Question: What do these phrases have in common?
- eating too much salt gives you high blood pressure
- most obese people get diabetes
- eating sugar makes you sick
- all obese people will eventually get sick
Answer: They are all untrue.
Some are exaggeration:
Large-scale scientific reviews have found that people with normal blood pressure have no medical reason to reduce their salt intake. Some (but not all) people with high blood pressure are “salt sensitive”. For those people lowering sodium intake could help, but they could also choose to eat more potassium since it’s actually the balance of those minerals that is the important thing.
In the pursuit of health well-meaning (and not so well-meaning) people can have a tendency to exaggerate, speak in generalities and repeat things without verifying them for themselves.
These things get repeated so many times that they become myths – the media writes about it (because “Salt Shown to Cause Hypertention” is a much sexier headline then “In some people with hypertension decreasing salt or increasing potassium may help”) then people can say “I read in a magazine…”. Doctors exaggerate to scare patients or repeat myths because they don’t know any better and then patients go out and tell people that their doctor told them… The diet industry will say almost anything to get us to buy their products and they’ll repeat it millions of times. Next thing you know some jackass is telling me how my diabetes is going to cost them their tax dollars and even if they are open to a teachable moment I have to overcome a mountain of misinformation.
People say that being obese is harmful to society but I really think that the real harm is coming from the confusion of correlation and causation, the pursuit of public thinness instead of public health, massive misinformation campaigns by the diet industry, and myths spouted by people who don’t know any better – and some who don’t want to know any better.
Access is a major part of health. That includes access to a wide variety of foods, access to safe movement options that you enjoy, and perhaps most importantly, access to true and correct information about our health. Unfortunately the last piece can be the most difficult, so I think that it pays to questions “everybody knows” statements, do research and make our own decisions.
Dances With Fat 
“If “everybody knows” such-and-such, then it ain’t so, by at least ten thousand to one.”
One of Lazarus Long’s aphorisms, written by Robert A. Heinlein quite a few decades ago now. Still true, if not more so than ever.
Excellent post, Regan, very true. I spend a fair part of my time trying to educate people around me & especially to explain to one absolute tv addict in my life that just because you see it on tv doesn’t mean that it is true, & that much of the ‘health information’ we are fed is actually health MIS-information, intentionally employed to sell products. This person is fat himself & 68 years old; he has a plump mother who has spent several years out of her life on & off Weight Watchers & who herself believes all the popular wisdom, but her body has, fortunately for her, refused to become fashionably thin, & she still lives independently at age 89. Years ago, well-known fat-hater Michael Fumento flatly stated that you never see fat people over 50 years old. Well, as I told my husband, you can plainly see that is not true, so try to remember that most everything else ‘everybody knows’ about fat is also not true.
I personally make a point of trying not to hear what is said on tv, which can be difficult with a hearing-impaired person constantly watching it in the next room. I also try hard to ignore the ‘obesity is killing us & costing us billions’ propaganda on the Net. It is a constant fight to survive in this culture as a fat person, more of a fight than surviving as a disabled person.
Hell yes to this. TV news is the worst place to get health info. There is no context or critical evaluation of reported studies and they create their news stories based on press releases from the researchers, which may give a very false impression of results which are not actually indicated by the study’s data(and of course says nothing about the quality of the study’s methodology). It’s all about attention-grabbing headlines. I roll my eyes when reporters talk about medical science on the news. Any time you see a medical news story that you think could affect you, you should research it yourself so you can get the real picture.
You’re right on about this–I spent a decent chunk of my career as a health and science reporter, and it’s very rare that television or popular magazines do any fact checking at all on what they report about health and science, or have someone with any science background actually do the reporting.
