This week an article in Runner’sWorld highlighted the story of Mirna Valerio, an inspirational ultramarathon runner who happens to weigh 250 pounds. While Mirna doesn’t have diabetes I found the article particularly poignant in that it highlights a fundamental misconception, that being overweight means you are not healthy. We are always told that being overweight causes us to be unhealthy but body weight varies all over the place. Obesity isn’t the cause of our having diabetes and losing weight isn’t a cure for our diabetes. And we can not only be healthy, we can manage our diabetes and be healthy for all our lives even if we remain overweight.
I don’t know why I feel the need to be a contrarian on some of this stuff, but it’s worth pointing out that outliers on the curve like Mirna Valerio don’t discredit the central tendency of the curve. Being overweight, especially dramatically so, is one of the biggest health risk factors we know, and keeping weight in check is one of the most powerful things we’ve identified that people can do to benefit their health. And although the causal arrow may also be reversed and diabetes may cause weight gain, the evidence that weight gain is a big risk factor for diabetes is pretty robust.
I guess some people will say that merely articulating this is “shaming” people, but how can we have any sort of causal conversations about our health while avoiding such supposed shaming, about weight, or taking vitamin D supplements, or driving without a seatbelt, or anything else?
Or maybe I’m being unnecessarily defensive and there’s a more nuanced conversation to be had here about averages and outliers and the simplistic stories that I definitely agree characterize our public health discourse, in this area and elsewhere.
ok, I’m gonna take a big risk here and divulge a lot of personal information. @niccolo I am 41 years old, T1D for 31.5 years, A1c of 6.1, I weight 220 lbs. There is NOTHING about me that says UNHEALTHY. I also walk 2.5 miles a day. My PCP and endo are very pleased with me.
I’m envious of the thin diabetics that can eat a moderate amount of carbs and not gain weight. That’s not my case. I am happy with my numbers and quite proud of all my accomplishments.
On average, being overweight correlates pretty well with various disease risks, like heart attacks, and we have some good reasons to think that correlation is causal to a significant extent. But that doesn’t mean that every overweight person suffers heart attacks, or that every person who suffers a heart attack will be overweight. It’s just that the risk of having a heart attack appears to rise as one becomes overweight.
That doesn’t mean you should despair, and it doesn’t even necessarily mean you should work hard to try to lose the weight, in part because there’s quite a bit of evidence that yo-yoing weight is even worse than excess weight.
But given a choice, from a health perspective, lots of evidence suggests it’s better not to be overweight. But choice is a funny word in this context, and it’s worth acknowledging that for a host of reasons, many not well understood, some people have a far harder time avoiding excess weight gain than others. One thing we do seem pretty clear on is that it’s far harder to lose weight than to avoid gaining it in the first place, so from a public health perspective, that can help guide interventions.
I am fine. Just had all types of testing done. Blood pressure was 118/70. Cholesterol levels are fine as well. I’m a muscular, athletic, retired competitive gymnast. Thank you for your suggestion though.
I replied to this conversation because I have struggled with my weight all my life. I was raised by my mother who is a textbook anorexic and told me since I have diabetes, I could not be fat. Boys wouldn’t like a girl like that. My father was an elite athlete all my life. He ran several marathons and finished an Ironman. So my dad sort of balanced my mother’s crazy out.
With that being said, I have finally come to accept my body and I’m quite proud of my accomplishments. After 31 years of diabetes, I have ZERO complications. I like who I am. Oh, and for what it’s worth, I have a boy that really likes me too.
@niccolo, I don’t understand what your point is. The article isn’t telling people to go out and gain weight because, oh well, being overweight doesn’t matter! It’s showing that people who are overweight (which is a majority of people in North America) can get out there and exercise and be as active as they want to (with their doctor’s approval, of course). I don’t understand how that can possibly be a negative thing. I don’t know anyone who would willingly choose to be overweight versus thin, but if someone is overweight, is it not better to get out there and exercise and get a bit of support while doing so?
Well said Jen. Trust me, if I could be thinner, I would take it in a heartbeat. But, that doesn’t discourage me from staying healthy and taking care of myself. I just have a very difficult time losing the weight.
I have the exact opposite problem, I’m 5’9" and 129lbs and 34 years old. My fiancee is 5’3" and outweighs me by well over 100lbs. Her cholesterol, blood pressure, and bgs are much better than mine was. I’m the one with the health problems, not her. I’m not completely convinced that overweight people are unhealthy. I did lose a lot of weight in the past few years, especially after my divorce. My heaviest was around 180. I eventually dropped to around 118-119(according to my bathroom scale
I lost quite a bit of weight following my divorce and was diagnosed with D in 2011, when I was 30. I probably lost more weight following my diagnosis because I didn’t have access to adequate and proper care.
@curlysarah: I’m overweight, too. I would have hoped that, of any site, everyone on this site would understand why a running magazine featuring an overweight runner is so positive.
