If You're Diabetic, Then Why Aren't You Trying To Lose Weight?
In August of 1996, I was diagnosed as a Type II diabetic. After recovering from the initial shock and disappointment, I went about the task of adjusting my life-style to deal with this disease.
Some of the advice I got, and some of the arguments I read, encouraged me to try to lose weight. I considered them. I really did. I had embraced the idea of fat acceptance before this. I believed that for most people, losing weight was an ill-considered and dangerous preoccupation. But, this was a special case, wasn't it?
After a great deal of consideration and research, I decided that any attempt at weight loss on my part would be an enormous mistake. I'd like to share my reasons for this decision.
If you are diabetic and fat, you should listen to your doctor's advice. You should also listen to any other advice you get. You should read whatever you can find, take any classes available to you, and generally find out everything you can about this condition. Educate yourself--make an intelligent, well-informed, and well-thought out decision about wether weight loss is advisable for you. After all, it's your life.
A person trying to control their diabetes must modify their diet and activity patterns to bring their blood glucose (bG) into a certain range. The drugs and insulin therapy help to reduce your bG and/or increase your insulin. But, it takes more that. You could take a large enough dose to guarantee you would be below a certain bG reading, but too low a bG is nearly as dangerous, in different ways, as too high a bG. Consequently, the insulin therapy (whether oral medication or insulin injections) helps to put your bG into a range which can then be managed by manipulating your diet and exercise.
That's the point--you must manipulate your diet and exercise in order to control your bG. That is the key to surviving with diabetes. Now, how does a person lose weight? They do so by manipulating their diet and exercise.
The problem is that the manipulations which you perform in order to control your bG sometimes align with what you try in order to lose weight. At other times, they are directly the opposite. Add to that the fact that a diabetic (just like anyone else) should have enough variety and volume in their diet to assure that they are getting enough of the nutrients that they need. Americans spend so much time worrying about eating too much of the wrong things that they forget that the most serious and immediate diseases associated with eating involve not eating enough of the right things.
So a diabetic who is trying to lose weight is trying to satisfy three inconsistent sets of requirements: 1) Eat the right things, at the right times, and in the right combinations to keep his bG levels in the correct range 2) Eat enough of the right kinds of foods to meet his minimal nutritional requirements and 3) Eat few enough calories to lose weight.
If he does not accomplish the first goal, the consequences are dismal--kidney failure, blindness ... any diabetic can quote you a complete list. If he does not accomplish the second goal, the consequences can be nearly as bad. If he does not accomplish the third goal, the consequences are .... What are they exactly?
Well, they are the same as they would be for a non-diabetic. I'd rather discuss that on a different page.
But there is one final argument often used to dissuade a diabetic to lose weight. This argument has to do with insulin resistance.
Insulin resistance refers to the condition in which a person's body does not utilize the insulin which the body produces. This condition is one of the touchstones of type II diabetes. The cells of the body are resistant to the body's own insulin (and perhaps somewhat resistant to artificially introduced insulin).
Now, it has been claimed that a person's insulin resistance is lowered when they lose weight. The most infamous study refers to a change of as little as five or ten pounds making a difference in a person's insulin resistance.
Should we consider this likely? If the person in question is anything like me, then this change in weight represents a total change in body mass of less than 3%. Do they really think that this can make a difference in a person's blood chemistry? If so, why don't they talk about large changes in weight having an even larger effect?
Isn't it far more likely that the data in question is being interpreted using a simple ad hoc fallacy? That is, a person is diagnosed with diabetes. He alters his diet and activity level, in an effort to bring the disease under control. He succeeds. Not surprisingly, there is a slight (and most likely temporary) change in his weight.
Consider the following evidence: Many diabetics have a huge weight loss before they are diagnosed. Unexplained weight loss is considered one of the warning signs of diabetes (your body can no longer obtain energy from the food you are eating, so it begins to digest itself). If losing weight is going to help control a person's diabetes, why isn't this weight loss self-limiting? As the person's weight drops, their insulin resistance should decrease, resulting in their condition stabilizing. This doesn't happen.
After the person is treated for diabetes, quite often they regain most or all of the weight that was lost. But, this coincides with their diabetes being under control, as their body begins to properly metabolize food again. Again, this hardly supports the theory that being fat increases insulin resistance.
Although we shouldn't draw general conclusions from a specific case, I personally lost over 70 pounds in six months when I first developed the disease. My eating and exercise habits were exactly the same as they had been for ten years. And, although my weight had been stable for ten years, the onset of diabetic symptoms (in hindsight) corresponded with this abrupt and disturbing weight loss.
As soon as I began treating the diabetes, the weight started to return. Even though I kept careful track of my food intake and exercise activities, and I tested my blood twice a day, I noticed no change in insulin resistance as a result of the weight gain. That is, the same types of food eaten at the same times in the same portions generally resulted in nearly the same bG readings, whether I was fatter or thinner (though I could never, even 70 pounds below my natural weight, be considered thin).
Conclusion? In my case, my weight has little or nothing to do with my insulin resistance. Since my decision whether or not to attempt weight loss effects only me, I must observe that weight loss is neither warranted nor prudent in my case.
But, let's capitulate. Let's say that in some rare cases, a person's weight does effect their insulin resistance. If that person is diabetic, should they attempt to lose weight?
Controlling your diabetes is a balancing act. You must balance your insulin or oral medication dosage with the foods you eat and the activities in which you engage. Too much sugar in your blood is bad. So is too little sugar in your blood. It's tricky, but in time you learn how to deal with your unique body and it's response to the foods you eat.
What if you lose weight? If your body's insulin resistance changes, you have to adjust your strategy for dealing with your diabetes. Then, you regain the weight. You have to adjust your strategy again. Then, if you haven't learned your lesson, you lose the weight again. Isn't it pretty obvious where this is going?
How will you ever get the hang of the game if the rules are always changing?
You have taken the task of trying to ride a unicycle on a tight rope, and asked someone to wiggle the end for you.
So, if losing weight for a diabetic is, at best, a mixed blessing, why are doctors so quick to recomend weight loss to their diabetic patients?
I can't speak for any other fat diabetic, nor can I make hius decisions for him. But, for myself, attempting to lose weight complicates the task of adjusting my diet to deal with my diabetes, offers no credible benefit, and may result in a fluctuatin insulin resistance. I have enough genuine health concerns to deal with, without having to worry about whether I fit someone else's arbitrary definition of a healthy body size.
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