The causes of type 2 diabetes are complex. So why do so many people treat it like a “lifestyle” choice?
By Anne Bokma
By Anne Bokma
When celebrity Southern cooking queen Paula Deen announced earlier this year that she had type 2 diabetes, the backlash was immediate. The diva of deep frying was labelled a hypocrite for keeping her diagnosis a secret for three years, all the while promoting recipes loaded with fat, salt and sugar. While Deen certainly shouldn’t be applauded for promoting an unhealthy diet, the fallout she experienced was harsh— and typical for many people with type 2 diabetes who face the criticism that they are somehow to blame for their illness and it’s their own fault that they are sick.
While being overweight is a risk for developing type 2 diabetes, there are other contributing factors.
Anyone living with type 2 diabetes who is even a few pounds overweight and who doesn’t always make the right food choices or exercise on a regular basis is subject to this kind of discrimination. They are judged by their friends and family, society in general, healthcare providers and even sometimes by those with type 1 diabetes. The thinking is that if only they tried harder, they’d get better. Sadly, many people with type 2 diabetes also believe this and blame themselves for their condition.
Type 2 diabetes is often viewed as a “lifestyle” disease that is modifiable—even curable —with proper attention to diet and exercise. But the causes of type 2 diabetes go far beyond personal responsibility. While being overweight is a risk factor for developing the disease, there are also a host of other contributing factors—such as age, family history and ethnicity (see “Risky business”, page 26). We also need to remember that being overweight is the result of a complex set of causes that include having a genetic disposition to obesity, the prevalence of inexpensive high-calorie/nutrient-poor food, urban sprawl, hectic lifestyles and sedentary entertainment. Yet the fallacy persists that people who are overweight are simply lazy and that weight is the sole driver of type 2 diabetes. “There’s no question that type 2 diabetes occurs more frequently in overweight individuals, but we have to remember that most people who are overweight never develop diabetes and, similarly, many people with type 2 diabetes aren’t overweight,” says Dr. Andrew Advani, an endocrinologist at St.Michael’s Hospital in Toronto. “There is an important genetic component with type 2 diabetes as well as a lifestyle component. And the genetic component for people with type 2 diabetes is actually stronger than it is for people with type 1 diabetes.” He also points out that age is an important risk factor for type 2 diabetes. “Because of all the media attention that’s been focused on the development of type 2 diabetes in the adolescent population we are missing out on the important fact that there is a much higher frequency of type 2 diabetes in the older population, he says. Dr. Advani adds that the vast majority of people with diabetes—about 90 per cent—have type 2 diabetes. “It’s so much more common than type 1 diabetes and that means most people who are going to develop long-term complications are people with type 2 diabetes. The research being done regarding diabetes complications is going to bene t all individuals with diabetes.”
“There’s a direct relation between how people with diabetes function emotionally and socially and how they care for themselves.”
THE EMOTIONAL TOLL
The misguided idea that being overweight is the sole cause of diabetes has an enormous impact on people with type 2 diabetes because the discrimination they feel can actually hinder them from losing weight and managing their condition properly. They may experience low self-esteem and depression, which can cause them to look to food for comfort. “There’s a direct relation between how people with diabetes function emotionally and socially and how they care for themselves,” says Michael Vallis, an associate professor at Dalhousie University in Halifax, whose expertise is in adult health psychology with an emphasis on diabetes. “If the bias they experience increases the distress they feel, then the distress can increase the eating.” People may also avoid getting the medical attention they need. A Yale University study of 500 overweight women found they often delayed seeking preventive healthcare because of negative attitudes by doctors and nurses and embarrassment about being weighed. If you think healthcare professionals are above judging overweight people or people with type 2 diabetes, think again, suggests Vallis.
The misguided idea that being overweight is the sole cause of diabetes has an enormous impact on people with type 2 diabetes because the discrimination they feel can actually hinder them from losing weight and managing their condition properly. They may experience low self-esteem and depression, which can cause them to look to food for comfort. “There’s a direct relation between how people with diabetes function emotionally and socially and how they care for themselves,” says Michael Vallis, an associate professor at Dalhousie University in Halifax, whose expertise is in adult health psychology with an emphasis on diabetes. “If the bias they experience increases the distress they feel, then the distress can increase the eating.” People may also avoid getting the medical attention they need. A Yale University study of 500 overweight women found they often delayed seeking preventive healthcare because of negative attitudes by doctors and nurses and embarrassment about being weighed. If you think healthcare professionals are above judging overweight people or people with type 2 diabetes, think again, suggests Vallis.
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