Also, I was taught in graduate school that 50%–an INSANE, WHOPPING 50%–of all television news is created by corporations as unpaid advertisements for their products. I’ve seen many, many of these pieces in classes and on TV since–you see a COMPLETELY believable reporter doing the most typical news story you can imagine, say, something about a new finding on the health benefits of vitamin C, and as the reporter is talking about it, you see images of store shelves with some particular brand of orange juice or vitamins, or whatever flashing past in the background. Guess who produced that clip from start to finish, including hiring an actor to pretend she’s a reporter? The company that makes OJ or vitamins or whatever. TV stations eat that stuff up because they can’t afford to produce half of the stuff they show, and it finances their other programming while giving them footage that LOOKS top-notch. These corporations even include B-rolls–short clips of partially edited footage–so that the stations can remix the commercials and cut in footage of their own reporters to make it look more real. 50%.
I just discovered your blog about a week ago, after reading your name on an e-flyer about an event in Austin. I have to say, you’re blowing my mind a little bit. I’m a 43-year-old woman who has struggled with my weight since I was 10 years old. As a mother, I look back at photos of me at that time and think “WHAT?!” Although I was receiving near constant messages from my mother about my weight, I was completely normal. In highschool I may have actually been a bit underweight, but I started to put on real weight after college. Over the past 20 years I’ve yo-yo’d between slightly overweight to “obese” dieting and exercising like a maniac to achieve my “goal weight” exactly twice (for about one week each time) during those years. I’m currently about 5 pounds under my historical “high weight” and I’m almost incapacitated by my intense feelings of failure and worthlessness, even though I’m “successful” in every other aspect of my life. I have a good marriage, wonderful healthy children, a comfortable, happy home, a job that I’m very good at (and like most of the time) and a circle of beloved friends.
Your words speak to me on a very deep level. I hear what you are saying and I believe it–as it relates to everyone but me. When it comes to myself, I’m caught in a weird place that says “Wait! If I accept and appreciate my body as it is, I’m just justifying my own failure” or “How is this different from making excuses. If I really WANTED to be thinner, I could be. I have been before. The reason I’m fat is that I’m lazy and I eat too much.”
I’ve also caught myself thinking, “If I could just love and appreciate my body, I’d get over whatever is causing me to sabotage it and I’d finally be in control and lose the weight.”
Sigh. See? I’m a mess. Your message has jogged my consciousness, but what’s there is pretty deeply entrenched!
How did you get to such a healthy and positive place?
Hi Robyncz,
I completely understand what you are saying. I used to have a lot of days when I really struggled. I still have them every once in a while. From my experience finding peace with your body is a process and the best thing that you can do for yourself is be kind and patient while you’re going through it. I might suggest that you focus on getting to a place where you accept and appreciate your body and don’t worry about guessing what will happen when you get there, but that’s just my 2 cents and you can take it or leave it! If there is anything that I can do to support you just let me know.
Hugs!
~Ragen
This is why wording and delivery of phrases like that are everything.
A few years back when my blood pressure was elevated, cutting down on alcohol helped lower it more than anything else. You don’t however, see much in the media about alcohol raising your blood pressure. In truth, alcohol, sodium, stress, and perhaps other factors we don’t know about will probably raise it in different people, and you can’t make blanket judgements. As for almost everything about health.
Here’s more ammunition to lend support to your messages above: http://dropitandeat.blogspot.com/2011/04/lies-theyre-feeding-you-about-your.html
One point to nuance, however. Type 2 diabetes, is strongly correlated with weight; being at a higher weight outside of the normal range increases the likelihood of getting type 2 diabetes. Will some thin individuals also get it? Sure. But way fewer (they are more typically the Type 1s, which has a very different etiology). Similarly, losing weight alone may improve blood sugar control–or it may not. Most MDs haven’t figured that out yet. But there is no question that both obesity and a sedentary lifestyle increase the likelihood of developing Type 2 diabetes, with a greater chance if you have a genetic tendency.
Lori Lieberman, RD, CDE, MPH, LDN
or …. type 2 diabetes causes obesity.
Type 2 diabetes, is strongly correlated with weight; being at a higher weight outside of the normal range increases the likelihood of getting type 2 diabetes.
