ignore the signals our bodies send as we work out. This is about a culture of masochism, where the more pain and agony you endure during a workout, the closer you bring your body to the edge of absolute destruction during a workout, the better. And as an exercise teacher this makes me absolutely crazy. Because, the messages you receive from your body are the most important line of defense, the most important tool you could possibly use to keep yourself safe as you work out.

I don’t want to scare you. Most people work out safely most of the time. But there ARE risks associated with exercise. If you have an underlying heart condition, you are more likely to face a heart attack while working out than you are in your bed. If you have issues with low blood sugar, they are more likely to surface when you are strenuously exercising. If you are at risk for stroke, this is more likely to be an issue when you are taking an exercise class than when you are reading a book. Again, the vast majority of the time, the vast majority of people exercise safely. But when things do go wrong, they are often preceded by warning signs like excess sweating and severe exhaustion and shortness of breath and dizziness. These are not indicators of a great workout. These are indicators of a problem. Exercisers ignore these symptoms at their own peril.

As a fitness instructor, I remind my students over and over and over again that they must learn to listen to their own bodies. I do everything I can to watch for visible warning signs and symptoms among my students. But the first and most important line of defense is for them to recognize warning signs in themselves. They will probably feel dizzy long before I sense that they look dizzy. Therefore, it’s my job to create an environment where they feel safe caring for themselves. Every time a new person comes to my class we have a ritual. I ask my long standing students to help me. I shout out, “What happens if you get the choreography wrong?” My students reply, “Nothing! It doesn’t matter!” I shout out, “What if it hurts when I do this?” They answer, “Stop doing it!” I ask, “Who’s class is this?” My students answer, “MY Class!”

I then remind the students that it is okay for them to modify any move that isn’t working for them and to ask for help if they need it. I give them a “safety move” like gently marching in place they should feel free to do when they get stuck. And I remind them that they can feel free to use any of the sturdy chairs located throughout the room to do a movement or even just rest in a chair whenever they feel they need to. I work VERY hard to create an exercise space where my students feel emotionally safe doing whatever they need to do to take care of themselves.

Although creating this emotionally safe space helps my students feel good about themselves, I don’t do it for that reason alone. I do it to keep them physically safe as well. A class culture based on “no pain no gain”, where students are discouraged to tough it out and not take care of themselves is risky and can be downright dangerous. Teaching students to ignore the messages their bodies are sending is the absolute LAST thing we should do.

I want students in my class to look different from one another. A class where students are modifying moves and resting from time to time and approaching the movement in different ways is good and healthy. It means the class is challenging enough for the more advanced students to get something out of it while being a safe place for less advanced students to increase strength, stamina and agility–gently and gradually. It means everybody is working at their own pace and having a good time. Which is as it should be. When students come to me and tell me that they are in pain, that is a signal for me to make some changes to my class. How can I teach that move differently? How can I make sure everybody is working at their own pace? How can I remind the students about body alignment and positioning to make them less likely to get hurt? How can I make my class better?

As I have stated before, this is why it is often best to just watch the first time you encounter a new class. Don’t wait until after you are in the middle of a testosterone-fueled judgement festival to determine that a class might not be for you. Don’t put yourself in a situation where you might let embarrassment push you into hurting yourself–perhaps permanently. Watch and learn. If your gut tells you that this is a judgement zone that is not emotionally safe–then walk away. If the class isn’t emotionally safe for you, it’s not safe. Period.

We tell people that exercise should hurt and feel awful. We tell them that listening to their own bodies is wrong and that they should push it until they puke. We tell them that getting injured is a sign of their own weakness and that real exercisers don’t let sprains or stress fractures stop them. THEN we wonder why half the world doesn’t exercise.

Fugeddabout it!

Find a way that your body loves to move and do that. When it stops feeling good, and it starts to hurt, then stop. Forever and ever, Amen.

Love,

Jeanette DePatie (AKA The Fat Chick)

Six Year Old Girl Dies–Diagnosed as Fat?

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Sorry to start your week out with such a sad story, but I think it needs to be told. Late last week I became aware of the story of Claudialee, a six-year-old girl who passed away after being misdiagnosed with type 2 diabetes, when she actually had type 1 diabetes. There is a very detailed account of the story here.

I’m not going to go into every detail of this story, but I did want to point out a few things that stand out for me. One is that Claudialee has a family history of diabetes. Another is that the doctor diagnosed Claudialee as obese. It is clear that the doctor was deeply concerned about the young child’s weight–prescribing diet and exercise in an effort to get her to lose weight. It is also clear that the mother closely followed the doctor’s recommendations–carefully monitoring what Claudialee ate and making sure she got plenty of exercise.

