A study on Type 1 diabetes and heart disease from the University of Pittsburgh Schools of Health Sciences has shown yet another obesity “paradox.”
This one, at least, is actually sort of paradoxical.
Although investigators noted a positive association for all measures of fatness and having any coronary artery calcification, in the two-thirds of patients who had calcification, the relationship reversed so that people with more fat had less severe calcification.
Meaning, if you’re a fat type 1 diabetic, you’re more likely than a thinner diabetic to have coronary artery calcification in the first place — but the fatter you are, the less severe it is.
That’s just my translation, though. And you know damn well journalists aren’t going to translate it the same way.
Reuters, for instance, leads with this:
In patients with type 1 diabetes, excess body weight and fat seems to increase the risk of coronary heart disease. However, as weight and fat levels increase, the severity of heart disease lessens, researchers announced at the 67th Scientific Sessions of the American Diabetes Association in Chicago.
Which is technically accurate, but I had to read it about 10 times before I determined that they were not actually saying, “Fat seems to increase the risk of heart disease; however, fat seems to lessen the risk of heart disease.” (There‘s an obesity paradox for you.) Seriously, that was the article I found first, and I went and searched for more precisely because I could not figure out what the fuck this one was saying.
David Templeton of The Pittsburgh Post-Gazette gets the gold star for warping this one, though. The lede:
It is no license to gain weight, but a University of Pittsburgh Schools of the Health Sciences study does show that people, and particularly women, with Type 1 diabetes who have more fat have less heart disease.
Actual quote from the press release:
“This is not a firm recommendation to people with type 1 diabetes to put on weight, but it does raise the possibility that weight recommendations in type 1 diabetes may be somewhat different than those for the general population, and emphasizes the complex relationship between body fat and cardiovascular risk in diabetes,” said Dr. Orchard, who also is professor of medicine and pediatrics at the University of Pittsburgh School of Medicine.
Templeton again:
Orchard said the findings could be controversial if diabetics misinterpret them as a license to overeat.
Orchard may or may not have said that to Templeton personally — it doesn’t appear to be in the press release — but these are Type 1 diabetics who have had the disease for an average of 34 years. The day they decide they have a “license to overeat” — and please note that this is the second time Templeton’s suggested some sort of formal document should be required for overeating or being fat — is the day I decide I have a license to drive a rocket ship.
I have said it before and I’ll say it again: eating healthfully is obviously a key component of diabetes management. But that doesn’t mean every diabetic who eats healthfully will be thin, or that every fat diabetic is scarfing Ho-Hos. I have never met a diabetic — let alone a Type 1 diabetic — who wasn’t achingly conscious of her food intake. Just because Templeton idiotically makes the leap from “fat can be protective” to “maybe overeating’s good then!” doesn’t mean someone who’s been living with diabetes since childhood is going to do that. Please.
Just in case you haven’t gotten the message yet:
Orchard said the study should not encourage people with Type 1 diabetes to gain weight.
Oh, thank you, David. I didn’t hear you the first fifteen times. Also, Orchard actually said this is not a firm recommendation to gain weight, which is rather different.
Besides which, as we’ve seen, deliberate weight gain is as difficult — if not impossible — for most people as deliberate weight loss. And as Templeton points out eleventy billion times, the doctors’ best hypothesis now is that weight gain may reflect better treatment with insulin therapy, NOT THAT FAT IS EVER NORMAL AND HEALTHY. So there’s no real point in arguing whether purposely gaining weight would help, since it pretty much can’t be done on a permanent basis. And for a diabetic, it certainly can’t be done by massively overeating.
But this is seriously interesting shit. Back to the fairly reasonable (on this matter) ScienceDaily:
“What it comes down to is a kind of double-edged relationship,” said Baqiyyah Conway, M.P.H., lead author of the abstract, adding that these associations of less severe artery calcification with greater fat persisted even when controlling for standard cardiovascular disease risk factors such as increased levels of LDL, or bad cholesterol, triglycerides, high blood pressure and lower levels of HDL, or good cholesterol. Controlling for kidney disease, another common complication of diabetes, weakened the association in men but not in women.
So, somebody with a science background tell me if I’m getting this wrong, but… I’m pretty sure that’s saying that regardless of cholesterol, triglycerides, and blood pressure, being fatter is more likely to prevent serious heart disease.
Only in Type 1 diabetics, you say. Well, yes. Except all this does seems to dovetail, in my not remotely expert opinion, with the evidence that fat people in general are more likely to survive heart attacks.
But, you know, whatever. Your application for a license to be fat is still denied.
