I am a cynical SOB, probably the most cynical guy you'll ever meet. I fear this move merely provides an excuse to those who are unwilling to accept responsibility for their own actions -- am I am a member of that group. I believe in most cases excess weight is the result of too much eating -- PERIOD.
There is no doubt in my mind that weight control is, or can be, an important part of diabetes management. I went from insulin at every meal and at night before bed to don't use insulin at all after a drop of 40-pounds.
Was I obese? Yup. Was I suffering from a disease? Absolutely not! I was suffering from my own ignorance and laziness, not to mention my stubborn rationalizing. As soon as I began to pay attention and do what I should have done years earlier-watch my carb. intake-I began to MANAGE my glucose level and the weight-loss came as a by-product. Had my Doc been able to get my attention earlier, I've told him that maybe "a 2-by-6 up-side the head" would have been a better course of treatment prior to beginning to use Metformin - he thought I might be right - I might have dodged the insulin-usage bullet
I am very fortunate. I have only 1 medical condition I must deal with - blood glucose level. I still test 3-4 times each day and any deviation from the straight-and-narrow shows up.
I've probably lot 500-pounds in my lifetime, and gained about 550-pounds. I weigh myself every morning, and holidays, grandkid's birthdays, etc. are easy to spot on the weight-chart.
I'm far more casual with carb-control today, but a birthday or a big dinner show up on my glucose meter.
In addition to being cynical, I'm also long-winded, as you can see. Your thoughts on "Obesity as a Disease" will be greatly appreciated.
I think it may be more complicated than that. Gary Taubes' "Why We Get Fat" notes clinical studies of people who gain weight while eating very lightly but I think that his conclusion is that eat less carbs is the way to do it. I was 275 lbs c. 2004 and am around 190 right now (working on getting it down, I was up to 200 maybe 8 weeks ago...) and at every stage of progress, I've looked at what I'm eating and cut some carbs out. I think there are genetic components to obesity that doctors don't bother investigating. I've never found doctors too interested in discussing food, with the possible exception of my PCP who is quite chatty about it. I find that if food comes up, I get referred to a dietitian. I haven't gone to that many of them but the ones I've seen have pretty much suggested that I'm not eating enough carbs. I get a bit peevish every time I hear "get active to fight obesity and diabetes" because I think that it's a lot harder than that and that the marketing should be "get active to have fun and feel good and improve yourself" without a specific weight loss reference. I didn't know what I could do when I started working out but have kept at it and achieved some successes. The important thing is to get going and enjoy the benefits of getting going.
Thanks for your input. I wouldn't be surprised if genetics is a player in obesity, just as it is in diabetes, and if you are fighting genetics winning is a whole lot tougher. There is also a big difference between us Type-2 folks and the Type-1 gang who, I think, fight a very different battle.
I'm not a dietitian-follower, mostly because I'm too lazy to put out the effort needed to following their instructions, I've a friend that weighs the amount of lettuce in his salad-that's dedication! I've seen notes on a number of forums about folks having very different effects from the same diet, or even the same food item, so there seems to be a lot of "different strokes for different folks" at play here.
Back in my "meaty days" I would have told you that I "ate lightly", which was a view of the amount of food I ate. Once I began to watch WHAT I ate, specifically carb-content, I paid no attention to calories, just carbs, and things began to change I'd tell you I drank a glass-or-two of milk and ate a couple of slices of toast for breakfast while I read the paper. I found it was 4 slices of toast with margarine and peanut-butter. That's a BUNCH of carbs.
I ate lunch when I realized I was hungry, typically a sandwich on the run, and it was not unusual to not eat any lunch at all, just more coffee.
I'd eat a late supper, often times a TV-dinner, followed by several sugar-free cookies. Another BUNCH of carbs.
You are absolutely correct - " The important thing is to get going ..." I find that the hardest part of all my chores is getting up from the couch, after that it's really pretty easy.
I can not go out and walk, I get bored. My kids gave me an iPad for my birthday a couple of years ago and now I spend a good deal of time reading on it. I've found I can prop it up on my treadmill and read while I walk, so I now walk for 30-minutes most days and have reached the point that my conscience nags a bit when I don't have a good reason to not walk.
