Bi And Large

Thanks for the well wishes everyone, I am back, and my parents have gone home. It was great to have them here... well except for my mother cleaning my house. She means well. We just have to work on those boundaries a little bit! In any case things are great, and the weather here is fantastic... above freezing which is very unusual for this time of year, and the sun feels so good. Everyone is able to get outside and play and walk and have fun and some fresh air, and that is great. Two thumbs up.

So.

This week, as I was at work, I was happily chatting away with one of my patients. Remember now that I treat peripheral neuropathy; so by and large the majority of my patients are older, and many of them are diabetic. The patient I was treating was just darling, one I really enjoy. She is 83 years old, and quite tall for her age, maybe 5'8". I would guess her weight to be about 140 or 150, very healthy and on the slender side especially for a woman of 83 who has seen a lot of life. At that age you start to worry more about keeping weight on, you know. Her husband is in an assisted living care residence now, but she is quite active. Despite her diabetes she walks well, even dances. She is involved with many activities with family, church and her community. She drives well, has a sharp mind, exercises every day, keeps a house and a garden, and for all the world looks and acts like a woman half her age.

So we're chatting about this and that, just catching up, and she mentions in a passing comment that she is fat, in a very self-depricating tone. This really surprised me, first because she tends to have high self esteem normally and second because she certainly is not fat. I paused and questioned her about it, pointing out that she seemed to be at a very healthy weight to me. Her normally chirpy voice tensed a little and she sighed and you could hear the resignation in her voice. Yes, she said, she was terribly fat. In fact, her doctor had told her that if she would just lose 15lbs, she probably wouldn't have diabetes.

I think I literally had to scoop my jaw up off the floor.

REALLY? This is what some medical professionals are telling healthy, happy, wonderful, SLENDER 83-year old women???? That they are responsible for their diabetes and the chronic pain it brings with it because they are so fat? Are you KIDDING me?

I don't argue that being overweight is a risk factor for diabetes. And people who are overweight or obese can lower their risk by losing weight, sure. And some people who have type II diabetes can even cure their diabetes by losing enough weight to restore their insulin function, it's true. But people who are already thin? They probably aren't going to make themselves any less diabetic by making themselves thinner. Sometimes diabetes isn't caused by being fat (shock!) and in those cases, weight loss won't solve it. Moreover, giving this advice to a normal weight patient who is in her eighties seems reckless to me at BEST.

But I think what bothers me most about this is the idea that if you are sick, you must have caused it yourself. And you must have done it by being fat - even if that is obviously not the case. It is so wrong to put that kind of burden on any woman, the double whammy of an emotional burden of thinking she is a social failure and a health failure all at once. Fat tends to get a bad rap anyway, it is always the cause of everything. I remember one time when Iris was a baby and we were rear ended. I went to my doctor after the car accident with pain in my shoulder and he advised me to lose weight. Apparently, fat causes car accidents. Who knew?? Now fat that doesn't even exist gets blamed. I am starting to think that we have trained some physicians in this country - the lazy ones perhaps - into using fat as the great scapegoat. Heart disease? Lose some weight. Cancer? You were fat anyway. Sore knees? Start a diet. Ear infection? Nice one, fatty. Giant gaping wound on your back? Well if you just lost some weight that wouldn't happen. It bugs the crap out of me. I'm not saying obesity is healthy, but when we have reached a point that a slender, elderly woman is blamed for her own diabetes and told she wouldn't have it if she would just man up and lose 15lbs, I think maybe something is a little out of whack.

I'm just saying.