Where are you getting your information about obesity causing an increased risk? Correlation alone could mean obesity increases the chance of developing diabetes, diabetes increases the chance of developing obesity, or some third factor can cause both obesity and diabetes.
That may be true. But losing weight in those with insulin resistance or PCOS (aka metabolic syndrome), often the precursor to diabetes, often improves the condition (the hyperinsulinemia and development / progression to Type 2 DM. I agree that it is certainly not one single variable that impacts the development of DM. But the correlation is quite strong. If improving weight fails to normalize sugars, than other interventions are essential. I certainly don’t advocate weight change as the only variable in those who are overweight. Increased physical activity (regardless of the person’s weight),and dietary modification are critical.
My question would still be whether weight loss is beneficial in and of itself or whether it’s nutritional and exercise changes that both protect against diabetes and (for some) cause weight loss.
The distinction is really critical because if you make weight the end goal and a patient can’t lose weight by exercising reasonably and eating well, they’re likely to feel the need to severely restrict calories or overexercise to the point of exhaustion or injury (or to not exercise at all because they can only function on 1200 calories if they don’t exercise). But if healthy eating and exercise are the end goals, people are more likely to stick with them regardless of weight loss, and to avoid dangerous weight loss behaviors.
My other question is, since 95% of people who try to lose weight long-term fail, why that’s considered the first and best option.
Diabetes is probably a function of the same thing that keeps us alive during famine going a little haywire. Starvation actually improves diabetes (that’s why WLS patients do better right after the surgery — most of them are starving). However, since starvation leads to a myriad of health problems on it’s own (you know, like DEATH), we need to find a way for those with diabetes to be able to eat. Most diabetics find that by eating intuitively and exercising, their blood sugar will stay pretty well under control. A good bit of research suggests that weight gain is actually a symptom of diabetes, not a cause (though the medical establishment tries to convince us otherwise).
Lori,
There is absolutely question that obesity increases the likelihood of developing Type 2 diabetes. Balding is strongly correlated to heart disease but growing hair won’t prevent heart disease and shaving your head won’t “increase the likelihood” of it because they are both caused by a third factor and they have no causal relationship with each other. Obesity is correlated with diabetes (although statistically 75 or more percent of obese people will not get T2D and the correlation has only shown to be present in societies that stigmatize the obese) but saying that obesity increases the likelihood of getting diabetes is completely inaccurate as that would require a causal relationship to be proven. Correlation never ever proves causation – that is the first rule of research. It is also very unlikely that making your body smaller (aka weight loss) is what actually changes blood sugar control since a massive loss of muscle would also create weight loss but would not be likely to increase blood sugar control. It’s much more likely that healthy behaviors lead to better blood sugar control and that another possible (although statistically most likely temporary) side effect of those behaviors is weight loss.
As to the number of thin people versus fat people who get diabetes there are several issues – the first is that thin people and fat people have very different societal experiences in our culture – since the obesity correlation only holds up in societies where there is obesity stigma, and since stress (like that caused by stigmatization) is also strongly correlated with diabetes, there is obviously more research to be done here. Further, they don’t test thin people for T2D nearly as early or as often as obese people are tested. If you test one group earlier and more often for a health issue you would expect to find more members of that group who had been diagnosed with the issue. It’s made worse by this type of confusion about correlation and causation. Case in point: I don’t have blood sugar issues but I’ve had doctors try to diagnose me without a test and put me on meds.
Further, not a single weight loss intervention has been proven to help the majority of participants lose weight over the long term (and that’s losing any weight, let alone proving that the intervention gets a majority of people into a “normal” BMI range for the long term). We are, however, very aware of the dangers of the weight cycling that is the most likely outcome of weight loss attempts.
So telling people that you know that being obese is increasing their likelihood of getting T2D is not accurate based on the evidence. And prescribing weight loss to help prevent or cure T2D is telling them to do something that nobody can prove is possible for a reason that nobody can prove is valid and I think that’s an ethically questionable thing for a health care provider to do.