The problem is those causal conversations often break down into fat shaming in the guise of health concerns. Now why that breakdown occurs might be a good conversation for another thread, but for me, the takeaway from this article is a vibrant, energetic and, yes, healthy woman is embracing life to the fullest. Shouldn’t that be a goal for all of us? Isn’t that a great prescription for health?
Our modern society has lots of problems. One of them is fat shaming. Fat shaming is somewhat bizarre. Throughout our history we have associated extra weight with health, fitness and survival. But these days we have turned the world on it’s head. Yes, excess weight is associated with things like diabetes and CVD. But association is not causation. Some of you may recall I [blogged about the misconception that obesity causes diabetes back in May][1]. There are very good reasons to believe that gaining weight isin fact not the cause of diabetes. During my time at the ADA sessions I listened to all these lectures about the physiological ways that Type 2 diabetes occurs. Not a single speaker identified obesity as a physiological link to diabetes. This comes through loud and clear in the [2009 Banting lecture from Ralph DeFronzo][2] who points out eight separate defects that are thought to be at the heart of Type 2 diabetes. I’ve shown them below, none of them are obesity.
We need to remember that association/risk is not causality. Yes, there is a strong association between obesity and diabetes. But there is also a strong association with lots of other things. Heck, high blood sugars are associated with diabetes as are high blood pressure and cholesterol abnormalities. That doesn’t mean that obesity (or high blood sugars, blood pressure or cholesterol) causes diabetes. The science just does not support a causal link between being overweight and diabetes.
That being said, the real point of the article was that health outcomes were more associated with being fit than being “normal” weight. A fit but obese person has better health outcomes than an unfit normal weight person. Fitness apparently trumps obesity as a risk factor.
Sorry Brian, I’m with nicolo on this one… Being overweight isn’t good for health, and it’s not particularly helpful to try to convince anyone it is…
And while it is absolutely remarkable that this athlete can accomplish such grueling feats while being overweight— just imagine what she could do at a more “healthy” weight.
@Brian_BSC is a much more engaged consumer of the research literature than I am. I’m surprised that his takeaway is that he personally thinks there’s no causal link between excess weight and diabetes, but given how thoughtfully I’ve seen him engage on other diabetes-research-related topics, that’s a significant datapoint for me. But if I had to make my best guess at this moment, my assessment would be that all other things being equal, someone who set about gaining a lot of weight via major lifestyle changes would also raise their risk of incurring or exacerbating Type 2 diabetes. But I’m intrigued by the suggestion that I might be wrong about that.
More generally, it drives me crazy when anecdotal evidence is cited as supposedly disconfirming more general trends. To cite a totally different example, some children who receive childhood vaccines will manifest as autistic later. But a few such anecdotes tell us nothing about whether vaccines cause autism. And even things that are clearly correlated are often not causal, which is precisely what Brian and others are suggesting characterizes the relationship between obesity and diabetes.
On the shaming topic, my perception is that people are very quick to brand any suggestion of a causal relationship between weight gain and diabetes as “shaming.” That strikes me as a way to stifle healthy discussion, I think it’s much more useful to try to engage on the science of whether there is in fact such a link. But I get that these issues are very personal for some, and I do think fat shaming is a very real thing, even if I would only apply that term to other, more overtly pernicious, commentary.
I am hardly arguing that people should deliberately make themselves overweight. Rather I am arguing that a better strategy for managing outcomes when you get diabetes might be to use low carb diets to normalize blood sugars and become fit through exercise. Instead people that are overweight and have diabetes or pre-diabetes are taught that they can cure their diabetes through weight loss when in fact that has not been shown to have good outcomes. If being overweight really caused diabetes we would expect weight loss interventions to work.
And I’m not suggesting you’re arguing people should deliberately make themselves overweight! But I am suggesting that you seem to posit that if someone deliberately made themselves overweight, you think that wouldn’t change their Type 2 diabetes risk.
Especially given how hard weight loss is, based on tons of evidence, I think there’s good reason to question how effective the prescription to lose weight is. A prescription to try to avoid gaining that weight in the first place strikes me as much more viable, though, of course recognizing that weight gain is only partly a function of lifestyle choices. And I know that suggesting people have any agency over their weight opens the door to supposed “shaming.”
And moderating carbs seems like a no-brainer to me, both for controlling diabetes directly and for managing weight.
I don’t understand how people are interpreting the article as encouraging people to be overweight. Of course people should maintain their weight if they are not overweight and should try to lose weight if they are overweight. The fact is that most people are already overweight. For those people, who are the majority, why can’t a running magazine feature an article about them?
Is a diabetes magazine that features an article about someone with diabetes complications being active in sports encouraging people to disregard their diabetes control and “get complications”? NO! It’s showing that if life circumstances have already brought one down that path, there is still hope and a way forward and that an active lifestyle is not limited one type of body.