What is not clear is why the doctor felt so strongly that this child had Type 2 Diabetes as opposed to Type 1. According to a source cited in the article (The National Institute of Health) at that age group, Type 1 Diabetes has an incidence of about 20 in every 100,000 kids, whereas Type 2 Diabetes has an incidence of .4 in every 100,000 kids or 1 in every 250,000 kids. What’s more, at that age, Type 1 Diabetes is a far more urgent problem than Type 2 Diabetes. So what led to the doctor’s misdiagnosis?

We may never know for sure. But it does invite one to speculate whether the child’s weight was a factor. Clearly, getting Claudialee’s weight down was a prime part of the prescription to the parent. And as the child’s weight went down, the doctor neglected to do some of the critical follow-up blood tests that would have indicated that something was drastically wrong.

The article states:

Because Mercado [the doctor] had locked in on type 2, she did not monitor her patient’s blood. She did not tell Irma [the child’s mother] to purchase a $20 blood sugar meter from the drugstore. She did not ask Irma about the frequency with which her daughter drank and urinated. And neither she nor Cabatic [another doctor] described to Irma the danger signs to look out for.

When asked in court, why the doctor seemed so certain that the child had type 2 diabetes when type 1 diabetes was so much more prevalent among children that age, she stood by her original diagnosis:

“How many type 2 infant diabetics have you treated?” a lawyer asked her.

“A lot,” she replied. “Maybe it’s geographical, because I work at Brooklyn as an assistant professor and also in wellness program where there are a lot of obese children, so we diagnose a lot of children with type 2 diabetes.”

Clearly there may have been other issues at play here. Claudialee was on Medicaid and doctors are paid significantly less for treating patients on Medicaid than they are for those with private insurance. The doctor was not board-certified, and the article points out that finding board certified physicians willing to work in clinics that take Medicaid can be difficult. And this is a single case where a single doctor has been convicted of malpractice. We will never know exactly what was in the doctor’s mind.

I but I personally found myself wondering if this doctor had ever previously considered that she may have a bias against fat patients–and maybe even fat children with low SES in particular. I wonder, had this doctor considered the potential for her own bias in this arena, would that child still be alive? Would Claudialee still be running around and playing today?

We certainly have plenty of evidence for a seeming “hysteria” around the issue of childhood Type 2 diabetes. A simple google search of “childhood diabetes epidemic” yields hundreds and hundreds of articles. This hysteria has spawned a number of shaming techniques aimed at children despite the fact that shame has been proven over and over again to be ineffective at treating obesity at any age, that shame is more likely to make kids engage in unhealthy behaviors, and that eating disorders are much, MUCH more prevalent among children than diabetes of any kind.

All I know for sure, is that stories like that of Claudialee get me even more fired up to fight against weight stigma in medicine. And that passion leads me to come to you with a plea. The Association for Size Diversity And Health and the Size Diversity Task force have embarked on a documentary film project to help doctors see and understand weight stigma and weight bias in medicine. This project is called the Resolved project. But this project needs a little bit of help from you. We are raising funds to finish the documentary on Go Fund Me here. Any help you can offer would be greatly appreciated. Even if you can only give a few dollars, that will help. And if you don’t have a few dollars to spend, would you consider sharing this with your friends and asking them to help? Let’s see if we can end weight stigma and weight bias in the healthcare industry for good. And maybe, just maybe we won’t have stories like Claudialee’s any more.

Love,

Jeanette (The Fat Chick)

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When doctors are wrong.

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I recently watched this video–a TED talk–by Dr. Peter Attia. You may have seen it as it’s become quite a viral sensation over the last few weeks. But even if you have seen it, you might find it useful to watch again. So here it is:

While I don’t agree with absolutely everything Dr. Attia has to say, I do think he brings up a few important points. One issue is that some doctors, scientists, and other medical professionals are really starting to question the causal nature of the link between obesity and diabetes. I think this is an important area that will require a lot more study. And I think it is our job to continue to push for this continued study.

But one issue that I want to particularly want to highlight here is how hard it seems to be for doctors to admit they are wrong. Dr. Attia is clearly deeply moved. He feels a tremendous sense of remorse for how he treated that poor woman with diabetes. Once he realized the level to which he had allowed stigma to affect his treatment of this woman he was devastated.

Many of us would be quick to state, well he should be. He may have deeply hurt this woman. He may not have given her the best medical care. Many of us don’t go to the doctor because we are so afraid of being hurt just this way at the doctor’s office or the hospital. Some of us have died because of this.

