Tag Archives: quality of life

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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Functional Fitness Means LOTS More Painting

I get asked a lot about functional fitness.  What does it mean?  How does it impact Quality of Life?  What is Quality of Life?  To me, Quality of Life, means the ability and energy you have available to do the things you love to do with the people you love.  Quality of life is not guaranteed.  It is not a status that you unlock or a level you achieve.  Quality of Life like “health” is a continuum. It fluctuates from day to day.  And each of us has a different default level from which we fluctuate.  Many things impact our quality of life including genetics, family, socioeconomic status, age, gender and fitness level and social network.  And only some of our quality of life is under our control.  We can, if we wish, work to improve the things over which we have some control. Fitness level is one of those things.  And functional fitness is the process of using exercise to increase our abilities to do things in our everyday lives.

LiftBoard

This has come home to me in a very personal way as we engage in the “eternal, internal, house painting project”.  I am not kidding you.  This has taken a week longer than forever.  There are days when I never want to look at a texture gun or a roller or a paintbrush EVER AGAIN.  However, I can state in no uncertain terms, that this bloody, everlasting, wall pigmentation project would have never even gotten off the ground if I hadn’t worked over the years on my functional fitness.  I primarily teach dance classes, but I do some yoga and resistance training and walking/running as well.  And all of this has helped prepare me for the rigors of home remodeling.  Whether it’s lifting one end of a 14-foot-long 2×12 board or rolling paint on to a ceiling or climbing a ladder or performing the equivalent of 100 squats in a two hour period in the course of spraying texture on the wall (using the power tool that my husband and I have affectionately dubbed the “poo flinger”) my more traditional fitness program has made this possible.  I’ve increased my aerobic endurance, upper body strength,  flexibility, balance and sheer bloody-mindedness so that I can do this painting stuff with my hubby for approximately eleventy billion hours per day.  I even have the strength (in theory) to bludgeon him to death with a HVLP sprayer.

PainterDown

Which makes me wonder, “Is this a good thing?”  Why don’t we just hire somebody to do this?  Hey, HUSBAND!  Why don’t we just HIRE SOMEBODY TO DO THIS?  I guess the main reason is that my husband really loves to do this kind of thing, and he wants us to do it together.   And even if I don’t love painting quite as much as he does, I do love him.  And I am deeply grateful that I currently have the strength to do that.

Does that mean everybody has to exercise this way?  Does that mean everybody is even capable of getting to the point they can exercise this way?  Of course not!  Everybody is in a different place on their fitness continuum and everybody has different priorities for how they fit exercise into their lives.  There is no moral imperative to work out or to ever wield a painting implement.  But I will say that exercise helps move you towards a point on the Quality of Life continuum which may give you more energy and more choices about how to spend that energy.  And that my friends is why I exercise.  Oh, and of course, because it’s fun.  Well except maybe the painting part.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. ‘m SUPER excited to announce that after months of planning, Courtney Marshall, Candice Casas, Ragen Chastain and I are launching the call for proposals for a new anthology about fat people in the fitness/exercise/athletics/dance world. We plan to include first person stories, interviews, academic pieces, poetry, and art. You can get all the information (including about how to submit a proposal) at www.fatfitnessanthology.com Let me know if you have any questions, deadline for proposals is July 15!

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.

Your Big Fat ASSumptions: The Right Now Show Episode 014

donkeys-who-assume

Today’s episode of the Right Now Show shares two things that you may safely assume when looking at a fat person.  We also discuss five Big Fat ASSumptions that we routinely make about people of size and whether or not those assumptions have any validity.  Enjoy watching, and don’t forget to share with all your friends:

Here’s some additional information and resources you may want to consult after watching the show:

Want to join a whole lot of other people enjoying exercise in an environment which is free of fat shaming at weight loss talk?  Check out the Fit Fatties Forum!

Want to stay up to date on the very latest info about fat and health?  Join the Fat Chick Clique.  It’s free!

Here’s a link to a lot of the most recent research about Fat and Health on my website.

Here’s some more information about fat and shame on my blog:

Here’s a comprehensive review about fat and health which reviews over 100 other major studies about fitness, fatness and health:

Here’s some information offered by the Association for Size Diversity And Health about Health At Every Size (R):

P.S. Like my posts?  You’ll love my stuff!

Buy my book: The Fat Chick Works Out! (Fitness that is Fun and Feasible for Folks of All Ages, Shapes Sizes and Abilities)–available in softcover and e-book versions

Buy my DVD: The Fat Chick Works Out! (A Safe, Easy and Fun Workout for Klutzes, Wimps and Absolute Beginners!)

Buy a book or a DVD for a friend and save $5!  Just enter FRIENDBLFT in the discount code box!

Check out my Training Programs–both in person and via Skype (Starting at just $25!)

or

Book me to speak at your special event!

Women’s Wednesday: Exercise as Medicine for Perimenopause

The Fat Chick leads a group of laughing and dancing menopausal and perimenopausal women in a Hot Flash Mob in Manhattan.

Are you perimenopausal?  Many of us have come to think of menopause as something that happens to “older women”.  Many of us don’t believe that we are old enough to be experiencing perimenopausal symptoms.  But denial ain’t just a river in Egypt, ladies.  As my Mom once told me, “I had been talking about ‘those old ladies’ as if it was a group that didn’t include me.  I had kind of a rough day when I realized I needed to start saying ‘we old ladies’!”  But denial aside, this condition can begin long before the moniker of old lady could reasonably apply.  Perimenopause is the segment in your life between when your periods start to change and up to a year after they have ended completely.  This process typically begins in your 40s, but may begin in your thirties.  It typically lasts five to fifteen years.  Some women have significant symptoms and some women have no symptoms at all.

Some typical symptoms of perimenopause include:

  • Vasomotor symptoms like hot flashes, night sweats and simply sweating more.
  • Psychosocial symptoms like anxiety, impatience, poor memory and depression.
  • And physical symptoms like body aches, fatigue, and insomnia.

There is a lot of debate about treatment for menopausal and perimenopausal symptoms.  While some doctors suggest hormone replacement therapy (HRT), there may be significant risks associated with that approach.  Some studies indicate that HRT is effective for treating the vasomotor symptoms like hot flashes and night sweats. However, other studies indicate that HRT may increase risk for breast cancer and cardiovascular disease.  And HRT hasn’t proved very effective at coping with psychosocial or physical symptoms like body aches, fatigue, weight gain or insomnia.

But do not despair.  There is significant and growing evidence that regular, moderate exercise can be extremely effective in improving Quality of Life (QOL) and relieving perimenopausal and menopausal symptoms.  Regular fitness activities have been show to increase brain function and offer relief from depression and anxiety.  Exercise can improve overall mood even 24 hours after the original exercise session.  A recent study indicates that women who engaged in moderate physical activity had significantly reduced hot flashes, sweating, weight gain, bloating and issues with intimacy.

Menopause and perimenopause can be a difficult time in a woman’s life, but it doesn’t have to be.  This time can also be a time of great creativity, strength and power.  And, as the women who have participated in The Hot Flash Mob Movement (created with partner Dr. Eve Agee) have learned, it can also be a lot of fun.  And whether you are pre-menopausal, perimenopausal, menopausal or post-menopausal, exercise is a safe, effective, inexpensive and fun way to have a better quality of life.  So ladies, why not gather up some girlfriends, lace up your sneakers and get to it!  You’ll be so glad you did!
Love,

The Fat Chick