The Dish

A reader with Type-2 diabetes joins the one with Type 1 to divorce the disease from obesity:

Your dissenting reader with the Type-1 diabetic child tells a compelling story, but the implicit conclusion you reach is all wrong. No, we shouldn’t let people with Type 1 off the “diabetes=obesity” hook. We should throw away the hook!

For one thing, the mechanism of diabetes causation is not well understood, so we simply cannot say that obesity causes Type-2 diabetes at all. The two are strongly correlated, but research strongly hints at a cluster of shared causes, rather than a straightforward chain of get fat -> stay fat for X time -> develop the diabetes you’ve earned by being fat, you obese loser that is so widely assumed, including by most press accounts.

For another thing, not everyone who develops Type-2 diabetes is or was ever overweight, or has a family history of obesity or diabetes. I know – I was diagnosed with Type 2 at age 36. I’ve never had a body-mass index over 24, and for most of my life I’ve been skinny as a string bean, as are most of the men in my diabetes-free family tree.

The first thing my doctor did after my diagnosis was pack me off to a so-you’ve-got-diabetes class at the local hospital. The class, like just every online and print resource I could find, focused its advice not on managing glucose intake and natural insulin function, but on weight loss. But I didn’t need to lose weight!

I’m 6’0″, and was down to 150. My doctor wanted me to try to gain 10 pounds! In the meantime, I was asking a question that confounded every doctor, dietitian, and American Diabetes Association hotline expert I talked to: What should I eat for breakfast? If I needed to lose weight, they had answers. If I was on insulin, they had answers. But if I was at an appropriate weight, and just wanted to find a plate of foods that my weakened insulin system could handle without unhealthy blood-glucose spikes, breakfast was a stumper. Our cultural faith in the diabetes=obesity myth runs so deep that the medical and diabetes-research professions cannot even answer the question, “What should a diabetic eat for breakfast, if he’s not fat?”

Now for the good news: I’ve managed my diabetes with diet changes, exercise, and minimal medication. I’ve kept my A1C well below 7, often below 6, since my diagnosis. The keys seemed to be significantly reducing, but also more evenly distributing, my carbohydrate intake. Chiefly, no liquid carbs (except wine and beer, because, come on). No soda, minimal juice, no sugar or flavored syrups in coffee. (Advice to your non-diabetic readers: Stop drinking sugar. Don’t go soft like Bloomberg and reduce your serving size; just don’t drink anything with sugar or corn syrup on the ingredient list.)

Yes, I miss the great big glasses of orange juice that used to start my day, and the tall glass of milk with supper, and the heaping plates of pasta too. But I’m healthier and fitter than ever before, except for, you know, diabetes. The problem is, I had to figure this out by myself, because I didn’t fit the assumed paradigm of diabetes=obesity. Riding in the annual diabetes fundraiser bike event Tour de Cure, I’ve met many people who, like me, had to figure out treatment plans themselves because their problem was having diabetes, not being fat.

I don’t see much evidence that the focus on treating obesity is actually helping people who are both fat and diabetic, but I do see evidence that this focus harms those with diabetes for whom weight is not also a crisis. Yes, people, especially kids, with Type-1 diabetes are the primary victims of the diabetes=obesity myth, but so to are a good number of adults with Type 2. So don’t just exempt the kiddos from the stigma. End the overall stigma of diabetes=obesity=you earned it.

A reader writes:

The comment from your reader who was a butch little girl broke my heart a little. I have an8 year old who is a little gender-queer, but not trans, and probably not gay, and he had a terrible time at school this year.  My son is an awesome kid – sweet, smart, and funny. He is both one of the butchest boys I know and one of the most gender-queer. He truly has no regard for gendered clothing, shows, or interests. He loves karate and superheroes and video games and Spongebob and Star Wars: Clone Wars. He also loves sparkly, brightly colored clothing and nail polish and hair color and My Little Ponies and Tinker Bell. He has been both Samurai Jack for Halloween and a fairy. He plays with girls and boys.

