Tom Hanks recently announced to the world that he has been diagnosed with Type 2 Diabetes (T2D). Let’s get the first thing straight – he, like Paula Deen before him, was under NO OBLIGATION to do so. Celebrities do not owe us every detail of their lives. Tom Hanks is an actor, his job is to portray a character, not to disclose all of his health issues to the general public. Can you imagine if your plumber told you that she’d been diagnosed with T2D four years prior and you were completely angry and indignant that she didn’t tell you sooner? So, though he was under no obligation to do so, Tom Hanks went public as is his choice.
In an interview with David Letterman he said “My doctor said, ‘If you can weigh what you weighed in high school, you’ll essentially be healthy and not have Type 2 diabetes.” If this is true, if Mr. Hanks did not misunderstand or misspeak, then his doctor is dangerously misinformed. His weight may have nothing to do with it. Some have suggested that it may be related to the major weight fluctuations he underwent for films like Philadelphia and Castaway.
Before we go too far into this, let’s talk about another issue: The best thing, the only thing that I believe is ethical, that we can do once someone has been diagnosed with a health issue is provide shame-free, future-oriented care. Though disease prevention is a reasonable thing to work on in general, it’s not reasonable to talk about it to someone who has a diagnosis already. At that point what matters is providing options to the patient moving forward that are evidence based, creating a treatment plan (or not) based on informed consent, and never ever blaming or shaming the person for their illness. Nothing good comes from blaming or shaming people about their health issues.
Prescribing weight loss as a T2D intervention is highly problematic. Choosing a random weight (just as a hypothetical example – what one weighed in high school) is ludicrous. Tom Hanks did a good job of pointing that out when he said that his response to his doctor was “Well, I’m gonna have Type 2 diabetes because there is no way I can weigh as much as I did in high school,” which was 96 pounds.
There are many reasons that weight loss as a prescription for T2D is problematic, not the least of which is that weight loss doesn’t work long term. so even if weight loss would cure T2D we would first need to know how to make weight loss successful. The second issue is that some methods of weight loss will actually cause blood sugar to become higher or to swing dangerously high and low. When weight loss is credited with improving T2D, typically it is an observation over a short period of time that inexplicably ignores the fact that behavior changes preceded the weight loss and the metabolic change, and so the weight loss and the change in metabolic markers are likely both caused by the behavior changes (thus the weight loss wasn’t the cause of the health improvement, but a side effect of the behaviors that led to the improvement.) This is significant because it’s likely that the weight loss will be short term and the weight will be regained, but the behavior changes can often continue to help the T2D.
I’m not going to get into treating T2D in this post other than to say that there are many options, that people of all weights get T2D, that there are definitely interventions that don’t involve weight loss, and that the best things I think we could do from a public health perspective is to eliminate shame and blame around it, stop prescribing weight loss as an intervention, and focus on creating behavior-based treatments plans based on patient goals and desires (including medication and “alternative therapies.”
Tom Hanks gets to do whatever he thinks is best to deal with his diagnosis, but let’s remember that he is an actor and his doctor is clearly just practicing medicine.
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If my selling things on the blog makes you uncomfortable, you might want to check out this post. Thanks for reading! ~Ragen
Dances With Fat 
Thank you especially for this post – having just started using a cpap machine for obstructive sleep apnoea, it was timely for me!!!
Sent from my iPhone
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I use a CPAP too, in a way I was lucky because just after the few hours of using one during the sleep study I needed one, so I was instantly on board. I had chronic nightmares up until the point I got my CPAP machine, now I sleep so well that I can’t imagine life without it.
I would advise that if you aren’t comfortable with the mask you started with to keep shopping around until you find the right one for you, it took me several masks to find the right one. Good luck getting used to your mask!
Thanks kprofou, I’m doing all the usual online reading and learning tons!! Hoping I can find a local supplier who’ll let me try masks – as I have chronic nasal congestion I’m anticipating it’ll be a challenge to find one that’s just right.
Ragen, I think ‘idiot’ is considered an ablist slur, and changing the title of your post might be a good idea. Other than that, I got nothing but love for your blog. ❤
I changed it to be on the safe side. Thanks.
~Ragen
also your next-to-last paragraph has an extra “and” here:
“to eliminate _and_ shame and blame around it”
(Love your posts! thank you for writing them.)