To which I would respond, “Yes, that’s true.”

But I think it’s also important to see what this video has to teach us about doctors and what it might be like for them to understand that they were wrong about something. We look to doctors to fix everything. We ask them to make us well and to bring us back from the brink of death. It takes a certain amount of arrogance to hold a person’s beating heart in your hand and endeavor to fix it. And I imagine there is a certain amount of pain when you have to tell somebody or tell their family that you can’t fix it. You can’t make it all better. You are not god. And I’m not sure that the pain ever goes away.

Please understand. I am not making excuses for doctors who bully and stigmatize fat people. It is wrong, and it needs to stop. Now. That is why I am working so closely with the Size Diversity Task Force and the Association for Size Diversity And Health on the Resolved project. We need to share our stories. We need doctors and the public to understand that weight stigma is extremely damaging to fat people in medical settings and is sometimes even fatal. There was a period of years in my life when I was quite sick and might have died based on the assumptions that doctors had made about me. So I get it. This must change.

But I think, if we want our work to be effective, if we want things to change, we need to be perceptive and understand what it means to help doctors understand that they are wrong about this. We need to understand this–not so we can let them off the hook–not so we can let them down easy– so we can find the best path towards an actual solution, so we can understand why many doctors are so resistant, and so we can better understand why this is taking so long.

The issue of weight stigma in medicine is complex and nuanced. But I do know one thing. It will only change if a lot of us continue to work together to bring about change. I would love to hear your thoughts about this issue. And I would love to have your continued support to make the Resolved project a success! Click here for more information about how you can participate.

Love,

The Fat Chick

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Dealing with Diabetes: Episode 004 of the Right Now Show with Jeanette DePatie (AKA The Fat Chick)

Daylight Savings Time: Here Comes the Sun

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Today is the second day of daylight savings time here in Southern California and since I’m typically an early riser, I’m enjoying the little extra jolt of sunshine in my day. I love the sunshine and since I live in So Cal, I get access to way more of it than most.

Many of us have come to fear sunshine because of it’s association with an increased risk for skin cancer. But if you manage your exposure, you can enjoy the health benefits of sunshine without a lot of risk. Some researchers recommend daily sun exposure for about half the time it would normally take you to get a sunburn. Others recommend that you spend 15 minutes in the sun each day without sunblock or sunglasses (the sun’s rays come through they eyes to stimulate the pituitary gland and helps control hormone production in other glands). A good way to get this 15 minutes is to combine it with little bits of exercise throughout the day like parking your car a little further from your destination, going for 10 minute walk breaks throughout the day or walking a few blocks to a lunch destination.

There are lots and lots of health benefits to sunshine. Here are just a few:

Promotes Better Sleep: Daily access to sunshine helps to regulate your circadian cycles. This makes it easier for you to fall and stay asleep.

Reduces Cancer Risk: The Vitamin D you get from sunshine has been shown to reduce risks of colon, breast, prostate and rectal cancers. And higher Vitamin D levels in the bloodstream seem to increase your likelihood of surviving a cancer diagnosis.

Lowers Cholesterol Levels: Cholesterol that lies under the skin is turned into Vitamin D3 which both increases the level of this important vitamin in your body and can significantly lower cholesterol levels.

Strengthens Immune System: Sun exposure increases production of red and white blood cells which tends to strengthen the immune system. Studies also show that Vitamin D may help activate T-cells which are the body’s first line of defense against pathogens.

Reduces Risks of Osteoporosis: Sunshine is one of the most potent sources of Vitamin D. Higher levels of Vitamin D have been shown to help increase absorption of calcium from the intestines and increase bone density in post-menopausal women.

Reduces Risk of Type 2 Diabetes: Increased levels of Vitamin D in the system also appear to be associated with lower incidence of type 2 Diabetes. Although it is not clear which sources of Vitamin D are most beneficial in reducing Diabetes risk, there is a link that bears further investigation.

Improves Mood: We’ve all heard of SAD (Seasonal Affective Disorder), but beyond that, sun has the power to make us feel better, make us less depressed and may even help us to think more clearly.

There are many other potential benefits to sunshine from increasing optimism, to improving milk production in lactating women to a link to lower risk of stroke, neuro-degenerative diseases, allergies, multiple sclerosis, hypertension and psoriasis.

So my dear friends, get on out there and feel the sun on your face–at least for a little while. But don’t stay out there too long. As I often say, you don’t need to feel the burn to get the benefit.

Love,

The Fat Chick

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