This year, I allowed him to paint his nails black and orange just before Halloween.  I didn’t think anything about it. It was the week before Halloween! His second grade classmates taunted him for it and called him a girl. One of them punched him in the balls. None of the boys would play with him any more. Only one girl would play with him.  My son has a rebellious streak and decided to respond by bringing “girl books” to school and wearing pink shirts and more fingernail polish. The bullying continued. Despite an anti-bullying policy, the school’s main intervention was to advise us to get him to tone down the gender non-conformity.  We did, but I can’t help but think that the message that my son got was that gender bullying is okay and that it was somehow his fault if someone bullies him for being a nonconformist.

We’re transferring schools this year. I can’t take it and my son shouldn’t have to.

Another:

I’m now a 60-year-old gay man, partnered for almost 25 years and living a reasonably happy life. When I was little, I was a mama’s boy and definitely not considered a typical boy.

I played with dolls, like to dress up and loved doing whatever Mom was doing. In my baby book, Mom even recorded my atypical personality at the age of three, “Ricke is still a little girl at heart.” I knew that I was different from my other little male friends, but it didn’t seem to make much difference until about 3rd grade. It was then that I began to be bullied at school for being a sissy. Feeling miserable and lonely, I began to pray nightly that God would change me into a girl during the night and that I’d wake up feeling that everything in my life would be OK. That was the only solution that came to my young mind back in the 1950s. I knew nothing about homosexuality and on my own, couldn’t see any other way for me to fit in.

Well, that obviously didn’t happen. In high school I began to understand that I was gay and by college fully accepted it and began to live my life. I grew up to be a man who can take care of himself. Thanks to Mom, I can cook, bake, iron, sew, knit, hang wallpaper, paint a room or an entire house, and in general do what needs to be done. But it does make me wonder about the current trend toward diagnosing transsexualism in young children. I certainly don’t feel like a woman trapped in a man’s body now.

Another:

I am really appreciating all of the posts you’ve had in the last year or so on trans experiences.  I don’t recall there being so many in the past, and your uptick coincides with my own son’s transition (from Laura to Lucas). I’ve also become acquainted with a young woman at our church who has a young son who is a “princess boy.”  She is very supportive, but her ex-husband is So Very Not.  I’ve been passing on all of your posts to her and they have been very helpful.  So thank you on behalf of both of us, plus the many other family members and friends who have also found various of your posts so enlightening.

David Graeber explains the origin of “please” and “thank you”:

The English “please” is short for “if you please,” “if it pleases you to do this” — it is the same in most European languages (French si il vous plait, Spanish por favor). Its literal meaning is “you are under no obligation to do this.” “Hand me the salt. Not that I am saying that you have to!” This is not true; there is a social obligation, and it would be almost impossible not to comply. But etiquette largely consists of the exchange of polite fictions (to use less polite language, lies). When you ask someone to pass the salt, you are also giving them an order; by attaching the word “please,” you are saying that it is not an order. But, in fact, it is.

In English, “thank you” derives from “think” …

[I]t originally meant, “I will remember what you did for me” — which is usually not true either — but in other languages (the Portuguese obrigado is a good example) the standard term follows the form of the English “much obliged” — it actually does means “I am in your debt.” The French merci is even more graphic: it derives from “mercy,” as in begging for mercy; by saying it you are symbolically placing yourself in your benefactor”s power — since a debtor is, after all, a criminal. Saying “you’re welcome,” or “it’s nothing” (French de rien, Spanish de nada) — the latter has at least the advantage of often being literally true — is a way of reassuring the one to whom one has passed the salt that you are not actually inscribing a debit in your imaginary moral account book. So is saying “my pleasure” — you are saying, “No, actually, it’s a credit, not a debit — you did me a favor because in asking me to pass the salt, you gave me the opportunity to do something I found rewarding in itself!”