It’s interesting to me that people always credit weight loss with improved health outcomes when I think it’s more likely to do with improved nutrition (if it’s the case that the person wasn’t eating well to begin with) or with increasing activity (if it’s the case that the person wasn’t exercising before.) Weight loss is sometimes the outcome of eating more healthfully and exercising more but not always. I am a firm believer that good nutrition can improve a lot of health issues for people but it doesn’t always lead to weight loss. I think if people listened to their bodies they’d feel so much better, regardless of what the so-called experts tell them they should do.
Except that most diets aren’t nutritionally sound and yet are still connected with improved health outcomes (which is a major factor in our culture seeing dieting as a healthy thing and adipose tissue as harmful in itself.) Here’s what I think is going on: If I was allergic to wheat and dairy and had less exposure to them simply as a result of calorie restriction, I could expect to see fewer symptoms. Since a non-calorie-restrictive but specific-food-restrictive diet would have the same effect without the weight loss (in line with HAES,) it would be erroneous for me to attribute it to my fat cells having shrunk up temporarily. Dieting isn’t only unhealthy because of the stress to the body, but it’s unhealthy because assumptions about its health benefits obscure the real issues.
So far as I know, less wheat doesn’t do much to relieve symptoms for celiacs– I don’t know about people who have problems with other wheat components. Celiacs see the big difference when they go from wheat to no wheat whatsoever.
You’re right about lactose intolerance, at least for a lot of people.
I thought calorie restriction itself does have health benefits, at least for diabetes and cardiovascular health. Of course, if calories are restricted enough to cause significant weight loss, that degree of calorie restriction will not be sustainable long term for must people.
There was a nutrition professor who demonstrated to his students that weightloss requires only a calorie deficit by eating a low cakorie diet consisting of junk food (snack cakes, chips, etc). He did indeed lose weight, and his cholesterol and blood pressure also decreased. It would be interesting to conduct his “experiment” with a large group.
As far as I know, a study of the long term effects of calorie restriction has not been completed in humans. I believe there was a study with monkeys which showed health benefits, but no increase in median lifespan (in rats, calorie restriction can increase lifespan by 80%). There are different theories as to how calorie restriction improves health, including hormesis (a little bit of chronic stress makes the cells better at handling larger stress loads) and reduced glycation. Research with different types of eucaloric diets might help researchers better understand what happens with calorie restriction. For example, in one study participants ate a eucaloric low carb diet–meaning they did not lose weight–and yet their cardiovascular health improved, suggesting that the health benefits of low carb are not due solely to weight loss.
Hi Elizabeth,
Thanks for your comment. Calorie restriction is not, in and of itself, helpful in diabetic patients. If a patient restricts calories but eats a high carbohydrate diet, they could actual make their blood glucose worse, if the person’s calorie restriction includes going for long periods without eating, that could also cause an issue with controlling blood sugar.
As for the Twinkie diet, I blogged about it here (https://danceswithfat.wordpress.com/2010/11/09/the-twinkie-diet/), but some of the main issues are:
* He didn’t track his eating before he started the diet to create any kind of baseline * It looks like he went from eating a few large meals a day to many small ones which can have an effect on the metabolism, at least in the short term * His study had no control group * obviously it was just 1 guy for 10 weeks
* The body corrects for weight over time – in long-term weight loss we like to see 5 year maintenance * His results have not been replicated (and I wouldn’t hold your breath for someone to try)Even the guy who did the study was clear that no conclusions could be drawn.
The studies that I’ve seen for caloric restriction, low carb diets etc. are typically very short a few months to a year at most – meaning that what they are actually testing for is the immediate reaction of the body to a change in diet, rather than the effects of that diet over time, so I think it’s important to be cautious.
