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Moralizing illness and weight

[ 150 ] January 18, 2012 |



I have a piece in the Daily Beast on Paula Deen’s “confession” that she has Type 2 diabetes. The belief that one can significantly lessen the risk for developing diabetes by avoiding certain foods has no scientific basis, but since it fits in so well with our general tendency to moralize illness and our specific fear and loathing of both dietary and body fat, it’s extremely commonplace.

The gender dynamics inherent in Anthony Bourdain’s criticisms of Deen are particularly interesting. Bourdain’s books paint a picture of a man who eats exactly what he wants whenever he wants (and what he wants to eat is very often high-fat classic French cuisine), and who has never counted a calorie or “worked out” in his life. On top of that he cheerfully admits to chain smoking, and to much indulgence in his youth in extra-legal recreational pharmacology. But since he’s thin and a man he gets to lecture America about all our supposedly terrible eating habits. It’s amusing to imagine what the likely reaction would be if a fat or average weight or for that matter even thin woman with the same autobiography tried to pull this off.

Deen has diabetes for three reasons: her genes, her age, and her weight. The big myth that drives all the moralizing regarding the latter is that it is somehow significantly more malleable than the former two factors, when in fact it would be more accurate to say that it is a product of them.


Comments (150)

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  1. And, as always, you’re a wee bit too hand-wavy in interchanging “being fat” with “eating a lot of unhealthy food.” The former is complex, while the latter is pretty straight-forwardly bad for you.

  2. J. Otto Pohl says:

    Lots of diseases are related to genetics and weight. If you have a genetic predisposition to diabetes or hypertension your doctor will probably put pressure on you to lose weight. Or at least they do in British style health care systems. But, this a health issue not a moral one. When my doctor tells me I should lose 10 kg because I have high blood pressure that is fine. Other people doing it is just plain rude.

    That said I do like Bourdain’s No Reservations or the one month I watched of it while in the US between Kyrgyzstan and Ghana. I am not sure his diet is all that bad. In most of the shows I saw he was eating the local cuisine in places with much healthier diets than the US. There is a lot less fat in my current diet for instance than when I lived in the US.

  3. Richard says:

    But the problem with Deen is that she seems to have vowed not to change her diet. Once you have diabetes, you need to change your diet and lose weight or you die an early death in many if not most cases. Even if her diet choices didn’t lead to developing diabetes (and I think that is unclear – you state that the same genetic condition causes weight gain and diabetes but that is not clear. Diet choices lead to weight gain which is tied to diabetes and while its wrong to say that weight gain causes diabetes, I don’t think its wrong to say that diet choices are a contributing factor).

  4. Scott Lemieux says:

    Good piece; esp. good point on Bourdain as self-appointed health guru.

    • Prodigal says:

      This seems an apt time and place to link to last august’s NYT article about the class hypocrisy in Bourdain’s attacks on Deen:

      When Deen fries a chicken, many of us balk. When the Manhattan chefs David Chang or Andrew Carmellini do, we grovel for reservations and swoon over the homey exhilaration of it all. Her strips of bacon, skirting pancakes, represent heedless gluttony. Chang’s dominoes of pork belly, swaddled in an Asian bun, signify high art.

      • Ben says:

        On a related note, this is a pretty good takedown (in the same vein) of Jamie Oliver:

      • Paul Campos says:

        This point also applies well to the McDonald’s-Starbucks paradox.

        Large order of fries = Imminent risk of death

        Vente americano latte espresso whathaveyou marked with foam = Tres chic

      • McKingford says:

        I call bullshit.

        The idea that Deen’s cooking is the only kind of affordable cuisine for working class people is wrong-headed and condescending, as well as dangerous. Given how much processed and pre-prepared items, as well as the high concentration and quantities of meat she uses in her cooking, it isn’t actually that cheap. It certainly isn’t cheaper than cooking other healthy ingredients from scratch, and including a lot more vegetables and other non-meat forms of protein.

        To say Bourdain’s criticism of Deen is based on class is premised on the bullshit notion that the only cheap calories are empty ones. This is wrong and helps perpetuate the myth that the poor are doomed to stay fat because it is all they can afford.

        • Prodigal says:

          “The idea that Deen’s cooking is the only kind of affordable cuisine for working class people is wrong-headed and condescending, as well as dangerous.”

          It’s also a strawman, since that’s not what Bruni wrote.

  5. Janastas359 says:

    I think my problem here is Deen’s underlying commitment to her brand. I don’t know enough to comment about whether her diet has led to her diabetes; however, I do know that the common conception in America is that diet and diabetes are connected.

    Even if that connection is false, Deen’s thought process appears to be “I peddle extremely unhealthy foods. Americans think that unhealthy foods lead to poor health outcomes like diabetes. If I reveal I have diabetes, then that will strengthen the connection in their minds between my food and bad health. Therefore, I will keep my condition hidden.” I think it’s telling that Deen waited until she could score a promotion deal with a producer of medicines for diabetics before she felt like she could tell the world about her condition.

    I don’t have a problem with Deen making her own health choices. I have a problem with what appears to be shameless opportunism.

  6. Pupienus says:

    The belief that one can significantly lessen the risk for developing diabetes by avoiding certain foods has no scientific basis, but since it fits in so well with our general tendency to moralize illness and our specific fear and loathing of both dietary and body fat, it’s extremely commonplace.

    Okay, I’ll buy that.