You know, the more I read about all these paradoxes, the more I’m convinced it’s all just nature’s way of ensuring we don’t live forever. Being fat will have some health benefits and some health risks, being thin will have others. There is no one magic weight that will garantee longevity. Which you’d think would be fairly obvious, but there we are.
“Now, don’t take this as a license to actually enjoy your food because that would be the Worst Thing Evarrrr.” Right, like type 1 diabetics just cram whatever they want into their faces and don’t think about their insulin levels every frigging second. GAAAAH. In fact, aren’t insulin-dependent diabetics of all types supposed to adjust their insulin intake to their carb intake, which is why they count carbs in the first place? Never mind, though. Any lede that suggests that fat =/= instant death is gonna get buried in the MSM — they’re paid to do exactly that.
Wow. Its as if things aren’t as simple as we’ve been led to believe. I’m shocked. How could the media and medical establishment do this to us? I’d have never suspected.
Must being meaningless. Best to just ignore these findings and get back to clapping louder.
This is the most honest and definitive statement you’re going to get on the subject:
” [it] emphasizes the complex relationship between body fat and cardiovascular risk in diabetes, ”
I like these studies because they undermine our illusions of simplicity.
Kate, I was just reading the insane “does a fat woman have the right to be a mom” question on Broadsheet, and lo and behold, there you are in the comments, kicking ass once again. You rock my world.
I’m going to have to read the paper, I guess, because I couldn’t quite figure it out either; they seem to be using “increased risk” to mean both “more frequent” and “more severe.”
But I think you have it essentially right: Type I diabetics who are fat have a measureably higher incidence of coronary artery calcifications; but the thinner ones who do develop calcifications get them worse.
And I would sum up their conclusion for the long term treatment of patients with Type I diabetes thus: ‘It’s entirely possible that we maybe don’t have to ride their fat asses so hard to lose weight if they’re not naturally thin. More studies are needed. Because, I mean, fat is Very Bad.’
Eleventy billion times.
It’s like if they don’t remind us that many times, their minor and tentative declaration that extra body fat might not always definitively be the cause of all our current and future illness and deaths… without their loving (*patronizing*) reminders and guidance about this, they may as well have just whipped off the big ol’ tablecloths, uncovering the Chinese buffet entryway to fat people heaven. And off we would be running. (Those of us that are, you know, mobile.)
Wheww. Lucky for us we have these guys looking out for us.
As an Australian, can I ask when US society became obsessed with the notion of immortality? Seriously, that’s what I’m hearing a lot of when I hear any talk about the “risks” of being “overweight” – people saying that if I lose weight, I won’t die as soon. Given my genetics (I have three grandparents out of four who survived past ninety, one of whom is still alive and kicking at about ninety-four now) I’m likely to have a good long innings. I also have chronic depression, complete with occasional suicidal patches, so when I hear these things it’s like “And I’d want to live longer for what?”
We all get the same amount of time on this planet: one lifetime. It lasts the same length, subjectively, whether we live one day or one hundred and fifty years. Losing weight won’t necessarily get you more youth – those extra years are added on at the end of your life – and the added stress, strain and misery of dealing with myself on a diet just adds to the problems of my depression. No kidding, I found quitting dieting added about another ten years onto the point where I had to go onto medication for the depression – simply because I found that without the constant daily twenty-four hour self-hate, I felt a lot better!
I’d ask why people aren’t just being encouraged to concentrate on what makes them feel happy, but I realise that if we all did that, the marketing industry would collapse in a heap. After all, they survive by making people feel discontented, so they’ll buy more of $PRODUCT_NAME to try and feel happier.
“License to be fat”–that’s an absolutely perfect concept for how people treat us!
Meg, I don’t know that Americans are obsessed wtih immortality (though I suppose some are) as they are with the idea of a Magic Bullet for Wellness. If you’re thin enough, they reason, you won’t ever get really sick, at least not until you’re well over 80.
Obviously that’s nonsense. People of all sizes and all ages get “really sick.” Yes, even if they’re perfectly slim, athletic, don’t smoke or drink to excess or eat anything “nonorganic.” All the time. Daily, in fact.
But nobody wants to hear it. Nobody wants to hear that they don’t have that much control over “wellness,” that it’s not like all the fat people who are sick or in pain would suddenly be perfectly healthy and running marathons if they could only give up the french fries (which would of course make us all slender as well as give us Perfect Cardiovascular Health). They want fat people to be sick, because they think we’re ugly, and Ugly Equals Unhealthy.
If we all get our feet lopped off from gangrene and go blind from retinopathy, then we can’t walk around their precious airports being eyesores and disrupting their upper-class-twit reveries. So of course diabetes is caused by stuffing your stupid face! It has to be!
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