~Ragen
Yeah, people seem to forget that no one loses weight spontaneously. You don’t just decide, “now I will lose weight,” and have it come off on its own. You have to change your diet and or exercise patterns. So why assume that it’s the weight loss that improves diabetes, and not the behavior changes? Otherwise, we could just get a prescription for liposuction and get all those wonderful health benefits of fat loss.:P
The two things that jump out at me are “Wow! That really strongly suggests that it has more to do with stigma and stress than weight” and “Wait, there are societies that *don’t* stigmatize the obese?”
Just pulled a few quick references to highlight the points. And btw, while association doesn’t not equal causation, it certainly identifies factors that are predictors. A strong correlation in a study which has ruled out other confounders absolutely has value in identifying the things which increase the likelihood of developing a condition.
Cigarette smoking is associated with an increase likelihood of lung cancer. But some smokers don’t get lung cancer. Or, as in the case of my father, some develop lung cancer who are non smokers and have no risk factors. But that doesn’t minimize the evidence again cigarette smoking and lung cancer.
Coustan DR, Carpenter MW, O’Sullivan PS, Carr SR. Gestational diabetes: predictors of subsequent disordered glucose metabolism. Am J Obstet Gynecol 1993; 168:1139-1145.
Dalfra MG, Lapolla A, Masin M, Giglia G, Dalla Barba B, Toniato R, Fedele D. Antepartum and early postpartum predictors of type 2 diabetes development in women with gestational diabetes mellitus. Diabetes Metab 2001 Dec;27(6):675-80.
Lauenborg J, Hansen T, Jensen DM, Vestergaard H, Molsted-Pedersen L, Hornnes
P, Locht H, Pedersen O, Damm P. Increasing incidence of diabetes after gestational diabetes: a long-term follow-up in a Danish population. Diabetes Care 2004;27(5):1194-9.
Linne Y, Barkeling B, Rossner S. Natural course of gestational diabetes mellitus: long term follow up of women in the SPAWN study. BJOG 2002 Nov;109(11):1227-31.
Schranz AG, Savona-Ventura C. Long-term significance of gestational carbohydrate intolerance: a longitudinal study. Exp Clin Endocrinol Diabetes 2002 Aug;110(5):219-22.
Smith BJ, Cheung NW, Bauman AE, Zehle K, McLean M. Postpartum physical activity and related psychosocial factors among women with recent gestational diabetes mellitus.
Diabetes Care 2005 Nov;28(11):2650-4.
Stage E, Ronneby H, Damm P. Lifestyle change after gestational diabetes. Diabetes Res Clin Pract 2004;63(1):67-72.
None of these studies are applicable to our conversation. They all look at gestational diabetes – these studies were done on pregnant women and women who had been pregnant and who had developed gestational diabetes. Their sample sizes lack the statistical significance to be extrapolatable even to pregnant populations let alone to the general population. Not a single one of them shows any causation between obesity and diabetes. They fail to address the fact that the correlation only exists in populations where there is stigma on obesity and they fail to prove that gaining weight actually increases the risk for diabetes or that losing weight decreases the risk. They don’t rule out other confounders.
Based on correlation all we can say is that T2D is diagnosed more often in obese people than in thin people and that invokes all the issues that I brought up in my previous comment. Correlation does not imply causation and no matter how strong a correlation might be you cannot say that a correlation is evidence that one condition increases the risk for another. Based on the evidence it is just as likely that diabetes increases the likelihood of being obese, or that a third factor causes both.
Your smoking example is inapplicable because because a causal relationship has been established between smoking and lung cancer (due to the mutagens contained in cigarette smoke). A causal relationship does not mean that there is a 100% occurrence of the health condition in the presence of the behavior, or that there are no other issues that can lead to the same health condition in absence of the behavior. Therefore not all smokers will develop lung cancer and some non-smokers may develop it even though a causal relationship exists.