    The gender dynamics inherent in Anthony Bourdain’s criticisms of Deen are particularly interesting. Bourdain’s books paint a picture of a man who eats exactly what he wants whenever he wants (and what he wants to eat is very often high-fat classic French cuisine)

    So why are you pointing that out?

    But since he’s thin and a man he gets to lecture America about all our supposedly terrible eating habits.


    Please cite such lecturing. His comment about Paula Deen pushing unhealthful eating habits while knowing she was ill, in large part because of those habits (not the specific foods but the amount of unhealthful foods combined with not maintaining a healthy weight) seems to me both not lecturing and justifiable.

    It’s amusing to imagine what the likely reaction would be if a fat or average weight or for that matter even thin woman with the same autobiography tried to pull this off.

    If it was a fat woman she would be crucified not because she is a woman but because she is likely to become diabetic herself. What your feverish imagination brings forth I can’t imagine. If a woman who maintained a healthy weight said the same as Bourdain I would think it justified.

    Yes, fat people are treated poorly, there is no denying it. The fact that obesity is a major risk factor for diabetes remains. Paula Deen was promoting, even proselytizing consumption of fat laden sugary foods AND doing nothing to counteract the risk of overconsumption by maintaining a healthful wait while she knew she suffered from a disease largely caused by same. That makes her a fair target of criticism by pretty much anyone, regardless of sex.

    You miss the point when listing Boutdain’s dining habits. That Bourdain has engaged in less than healthful behavior does not negate his criticism of Paula Deen continuing to engage in and Promote, even proselytize behavior that

  7. Nigel says:

    You can’t reduce your risk of diabetes by avoiding high-sugar foods? Is that true? We have one diabetic and one definite at-risk in my house, and we control their blood sugar levels through diet. I’d be distressed to discover that we go to fairly great lengths to minimise carbohydrates for no reason.

    Other than that, I agree. Our diabetic, for example, is as thin as a rake. The at-risk person is by no means overweight, either.

    • Katya says:

      High-sugar is not the same as high-fat. I understood the claim was that high-fat diets were not causally related to diabetes.

      • Nigel says:

        ‘The belief that one can significantly lessen the risk for developing diabetes by avoiding certain foods has no scientific basis’ was what he said. He didn’t specify that the ‘certain foods’ were high-fat. If that was the case, fair enough.

        • rea says:

          But Nigel, you’re missing what he is saying, which is not that diabetes can’t be managed by diet, but rather than a person not otherwise at risk for diabetes will not get it simply by a “bad” diet.

          • BruceJ says:

            We don’t know that.

            There are very great many things we don’t know about individual variability and susceptibility to medical conditions.

            We DO know that on the aggregate, people eating a high fat diet and leading a sedentary lifestyle do in fact get diabetes, heart disease, and cancer far more often than people NOT eating a high fat diet and leading a sedentary lifestyle.

            People will point to Jim Fixx (they guy who popularized running to the American public) was in superb shape on the day he dropped dead of a massive heart attack at 52, or 300 pound, clearly obese winning triatheletes, but anecdote != data.

            • Paul Campos says:

              The point about sedentary lifestyle is true. The claim about high fat diets and increased health risk isn’t, and continuing to repeat it doesn’t make it so.

              • Dirk Gently says:

                Hang on a second: citations please? Because the broadness of your claim is at best oversimplified, and at worse flouting pretty much everything people in public health and human nutrition have been asserting for some time now.

                The correlations between CERTAIN KINDS of fat, and CERTAIN KINDS of other foods, and type 2 diabetes is fairly high, is it not? Diet alone is not the cause, that is true. But it IS a factor (in most cases, anyway). Your assertions here that this IS NOT the case is just as sweeping and reckless as the assumptions that Deen’s diet is what has given her diabetes.

                • Aaron says:

                  Lets be clear here: correlation is not of itself proof of causation. If you’re calling for sources from others, arguably you should do better than make an argument no better supported than your characterization of the one you’re criticizing. I suspect that there is something to diet, and that the onset of Type II diabetes can be delayed and perhaps avoided by diet, but as we see more research and less assumption the picture seems a lot less clear than it was even a few years ago.

                  If diet and weight were the only factors involved in Type II diabetes, I have some relatives who should have been diagnosed with it decades ago. That side of the family has none of the genetic markers for Type II diabetes, and has zero cases of Type II diabetes. I’ll leave open the question of whether and when various genetic factors create a possibility of Type II diabetes that could be prevented, or at least delayed, by weight and diet management before it starts to manifest.

                • Dirk Gently says:

                  Aaron: All I was suggesting (or intending to) was correlation, not causation. Paul gives the impression, if not makes the flat assertion, that this correlation is effectively meaningless.

                  Since I am personally not an expert, nor do I currently have university-level journal access, all I can do is a bit of googling, which you can do at least as well as me.

            • JupiterPluvius says:

              We DO know that on the aggregate, people eating a high fat diet and leading a sedentary lifestyle do in fact get diabetes

              If by “we” you mean “researchers and people who follow research” then we know no such thing.

              If by “we” you mean you and your fellow professors at the University of Your Ass, then let me suggest looking at some actual research.

          • Nigel says:

            When my wife was pregnant she was flagged as at risk from gestational diabetes. On medical advice, ALL we did was manage her diet – mainly the sugars, mind, low carbohydrate – and we managed to stave it off. Maybe he really should clarify that sentence by specifying that he means a high fat diet. It seems misleading.

            • