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HAES® Matters: Dieting, Disease, and Weight (part 2)

From time to time the Health At Every Size® Blog will be sharing HAES Matters “roundtable” posts with our readers. The questions that appear in the HAES Matters posts are based on questions generated by participants at ASDAH’s 2011 Educational Conference.  The participants were asked to list the most common questions they heard with respect to health, weight, dieting, and the Health At Every Size approach to promoting wellness.  We have compiled responses from some of ASDAH’s HAES experts to these commonly asked questions. We hope you will comment below with your own questions, answers, and reflections on these HAES matters.

 Q: Isn’t it true that fat people need more medication, surgery and other medical interventions than people who weigh less?

A: Sandy Andreson
Most health care issues for which people seek treatment are unrelated to fat. Many fat people avoid seeking health care because of misdiagnoses and shaming and blaming about their body size by health care professionals. Therefore, some fat people may be sicker by the time they seek healthcare. More and more fat people are finding fat friendly health care providers and are able to take advantage of early intervention for a presenting health care issue.

A: Deb Lemire
No. UNHEALTHY people need more medication, surgery and other medical interventions. And unhealthy people come in all shapes and sizes. If we assume all fat people are unhealthy and all thin people are healthy, then thin unhealthy people who need medical care will go untreated and fat healthy people will be over-treated. And either way it is not cost effective.

A: Deb Burgard
I am not sure we really know what fat people need.  We are moving to a medical system that is more and more driven by BMI.  The belief that being heavier is automatically less healthy triggers more interventions, more extreme and untested interventions, and many of those interventions leave people with more problems that need to be treated.   Moreover, because higher weight is correlated with lower access to economic resources, it seems clear that fat people are often undertreated medically, or treated in more expensive settings like ERs at a later point in a disease process.  So we have interventions that aren’t needed, interventions that cause their own problems, and lack of access to timely interventions that would prevent more complicated treatment.

Perhaps the broader point is to ask, what is the problem if fat people need more medical resources?   Women of childbearing age need iron, athletes need electrolytes, and men need their prostates checked after a certain age.  Demographic differences in medical needs don’t make that demographic wrong.  We need to take a step back and look at the healthism in our culture, the moral judgments about people who are disabled or sick or in need.

A: Dana Schuster
It is also important to remember that it is fairly common for a health professional to make an assumption that a fat person requires some type of medical intervention without actually objectively evaluating that individual fat patient’s health. This leads to over-prescribing medications, medical tests, and interventions, which in reality may not be needed.

Q: Doesn’t “obesity” cause type 2 diabetes (T2D) in genetically susceptible people? Will trying to lose weight help people with T2D?

A: Lindo Bacon
While it’s true that the majority of people with T2D are in the BMI categories of “overweight” or “obese,” that’s at least in part because the insulin resistance that underlies most cases of T2D often causes people to gain weight. In fact, weight gain may actually be an early symptom—rather than a primary cause—of the path toward diabetes.

Without a doubt, weight loss is very effective at improving blood glucose control in the short term. But this doesn’t mean that your health will be better off in the long run. A review of controlled weight-loss studies involving people with T2D showed that initial improvements in glucose control were followed by a return to starting levels of control within 6 to 18 months, even in the few cases where weight loss was maintained.

Evidence shows us that the pursuit of weight loss can actually be harmful, both physically and emotionally. It also tends to distract a person from the behaviors and attitudes that really can improve one’s health, such as eating well, being physically active, and cultivating a positive sense of self.

What can have lasting positive results, however, is developing sustainable behaviors. A wealth of evidence shows that people of all sizes can substantially improve their blood glucose control and their general health and well being through healthy behaviors—even in the absence of weight loss.

To learn more about a HAES approach to T2D concerns, check out this article I co-authored with Judith Matz in Diabetes Self-Management Magazine.

A: Sandy Andreson
Exercise and increasing movement opportunities show the most overall promise in lowering blood glucose levels.

A: Fall Ferguson
There is actually some evidence now that T2D, or more specifically, insulin resistance, causes weight gain rather than the other way around.  With insulin resistance, certain cells become “resistant” to the effects of insulin, which functions to trigger cells to take in glucose from the bloodstream.  The result is excess blood glucose.  The insulin then triggers the fat cells to accept the excess blood glucose and store it as fat.

A: Deb Lemire
I am not a researcher or medical professional, but the data I have seen seems to indicate that someone genetically susceptible to Type 2 Diabetes experiences insulin resistance, which leads to weight gain well before blood sugar levels become “diabetic.” So does the diabetic state of insulin resistance cause the weight gain, or does the weight gain cause the diabetic state?

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