In order for a link between diabetes and obesity to be useful, first one would have to prove that someone’s weight in pounds times 703 divided by their height in inches with a solution set of 30 or more actually causes diabetes. Even then weight loss would still be contraindicated as a treatment since the most common long term result of weight loss attempts is actually weight gain. The only way that weight loss would be be an effective cure is if an intervention was proven to move a majority of subjects into the healthy BMI range on a long-term basis and that was proven to cure their diabetes. At that point we would have to study any side effects of that weight loss to be certain that they weren’t medically more dangerous than having diabetes in the first place, and look at what happens to the people who aren’t successful with the intervention.
In the meantime, I think that it’s much more likely that behaviors will control blood sugar than that trying to change the size and shape of people’s bodies will control blood sugar.
~Ragen
“the correlation has only shown to be present in societies that stigmatize the obese”
Wow, Regan, is that true? That’s an amazing fact if so. What countries/societies do not have that correlation, do you know?
I have been diagnosed with T2 Diabetes, and although last year I had it under control with exercise & healthy eating (& maybe less stress?), this year I do not. Unfortunately, my doctor is one of these “weight loss solves all” (he wasn’t very happy when my blood sugar was under control *without* my trying to lose weight). I’m having a hard time getting myself to move my body – maybe I can work on reducing my stress/depression to work toward enjoyable body movement again.
Keep up the great posts (and the very informative responses!). I keep learning a lot.
— Buffy
Dear Lori,
I am a T2 Diabetic, diagnosed about 3 years ago. I was 230 lbs then (and I’m 5’9″ so that puts my BMI at 34). I am the same weight today, and have not lost a single pound. However, my HbA1c is currently 5.5%. Clearly, I am evidence that it is not necessary for a diabetic to lose weight in order to control their blood sugar. I keep my diabetes under control with a combination of metformin (a fairly low dose) and intuitive eating, keeping mindful of the amount and types of carbs I eat, and with moderate amounts of exercise. I eat healthfully and joyfully and happily, and I have lots of love and support and lean on the wonderful folks in the fat-o-sphere to keep my spirits up and inoculate me from the social stigma and stress.
Also – ONLY people with a genetic tendency can get diabetes. People without any of the several genes known to be involved in T2D cannot EVER become diabetic, no matter how much sugar or other foods they eat.
It’s sort of like phenylketonuria. You can feed someone who DOESN’T have PKU all the phenylalanine you want and they’ll never react poorly to it, but give it to someone with PKU, and they could die. It’s sort of an extreme example, but quite apt, I think.
“Also – ONLY people with a genetic tendency can get diabetes. ”
Is this true? I have never, every heard this before. If it is true, what percentage of the people with the genetic tendency get diabetes?
Yes, Buffy, it’s absolutely true. You cannot get type 2 diabetes unless you have the genes that contribute to it. AND – the more studies they do, the more evidence builds that it is the underlying genetic defects that cause both obesity and diabetes.
http://www.phlaunt.com/diabetes/14046739.php
all obese people will eventually get sick
Anyone who lives long enough is going to get sick. It seems to be fashionable in public health circles to push the assumption that any increase in diabetes or heart problems among people in their eighties and nineties is because they’re all suffering the effects of gluttony, not because a lot of people who would otherwise have died are now living long enough for those problems to manifest. It’s almost like they seriously think that anything less than a century of perfect health is punishment. (Or that they see life with chronic health problems as such a horrible fate that they can’t bear to believe it’s happening to people who didn’t ‘bring it on themselves’ in some way.
If only the prevalence of type 2 diabetes were increasing only in the over 80 age bracket! Unfortunately, we are now seeing Type 2 diabetes in preadolescents who are obese; this is not uncommon.
Actually, Lori, it’s VERY uncommon in the US population at large. Less than 50,000 people under 20 in the US have a t2d diagnosis. That’s out of a population of over 83 million in that age group! It is, of course, more common in certain ethnicities and income brackets than others (genetics + stress hormones, anyone?).
And trust me, they never, ever used to test anyone under 20 for it unless they were passing out, until about 15 years ago or so, when they also lowered the diagnostic criteria from FBS > 140 to FBS > 126. Nobody — but nobody ever, ever, ever took my blood when I was that age (1963-1983). I would have remembered that. Nowadays they look under every possible rock for it.
