Tag Archives: type 2

Paradoxically(?!) Fatter Diabetics Live Longer

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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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.