~Ragen
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Right. Which is why I didn’t say a single word about diets. “Improved nutrition” is a whole other thing than “diet.” It also has nothing to do with calorie restriction. Improved nutrition has more to do with choosing more foods that are better fuel for your body and nothing whatsoever to do with losing weight. You MAY lose weight, but you may not and that is not even the point. I was so careful in how I worded this, too, so I’m curious, how did you get “diet” out of that?
that’s certainly been true for me — when i was diagnosed as pre-diabetic, i changed what i ate (lower glycemic load) and started exercising (mildly so at first; walking 30 min most days). i am out of the danger zone now, and yet i am still obese according to the BMI. so weight/fat loss clearly had nothing whatsoever to do with my improved condition.
i’d like to point out to all doctors who practice medicine by treating weight loss as a panacea that “practice makes perfect” whether or not one practices the right thing, and that it is important to determine what the right thing is instead of settling for the visibly “obvious”. if you practice the wrong thing you’ll never actually get good, you’ll just perfect the bad.
it’s kinda funny, isn’t it, how western medical practitioners scoff at the snake oil remedies of the past, which allegedly cured every which ailment — and yet they do the very same thing by looking to weight loss as the cure for whatever ails us fatties.
I’ve long had a soft spot in my heart for Tom Hanks as a person. He just seems to be a pretty reasonable and very nice guy. Hearing about this has only increased my fondness and respect for him.
I also really loved the fact that he was matter-of-fact about diabetes. He emphasized that it’s a controllable condition, not a hideous death sentence. So many people act like a diagnosis of Type II Diabetes is virtually the same thing as a diagnosis of Advanced Bubonic Plague, only with more amputation involved, and I get really sick of that. Yes, amputation is a potential issue, but it takes a long, long time to get there and usually only after extremely poor control of the condition over that long, long time.
As for ‘coming out’… I’m glad he did, but I certainly would never have thought it was my right to have him do so. I think he puts a less scary face on diabetes, and that’s a good thing. I hope his announcement will cause a few more people to get tested and find out for sure whether they have diabetes. I hope he will help other people facing diabetes to remember it’s a medically controllable condition and not a judgment from on high for eating a jelly donut once.
But he no more owed it to anyone who isn’t him than I owe it to anybody to flap my arms until I fly to the moon and back again.
But if you manage that, you DO owe us pics. 😉
Pics? Hell, I’ll make a freaking movie! And I’ll star in it, too, because nobody could be me but me.
Damned right, they couldn’t! 😀
“… he, like Paula Deen before him, was under NO OBLIGATION to do so. Celebrities do not owe us every detail of their lives. Tom Hanks is an actor, his job is to portray a character, not to disclose all of his health issues to the general public. ”
THANK YOU for that! We can take that one step farther and explain that NO ONE owes their medical history and health details to anyone else, either. As a fat person, I’m tired of being expected to ‘explain’ why I’m fat or why I’m not “working on getting thin” right now.
As for diabetes; I’ve just recently been told by my GP that I’m “borderline” diabetic, or “pre-diabetic”. Type2 Diabetes runs in my family, although it seems to have skipped the generation just before mine.
But anyway, hearing that ‘pre-diabetes’ diagnosis put me in quite the tailspin, because I KNOW most people (who eventually find out about it) will immediately assume that I’ve *caused this disease to happen to me.* You know – it’s my own fault… being fat and eating badly and all….
I’ve since done a lot of research into diabetes on my own and thankfully have come across more than enough statistical research and expert doctors’ observations and experience to know that “diabetes happens” – it happens to thin people, average people, & fat people. I am not to blame.
Hang in there! There was no diabetes in my family until this generation. Both my brothers and I have type 2. The thing we have in common is that we, all three, have had weight fluctuations over many years… two of us from ‘dieting’ and one from stress and lifestyle. We have all been active (mostly). I think I messed up my pancreas by the radical dieting of the 70’s and 80’s in my lifetime. But I can’t prove it.
My current situation is to control my blood sugar levels… mostly through meds so I don’t trigger old ‘dieting issues’… but I also avoid wheat. I developed an inflamation response that is very bad for me.
It’s a doable lifestyle and not necessarily going to lead to weight loss.
Susan
_Diabetes Rising_ (by a medical jounralist with Type 1) says that both types of diabetes (and the situation is more complicated than just two types) have been increasing dramatically for the past century, and none of the theories cover all the facts.
Amen! I do not share my T2 diagnosis with many people for just that reason. I blame it on many factors including genetics, my past medications for mental illness (and weight fluctuations due to Bipolar II..the only successful “diet” I ever had was extreme suicidal depression) and heavy use of diet soda. Thankfully, my doctor and I have come up with a management plan that includes healthy eating and exercise. The most surprising thing to both of us is that my body reacts the best to weight lifting and low to moderate intensity cardio. My best numbers have been when I lift consistently, not when I have been at my lowest weight!
