Reanalysing the Blame Directed at Obese and Diabetic Patients

Obesity has become a controversial term, sparking ideas of laziness, ill-discipline, and irresponsible lifestyle. In fact, obesity is a hormonal disease, characterised by pathological changes seen throughout the body. The disparity between public perception and the reality of this disease arises from the profound failures of legislating health bodies.

10 August, 2021

The component of blame which underlies the public perception of obesity is due to the notion that this disease is caused by high-fat diets. In fact, the causes and consequences of obesity are poorly understood, and so the blame is unfair and unfounded. What is clear, however, is that obesity is characterised by a number of pathological changes: insulin resistance affecting the majority of obese patients. As a result the disease is often studied in unison with type-two diabetes, another disease characterised by insulin resistance. In fact, insulin resistance in one form or another affects nearly 50% of the adult American population, and 25% of healthy-weight Americans. As a consequence of its prevalence, diabetes is classed as an epidemic in the United States.

Within the body’s circulation, insulin resistance leads to elevated circulating insulin; alongside other negative metabolic effects, this makes us hungry. This state is greatly exacerbated following a carbohydrate-heavy meal – blood glucose and insulin skyrocket, to a much greater extent than following a protein-heavy or fat-heavy meal. In principle, carbohydrates exacerbate a state of insulin resistance and should therefore be avoided by insulin resistant patients.

Further, categorising food into three distinct groups – carbohydrates, fat and protein – reveals that carbohydrates represent absolutely no dietary requirement for humans. Essential amino and fatty acids – represented by the other food groups – are the only essential dietary components required for human health (essential here refers to a nutrient which we require to function and cannot be made from another molecule within the body). The human body produces its own necessary glucose through a metabolic process called gluconeogenesis – this means we do not actually require the glucose derived from dietary carbohydrates.

Why then, is the advice for type-two diabetics to eat 40 to 65 grams of carbohydrates per meal (excluding snacks)? The American Diabetes Association (ADA) guidelines stipulate there is ‘inconclusive evidence’ to recommend a specific carbohydrate limit, despite asserting that carbohydrate diets are the single biggest determinant of blood glucose. Within the same guidelines, there is advice that under certain diabetes medications – which aim to decrease circulating glucose – patients must eat carbohydrates to inhibit blood glucose levels from falling to dangerously low levels. The advice, therefore: eat carbohydrates, take diabetes medication, and then eat more carbohydrates to ameliorate the side effects of the diabetes medication. Type-two diabetes is a pathological state which can be reversed: the rhetoric of these guidelines suggests, or at least implies, that type-two diabetes can only be managed, not reversed.

As an alternative to the functionally null advice offered by the ADA, Dr. Sarah Hellberg, Clinical Professor of Medicine at Indiana University, recommends eating carbohydrates as the minority food group in her clinic aimed at patients with or at risk of diabetes. As a consequence, her patients must make up their diet from one of the two remaining food groups: Hellberg recommends her patients eat a lot of fat, to keep blood sugar and insulin levels low. To support her advice, Hellberg’s clinic completed a 6-month study comparing results of 50 low-carb, high-fat patients and 50 patients eating a diet recommended by the ADA guidelines. Not only did the low-carb group show a significant metabolic advantage (greatly improving their diabetes), completely removing the diabetes medication in these patients could amount to cost savings of 2000 US dollars per year. Here, Hellberg is aiming and succeeding at reversing type-two diabetes, without the need for medication.

In total, the United States spends 250 billion US dollars per year on its diabetes epidemic. Ultimately, the result of reversing this disease is a reduction in the need for diabetes medication: to reflect this, the ADA panels – which are stacked with conflict of interest due to financial incentives from large pharmaceutical companies – are not promoting the reversal of the disease, but instead to increase patient dependence on expensive diabetes medication.

Social prejudice can be difficult to shake because it requires a fundamental re-analysis of hard facts but is necessary for the progression of science and society. The issue, however, is that those in positions of influence, even in possession of all the necessary facts, are unwilling or unable to promote the changes which could shake the stigma. Adjusting advice, which involves a challenge to the status quo, by suggesting removal of carbohydrates, not fat, from the diets of obese and diabetic patients (and those at risk of those diseases) could redirect scientific research and greatly improve the unfair prejudice these patients suffer.

Obesity and diabetes are poorly understood even by experts, but still stir strong feelings in lay audiences who are quick to label the cause of these diseases as nothing more complicated than laziness. The fact is, those with the final word on diabetes and obesity are doing nothing at all to present real evidence to redirect scientific research, actually help these patients, or to shake the harsh prejudice they face.