Tag Archives: socioeconomic status

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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The Health Continuum

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The day before I woke up in excruciating back pain, I gave a keynote address at a health conference.  And during that keynote I talked a lot about how we need to make the ideas of health and wellness more inclusive.  We need to have a bigger tent where every BODY can participate.  We need to imagine a spectrum where we can all experience health.

I asked people in the audience to close their eyes and envision health.  What does a healthy person look like?  Then I asked them, if by any chance, their vision of health looked like a skinny white woman eating yogurt?  How about salad?  Does she look like she’s feeling orgasmic over these food choices?  Several people in the audience smiled or laughed.  Yup, that was exactly what their vision of health looked like.  But I told them they shouldn’t be surprised.  As a culture we are taught by marketing and advertising and Photoshop that this is what health looks like.  But what happens, I asked, if you are not white, or a man, or not thin, or not conventionally beautiful? What if you really, really hate yogurt?  Do you not get to be well?  Do you not get to experience health?

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At this point, I took some time to define health and wellness.  I suggested that there is no particular state that a person achieves that call be called healthy or well.  While tons of money is spent convincing us that if we just buy this thing, use this product or service or spend money in a particular way, we will arrive at the ultimate hereafter picture.  There is a place that is nirvana.  We call this place perfectly healthy.  Except there is no such place.  If we are alive, we are aging.  If we are aging we are headed towards our ultimate demise.  No matter what product or service we use, we are still, in the end, mortal.

So I went on to describe health as a continuum.  Or you can call it a spectrum.  (I like continuum because it’s one of the only words in the English language that has to letter “u”s back to back, and like the word banana, it’s nearly impossible to stop saying once you have started.  You know, like continuuinuuum…)  A continuum is a scale.  It is a line with no beginning and no end.  The scale increases in a particular value as we go one direction and decreases in a particular value as we go the other direction.  As we move along the scale towards healthy or well, we get more capacity and energy to do the things we need to do as well as the things we enjoy.  We feel better.  We have more energy.  We sleep better.  We are able to relax sometimes and experience peace.  As we move down the continuum away from health and wellness these things (like energy, enjoyment, peace, sleep) are more difficult for us to access, or we experience them less often.  But again, the line has no beginning and no end.  There is no destination called perfect health where we get to arrive.  And there is also no perfect place which we cannot access.

This is important for a lot of reasons.  One reason is that we are all born at different points on the continuum.  Based on genetics and parenting and socioeconomic status and friends and other family and cultural values and lots and lots of other stuff, we all land at different points on this continuum.  And as we go along and live, circumstances will change our location on the continuum.  We will experience stress.  We will get sick.  We might win the lottery.  We might lose our jobs.  We might get married or be in a car crash or fall down the steps.  Stuff happens.  Sometimes that stuff is wonderful and eases the way towards increased health on the spectrum.  Sometimes stuff is downright catastrophic and vaults us towards decreased health on the spectrum.  Were we to look at health and wellness as a state of being or as a location, most of us just wouldn’t be able to get there, let alone stay there.  Most of us would be on the outside looking in.  And most of us have been taught that we should be consumed with guilt and self-loathing for not being there or staying there.  But if we look at health and wellness as a continuum, there is a sane and guilt-free place for everybody.

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No matter where you land on the continuum, there are things you can do to help ease the way towards better health.  Those things you can do might be wildly different from what somebody else can do.  You might be creeping along towards health at a very different point on the spectrum than somebody else.  But everybody can play.  And we can play with the knowledge and understanding that sometimes fate rolls the freakin’ dice and we land in a different spot on the continuum that we neither desired nor planned for.  But from every place, we can strive.  We can move towards the healthy/well side of the continuum with whatever resources we have at the moment.  This is with the understanding that sometimes those resources will be very low.  Sometimes the movement will be very slow or even imperceptible.  And sometimes, it’s okay to just rest there at our spot on the continuum until we have the resources and/or the desire to strive again.  Sometimes we can be there and just breathe out and in for a while.

You know it’s funny, in a physician heal thyself sort of way, how I gave this talk the day before I found myself tossed violently to a very different spot on my own continuum.  As I woke up, dazed and in pain, I looked around.  Oh, so I’m here now?  This is my spot on the spectrum today?  Okay.  I’ll just have to see what I can do.  Maybe tomorrow.  After I take a pain killer and watch some telly and gather my forces.  It has made all of this a lot easier to bear.  And I offer this in the hopes that it will be a useful visualization tool for you as well.  Or not.  Because we’re all different.  And just as there is no place called health, there is no single immutable path towards wellness either.  There’s just all of us, muddling along in our own way, as best we can.

Love,

Jeanette DePatie AKA The Fat Chick

P.S. Want to book me to speak to YOUR group about the wellness continuum?  Click HERE!

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What are the odds?

Hey there!  Sorry I haven’t blogged in a few days.  I’ve been on the roller coaster and hanging on for dear life.  Seems like that’s the way of it, doesn’t it?  First you’re on top of the world, and then BOOM, sick in bed with a terrible, nasty, icky head cold.

It’s not like I haven’t taken prophylactic measures.  I’ve been taking lots of vitamin C, drinking lots of water, washing my hands raw and all of that good stuff.  I’ve been doing my very best to get good sleep and trying my best to manage stress.

Ever since I felt a sniffle, I’ve been rubbing menthol on my feet and sucking a zinc lozenge every few hours and drinking massive quantities of tea.

I’m doing everything that statistics suggest I should to prevent and minimize colds.  So why am I still sick?

I got sick because I got sick. No matter how many steps you take, you can stick get sick at any time.  Does that mean I shouldn’t have taken those steps to try to minimize my risk and minimize my symptoms?  Well no.  The steps didn’t have many potentially negative side effects and weren’t too difficult.  And they might have worked.  And who knows, things might have been worse had I not taken those steps.

But this is the thing about statistics and health.  If there’s a 1% chance of getting sick, that means that out of every 100 people, about 1 will get sick.  And no matter how many remedies you try, no matter how strong your immune system may be, that one person might be you.  And as tempting as it might be to believe you didn’t get sick because of the mouthwash you used, or the special ritual you followed, you might not have gotten sick because of dumb luck.

So as much as we may wish to believe that we are “healthy” because we are virtuous people who eat whole grain cereal and do yoga, I think we need to give at least a passing nod to all the other stuff that goes into it.  As Fall Ferguson writes in her post on the ASDAH blog: there are many, many factors that go into whether or not a person is healthy.  Doing healthy stuff is just one of those things.  So where does this leave us?

We may wish to do stuff that increases our odds of being healthy.  How much stuff we are able to do may well be decided by our socioeconomic status or access to good healthcare.  How effective those healthy behaviors are may well be decided by our genetic makeup.  How much stuff we choose to do is up to each and every one of us.  It’s time we give up the notion that being healthy is “virtuous” and being sick is a sign that we are “weak, lazy, undisciplined or unconcerned”.  Sometimes we just got sneezed on by the wrong person at the wrong time.  There are no guarantees.

So even though I feel tired, and cranky and stuffed up and sneezy and sick, I choose not to bother feeling guilty.

Love,

The Fat Chick

P.S. Still waiting to hear when our Katie Couric episode will air.  Will keep you posted!  oxoxoxoxox