Your posts make me happy.
Enjoyed this post. I have come to think of weight loss as nothing more than an occasional and temporary side effect of engaging in certain behaviors. I’m a regular exerciser and a reasonably nutritious — but still intuitive — eater. (Through trial and error, I’ve discovered that those two things are best for me in terms of feeling well and mitigating the effects of an under-active thyroid — fully recognizing that what works for me might not work for others.)
Over time, I’ve noticed some slight variations in my size. (I don’t weigh myself so I’ve noticed it via things like my clothes fitting differently, or when measuring myself so I know what size dress to order from an online store.) And it’s just no big deal to me anymore; just a highly variable little side effect.
I saw an interesting TED talk on epigenetics yesterday which ended talking about T2D. I thought you might be interested in the info. Sorry about the wiki, but hopefully you can skip onto the research from there: http://en.wikipedia.org/wiki/Dutch_famine_of_1944#Legacy
There is a groundswell of evidence that the environment of the womb *causes* a huge increase in the incidence of T2D, mostly those experiencing famine symptoms in Western society, and so the drs would be better off concentrating on better treatment for hyperemesis gravidarium than telling fat people with T2D to diet.
Wow…yeah. And, irony of ironies, the fat people they’re telling to diet include pregnant women.
Great, isn’t it? No one connects the flipping dots…
What is it with doctors/society wanting everyone to look prepubescent? I am unhappily participating in a “wellness” program at my husband’s work in exchange for $1000 being taken off of our insurance premium for the upcoming year. I am only a willing participant so we can get back some of the money we’re losingdue to our insurance rates taking a big jump that we really can’t afford. Anyway…After completing my “Health Assessment” I was informed that I am high risk for things like “stroke” “diabetes” and heart “heart problems” despite the fact that my cholesterol, blood pressure, and glucose numbers were normal. On my health summery I see BIG RED dots next to my BMI, Body Fat Percentage, Waist Circumference, and Weight. Their solution to avoid years of suffering or certain early death from these terrible diseases is that I lose weight. Their goal for my body according to my height is that I get below 135lbs and my waist should be under 35 inches. Um… My waist hasn’t been under 35 inches since I was a junior in high school – and I was two inches shorter than I am today!!! After reaching physical maturity and giving birth to 4 children I weigh 230lbs and my waist is 42 inches… The doctor suggested I follow the “South Beach Diet” at 1200 calories a day and to begin a daily vigorous exercise routine. So… after the exercise burning close to 400 calories of my 1200 I would be operating on less than 800 calories daily… talk about a starvation diet! I’m not going back to him… if I decide to lose weight I will do it in a healthy manner. I do not understand the medical profession!!!
One of the biggest revelations for me about the sheer bullshittery of assuming that weight is THE FACTOR IN T2D OMG actually came before my own diagnosis, while I was living in Japan. I got sick with stomach problems and one day I was discussing diet (in the sense of “what I eat,” not in the sense of “going on a diet”) with one of the Japanese teachers I worked with and she told me she had to watch what she ate because she had diabetes. Even though I was getting more into HAES at that time and already pretty much accepted that the idea of weight loss as a cure-all was BS, I was still surprised when she told me that and ultimately realized that a good chunk of my surprise was because she was thin, and clearly a part of my mind was still clinging to the idea that diabetes was mostly a fat-people problem. Anyway, I wish more people would actually apply some logic to these issues. If people of all sizes can get a disease then it just doesn’t seem logical to me that weight loss would be the cure. Unfortunately there seems to be a lot invested in making people believe that T2D is a fat-people-only problem.
Re T2D being a “fat-people-only” problem, it goes even further than that. I got a hell of a shock at my physical last year because the doctor told me that my weight, combined with my recent high blood pressure reading (taken with a standard cuff) and my history of gestational diabetes, put me at high risk for T2D.