I personally don't believe that obesity is a disease, but I do think it is very complicated. Having read people's comments here on TuD over the years has caused me to observe those around me more. I notice that the obese people I know are IMO "carb junkies." They just crave those carbs. I am also around a number of thin/very lean people, and interestingly they are not carb junkies, but dang they eat a lot of food. Considering our sedentary lifestyles and abundant food supply, I think it's a miracle that anyone is thin! And my last musing is that I think for women especially, there is pressure at a young age to do calorie-restrictive diets, and that just starts the vicious cycle that leads to weight gain. I feel so fortunate that I didn't get on that diet hamster wheel.
Hi Melitta - It's nice to know that my views of those around me is shared by others :)
Someone in another conversation made a comment about "eating to your meter". I'd never thought about that but I think it well describes how I now operate. When I "cheat" it shows up the next time I stick-my-finger, and if the glucose level seems high I can, almost always, understand how it came to be.
Your "very lean friends" comment brought a smile. I have a very good friend who is not "thin", he just doesn't carry any excess weight. I have teased him for years that he burns off the junk he eats by twitching his foot ALL THE TIME. I suspect the real reason is just his metabolism is different from mine.
After I had dropped 40-pounds I had to buy new pants, because the ones in the closet were too big - THAT is a really fun shopping spree :) I made that comment to my neighbor and he told me I should stand up on the roof-top and announce to the world what I had done. Not because I deserved praise but because it would pressure me to not fall back, THAT, he said, is called incentive :)
I think that, for some people, obesity is a disease--it's in their genetic code, and there's nothing they can do about it. I know someone whose entire family is obese--and one of her sisters teaches ice skating lessons all day. No matter what they eat (or what kind of weight-loss surgery they've had), they can't get down below a certain weight.
That being said, what the article says is that obesity is a disease--when we objectively classify it as we classify diseases. Obesity doesn't have to be caused by a disease, but it interferes with cellular and bodily processes--that's what classifies it as a disease. And, as a disease, it can cause other diseases.
All that being said, I'm not obese and never have been (and hope never to be). This is my opinion based on a lot of independent research and biology classes.
I suspect you are right. Since I began paying attention to my diabetes and made the changes I've made I've gotten quite an education. No two of us are the same was not really big news, but the role genetics plays in EVERYTHING is absolutely amazing.
I opened this thread because,being the cynical-bumbling-bear that I am I wondered if my "sure, give it a fancy label and now I have an excuse to let someone else take care of it" response is reasonable or should I just shut-up. The responses have been interesting. I should probably sit-down and shut-up -
BUT - as my wife will attest, that is REALLY HARD for me to do :)
Thanks to you, and to the others who've taken time to chat here, I appreciate it and it's nice to know that while my perspective is not totally off-base, it is skewed some, as are most of my opinions.
The sun is shining, the sky is blue and the thermometer says 75-degrees, I'm headed for the patio to do some Sunday afternoon lazing and read. See ya all later.
"I've seen notes on a number of forums about folks having very different effects from the same diet, or even the same food item, so there seems to be a lot of "different strokes for different folks" at play here."
That makes sense to me. No matter how politically correct we'd like to be African and Europeans and Asians adapted to eating quite different things. Lactose intolerance for example, is a genetically-determined characteristic. The frequency of decreased lactase activity ranges from 5% in northern Europe through 71% for Sicily to more than 90% in some African and Asian countries.
So it make sense that we all wouldn't have the same reaction to food given our genetic diversity.
I consider this move by the AMA to be "Disease Mongering." This is just a "business" move intended to create a new condition thus increasing the total available market. Following this declaration will be pressure for insurance/Medicare to cover diagnosis and treatment, new treatments from the pharmaceutical/medical device industry and increased numbers of health care professionals making a business out of managing diabetes as a disease. This will certainly be a boon to Bariatric surgeons.
The AMA doesn't look out for us as patients, they are a "trade" association for the health care industry. Patients desperately need a voice to protect our interests in these sorts of matters.