And regarding their “looking under every rock for it” I wish it were so. the current cutoff of 126 is not a normal fasting blood sugar (that number is under 100). Rather, it is the more practical, cost effective public health approach to screening. By the time most Type 2s are diagnosis by this criteria, they experience secondary symptoms such as neuropathy, having had elevated sugars for on average 5 years.
For clarification, I am talking about Type 2 diabetes–people are not typically passing out form this condition.It is a valid point that the diagnostic criteria have changed as you mentioned, which certainly identifies more individuals with DM. But the association remains, and pediatric obesity is a bigger problem than ever. And I say this referring to those whose weight is climbing more rapidly than what is appropriate for their age, exceeding even their normally high weight for age percentile, which in and of itself is NOT the issue. And the increased rates of DM parallel the increasing rates of obesity, across states and age brackets. Weight reduction typically improves blood glucose in Type 2 obese individuals, although certainly it is not the sole variable that impacts these levels..
As others have pointed out, weight reduction has NEVER been examined on its own, completely independent of other factors. You must know that in a good scientific experiment, you only change one factor. Weight reduction CANNOT be separated from other factors, because the way in which weight reduction is established is by controlling diet and exercise. When you say, “Weight reduction typically improves blood glucose in Type 2 obese individuals” you are using bad experiments. It is FAR easier to isolate changes in diet or activity level, and therefore would be a much better (and more responsible) experiment. If these improvements were not seen independent of weight loss, THEN it might be appropriate to prescribe weight loss.
Studies are done all the time isolating one variable–for instance, the effect on weight loss of a diet high in carbs, fat, or protein, with calories and activity kept the same.
This is a reply to Lori Lieberman’s comments below, since I can’t reply to it directly.
The effect of certain diets on weight loss isn’t quite what Skyfire was getting at though. Have there been studies comparing the effect of different diets with similar weight loss results on diabetes, or of the same diets with varying weight loss results? (For example, put people on diets A, B, and C–track both their weight loss results and their diabetes symptoms. Do people who tend to lose weight have similar symptom improvement regardless of the diet? Or do certain diets seem to be beneficial whether weight is lost or not?)
To show that the benefit comes from the weight loss itself, you’d have to isolate it from those other factors.
Thanks for your website Reagan. I’ve been meaning to write you a fan letter for some time. You make me feel better about myself, and have contributed to me forming a more loving and accepting relationship with my body.
I adore seeing other women (of all sizes) who buck the stereotype and love their bodies.I also agree that doctors, mostly, talk a bunch of crap in order to sell product without looking at underlying causes or other factors.
I especially love the points you made a while back that you don’t love a dog any less if it is overweight. Same goes in other areas. You don’t love your parents any less for the way they look, and if you do you have serious issues!
I am glad that there are people like you who are vocal and active in changing the stigma, encouraging people to be healthy – not just changing their body and habits to conform to the current fashion.
Anyways, keep doing what you’re doing!.
Hi Chloe,
Thank you so much for the comment. I’m really glad that you are finding your path to peace with your body and I’m happy that my work can support that. I hope to “see” you around here 🙂
~Ragen
I’m replying to emi11n (for some reason, the comments section there is closed).
To complement your post: Linda Bacon sited studies in her book “Health at Every Size” which demonstrated that people who had lost weight through liposuction showed no changes in blood sugar while people who had bariatric surgery had rapid changes in blood sugar (decrease) PRIOR to having lost any weight. The speculation was that it was not the weight loss that caused the drop in blood sugar, but possible something to do with changes in the ability to digest food.
~ManDee
If you read my comments above you’ll see that they are largely consistent with what you are saying–that there is genetic predisposition and the development if type 2 dm is multifactorial, and that there are many factors that impact improved BS–and weight just happens to be one, in many individuals.
My last comment was for the commenter above, but also showed up in the wrong spot!