[b]Except that I have never had gestational diabetes. [/b]
They had me testing my blood sugar every day during one of my pregnancies because they were so fricking sure that I must come down with it aaaaaaany day now, but they failed to test any of my numerous urine samples for the UTI that almost had me in premature labor, because as a big old fat fatty fattaloo the only problem I was facing had to be diabetes. And when I “failed” to produce the expected diabetes during any of my pregnancies, some ass came along after my last baby was born and wrote “history of GD” in my file! Because everybody knows that fat women get GD.
Oh, you better believe I blew my top.
My husband’s doctor’s are dumbfounded that he still has T2D even though he unintentionally lost weight….went from a steady 230 down to 200 over the course of a year or so. I mean seriously, can they be that dumb? Now they are saying he was misdiagnosed at 23 with T2D, when it should have been T1D…face.palm.
I think your husband’s doctor might also be totally incompetent if he misdiagnosed T1D for T2D…those are two pretty profoundly different diseases, and generally easily distinguishable.
It is my understanding that pre-diabetes is not even diagnosed in Canada and Western Europe. Pre-[sick with anything] means well! The people on the committees who came up with this non-diagnosis for people with normal (albeit it near the top of the normal range) sugars were all on pharmaceutical company payrolls. This is only one of many diagnostic cutoffs that have been lowered in order to widen the net for treatment (money). And an unfortunate side effect is that it does send people into tailspins. The emotional stress, the effort to make the recommended behavioral changes, and the expense for meters, strips, medications, and special diets. . . and they’re not even sick. And may not become sick — apparently most people with borderline sugars spontaneously remit.
So my advice to anyone who’s just been “diagnosed” with pre-diabetes (which is to say, no diabetes) please don’t panic, consider carefully any prescription, as the literature shows in pre-diabetics it can lower sugar dangerously — plus, if you aren’t very sick to begin with, there’s little a medication can do for you BUT you get exactly the same side-effects as somebody who’s sick enough to have some potential benefit to balance out the PITA factor.
I’m not a physician, and I’m not practicing medicine. But I was once diagnosed with pre-d myself (and indeed, it spontaneously remitted), and in my job I work with eating issues and medical non-compliance, so I’ve done a little reading.
Spontaneous remission, by the way, is probably responsible for as much improvement in people’s conditions as behavioral changes, but since they happened to have lost a little weight along the way, the change gets mis-attributed to the weight loss. Alas.
I’m in the UK, an the only time I’ve heard about “pre-diabetes” is when reading blogs/articles from the US.
Virginia said: “… This is only one of many diagnostic cutoffs that have been lowered in order to widen the net for treatment (money). ”
BINGO! They did it with BMI years ago (lowering the range for “obesity”), they did it with blood pressure, and now with diabetes.
This is 90% of the problem with “Pre- [insert disease here]” diagnostics. The other 10% comes from lazy doctors who become a willing cog in the machine of assembly line medical care. Example:
*Diagnose a pre-[disease] condition; write a script for meds, order blood work in 6-12 weeks, adjust meds, order blood work in 6-12 weeks, adjust meds, admonish patient for not complying with Dr’s ordered diets and exercise plans, and on and on it goes….
oh, it’s done in canada as well. to the credit of my doctor at the time, he didn’t do that whole spiel you mentioned above; he said that a lot of indicators in my life at the time were risk factors for more serious health problems, and that it would be good if i could change the way i ate and be less sedentary. he didn’t prescribe any meds, nor ordered more blood work, and he didn’t harp on weight loss as a “solution”. he was right, and i already knew it; i wasn’t living particularly healthy, and i’ve been feeling much better since i changed both what i eat (nothing crazy, no fad diets), and my level of activity (again, nothing crazy) — and i was lucky that my body responded well to the changes. i did have sky-high blood pressure (>200), and he prescribed meds for that, but he said it was hopefully temporary, and it was. i really started to like him when he said that these days there was a lot of pressure to keep BP even below the once touted level of 120/80 but that he was not convinced that was medically sound.
IMO you’re absolutely right that a lot of these “pre-diagnoses” are manufactured to cash in on our fears. it’s too bad most people do not understand statistics, and that risk factors are about probability (and usually not even a particularly strong probability), that correlation does not prove causation. and the way studies are presented to us through the mainstream media blows those risk factors all out of proportion. what really chafes me is that too few people seem to realize the stress all the health scares put us under is a risk factor too, and that stress is increased by fat shaming and the “war on obesity” which seems more a war on fat people than on health risks. we see more and more studies coming out how very negatively this affects children; maybe that will change something.
“pre-diabetes” is definitely diagnosed in Germany. And yes, they just lowered the cut-off AGAIN.
Tom Hanks did not have to tell anyone he had Type 2 Diabetes, but I am glad he did, as he is average weight and proves that being you don’t have to be fat to get it. I wish more people would understand that and also that it is genetically based.
Virginia, neither of us are doctors, but when my doctor explained I had pre-Type 2, it was because the high blood sugar damages the organs a little bit over time. If not taken care of, it adds up to big damage.
I don’t know what the threshold is for diabetes in other countries though, it may be the same as our ‘pre-diabetes’ or maybe in cultures where walking is more the norm, it is less of an issue altogether.
Anyway, kudos to Hanks, thank you to Ragen for sharing, and good luck to all of us with health issues.
FWIW, a person’s a blood sugar can become elevated during and right after exercise, so if you were to take your blood sugar shortly after your morning exercise, it could be higher than normal. I read a study, which of course I can’t find right now, were they did a study on healthy, “normal” weighted athletes and about a third of them had high blood sugar during exercise and it simply didn’t mean a thing. So keep that mind if you get an anomalous reading one day.
I had a high blood sugar reading once after a fire drill at the doctor’s office which involved going down several flights of stairs, then walking back up the stairs, then back down and he just went kind of crazy about it, but then had a normal A1C; my eyeroll was WAY beyond normal though. 🙂
It seems to me that during exercise or any activity where your muscles are called upon to do more-than-normal amounts of stuff, there would of course be a corresponding higher blood sugar, since that is the energy used by muscles. This merely means your body is working normally.
But you’re right, they make a fuss of it. A fuss over nothing.
I’ve had a few diabetic patients (I’m a dietitian) that had lost a lot of weight but whose blood sugars were still WAY out of control. Why? They ate all the wrong things for good diabetic blood sugar control (juicing, anyone?). So it’s stunningly wrong to suggest that just losing weight is going to improve one’s diabetes. I had to try to teach them to eat in a way that had nothing to do with weight loss and more about focusing on better food choices and timing, which is hard enough as it is without trying to starve yourself. I’ve also had diabetic patients that run the gamut from from extremely thin to extremely fat, which tells me that diabetes is a disease that has nothing to do with weight.
The whole idea of “what I weighed in high school” always cracks me up a little bit, because I’m the same size and shape I’ve been since I hit puberty, give or take 10 pounds. Today a coworker complimented my pants and asked where I got them. I told her that I’ve had them since middle school, and she nearly fainted at the idea that I’ve always been this size– that I didn’t “get fat,” I just AM fat. Always have been, always will be, really just fine with it. I wonder what Tom Hanks’ “doctor” would say to me if I developed T2D (which does run on both sides of my family).
Maybe I’m the only one, but whenever I see “weight what I weighed in high school” it baffles me. I didn’t weigh myself in school! I have absolutely no idea what I weighed then. In fact I didn’t realise I was fat until I got to my mid-20s or so. I am very very lucky in that regard. When I was in my last year of school, boys used to call me a “heifer”, but all I thought about that was that I was glad I was leaving school soon and would never have to see them again.
Yeah, when the news about Tom Hanks hit I was at a convention, and folks were talking about it. I kept quiet as long as I could, then mentioned I weigh about what I did in High School. Could’ve heard a pin drop for a minute there.
Priceless!
My high school weight? You mean before I had my last spurt of skeletal growth, in college?
I am fortunate to have a young woman in my life who is as petite in stature as I am amazonic…. she’s one of my students. She and I both have diabetes. She’s been on a pump and is now off it and just doing injections. She’s had quite the wild ride getting her blood sugars under control. We like to talk about our challenges together and give each other support. You should see how angry she gets when people say things about fat = diabetes.
I’m certainly not a health professional, nor do I have diabetes. However, I was under the impression that it was mainly genetic. When my grandfather was known to have it much later in his lifetime, (nearly twenty years before his death) I never heard of a physician suggest he lose weight to treat it. He was overweight and lived happy and healthy until 82. The weight-scare tactic is very millennial.