@ManDee Of course there will be a significant drop in blood sugar immediate post gastric bypass; the contents of the stomach are limited to the size of an egg, so ability to take in foods including carbs which have the greatest impact on blood sugars, is dramatically reduced. Plus, with the diarrhea/malabsorption and GI distress most experience, they are not consuming much at that point, likely the GREATEST reason blood sugar drops!
But note that A1c stays low despite increased ability to eat after time, at which point there has been significant weight loss.
As for losing weight via liposuction? Not a very significant reduction in weight as a percentage, in obese having this procedure.
Did that study control for the amount of weight lost? I didn’t think you could lose much weight via liposuction, while bariatric surgery often results in dramatic weight loss (at least in the short term).
The liposuction study removed about 25 pounds of fat from each person participating, and measured a whole bunch of metabolic markers (including FBS and A1c) right before and 10 to 12 weeks afterwards. A possible confounding factor, of course, is that this was subcutaneous fat removed, since visceral fat can’t be removed that way. OTOH, 25 pounds of fat is more than most people are able to remove even temporarily while dieting (considering that weight loss while dieting is never just fat loss, there’s water and muscle in there too). And it did nothing for any of the metabolic markers studied. Besides, let’s face it — people judge each other based on subcutaneous fat, since they have no clue how much visceral fat anyone has by looking.
There should be a required reading list before people comment. And I’ve gotten to the point that credentials make me trust someone less. Just another soul indoctrinated by the weight loss industry even when they don’t realize it.
I got diagnosed with T2 about 4 months ago and as a result drastically changed my diet to eat healthier and reduce my carbs to the recommended levels. I also started exercising more regularly. As a result my blood sugar improved. I also lost 20 pounds because of the change in diet and exercise, but that’s not why my blood sugar improved. Losing weight and eating healthy are not the same thing.
Here’s another way to look at it. If I only consumed 2000 calories a day, I would start to lose weight. If those 2000 calories were the proper mix of carbs, fat and protein, I would keep my blood sugar in control and lose weight. If those 2000 calories were all carbs and fat with very little protein, I would lose weight but my blood sugar would skyrocket and my diabetes would worsen. Or to look at it another way, if I consumed 3000 calories a day, but they were the right combo of carbs, proteins and fats, my blood sugar would be much better than if I consumed only 2000 calories of just carbs. So, it’s not the weight loss that helps with blood sugar control, it’s the healthy eating/exercise.
It’s actually a pretty simple distinction, so I’m not sure why the healthcare profession seems to be so resistant to it.
In this example, you have confounders–weight loss, dietary change, and increased activity, so you could no more definitively state that the weight loss didn’t contribute to the improvement, than you can say the other factors did!
Yes, but the weight loss is due to the change in diet and activity. It didn’t happen on its own. It’s the diet and activity that are the key. If I had lost weight by eating only carbs, but fewer calories, my T2 would not be under control.
No, you can’t definitively say that weight loss was unhelpful, but that’s not really enough to recommend it. How many other medical recommendations are made based solely on, “Well, we don’t know that it *doesn’t* help.”
The fact that people like zaftigwendy have tweaked their diets, exercised more *and not lost weight* but still controlled their diabetes, is also a suggestion that the weight loss is not the most important factor.
And again, focusing on weight loss encourages any and all methods of losing weight, whether they’re healthy or not, and often motivates people to give up on healthy behaviors that aren’t “working” (if you interpret “working” to mean making them thinner rather than making them healthier).
About 10 years ago I was diagnosed with extremely elevated triglyceride levels (cholesterol was perfect, only the trigs where elevated) – my doctor warned me that this was considered a pre-diabetic condition and that often the time frame for moving into ‘full blown’ diabetes was only a few years. He suggested that I try to get them under control via nutritional changes and exercise.
That was 10 years ago. I still struggle occasionally with slightly elevated triglyceride levels, but no where near where they where back then – I watch my carb intake very carefully (strictly complex carbs in small amounts for me!) and balance the rest of my diet, I’ve increased my activity level tremendously since 10 years ago. My weight has changed by 3 pounds in those 10 years….. but I’m not diabetic, and I’m not taking any medication for either triglycerides or sugars.
So I would say that I’m certainly a walking talking example of nutrition and exercise being much more significant factors than weight loss.
I’m have diabetes type 2, I’m also in recovery from anorexia, at the current time my blood sugars are under good control I also have a BMI of 29. When I was around and under 100 lbs my blood sugars were high this was many years ago about 19, I think, I would have my blood sugar read at 190 after not eating for two days but the doctors insisted it was not diabetes because I was thin ( just a weird spike). I was diagnosed with gestational diabetes when pregnant with my son 16 years ago and it just stayed after. I manage it rather well with diet exercise and and metformin, no complications so far, but I am fat my usual weight is over 200 lbs. Last spring I had a relapse after a doctor who is not my own ( it was a sudden non weight related illness) made some unfortunate remarks about my size. I stopped eating pretty much for three months.I lost weight 210lbs to 170lbs( I prefer not to use numbers but it illustrates). In those three months my blood sugars went crazily out of control, I was too tired to exercise. So weight loss without proper diet and left me with liver issues, anemia, vitamin deficiencys. random blood sugars over 250 and for the first time in years an A1C over 7.I’m eating now, back in therapy, put back some of the weight and my blood sugars are great to just fine.So at least anecdotaly weight loss won’t necessarily fix things.
Yikes. I’m sorry to hear that you were that badly triggered by a doctor’s remarks. I’m glad you’re back in therapy and on the mend now, and I hope you wrote a letter to that doctor explaining how throughly their stupid and insensitive comments derailed your recovery.
Dr. Joel Fuhrman has pretty much proven in his years of clinical practice that it’s not weight loss that improves and reverses T2D. It’s diet! And yes, you can REVERSE T2D. There’s no need to spend the rest of your life on medications. The human body has the most remarkable ability to heal itself with the right nutrition. Dr. Fuhrman’s approach to a healthy diet completely reversed my Father’s T2D diabetes (diagnosed in the mid-90s, but he didn’t discover Fuhrman’s approach until about 3 years ago). My Father experienced a moderate weight loss of about 25#, not really that dramatic for a 300# man, just as a result of completely overhauling his diet. The diet (which is strictly vegetarian UNTIL the diabetes is reversed), has reduced widespread inflammation and has boosted his energy levels to the point that he feels significantly younger and healthier, and he now has the energy to exercise everyday and be physically productive around the house (he’s currently building a greenhouse for my Mom with his own physical labor).
I have read tons of nutritional research over the years, and I remain convinced that it’s largely diet that heals diabetes. Physical activity is closely linked to diet as it brings hormone levels back under control and stimulates the body to burn fat reserves stored in the abdominal cavity (considered the most dangerous to diabetic patients as it puts pressure on the organs and screws up hormone production). Weight loss is not the road to healing diabetes, but it’s just a benefit to changing diet and increasing activity.
Using this same logic, it’s not maintaining a “healthy weight” that prevents diabetes, but rather maintaining a healthy diet with regular physical activity. Superior nutrition is the road to a healthy life, not being thin! Doctor’s telling patients they need to loose weight to manage diabetes is a recipe for disaster. I want to see these doctor’s telling patients to throw away their processed food meals and learn to cook healthy food for themselves!
While I agree with a lot of what you said here, pressuring people to cook can have some of the same negative impacts as pressuring them to be thin, though (e.g., guilt, stress, screwing up their relationship with food). When you’re tired or busy, processed meals can be a lifesaver. (I mean that figuratively, but it can certainly be literal–you need to eat to live, after all.)
So that explains why my half sister, who has been a vegan since her teens, exercises between 4 and 6 hours a day, and will not eat anything she didn’t cook herself (and during the summer and early fall doesn’t eat anything she doesn’t *grow* herself) was recently diagnosed with type 2 diabetes.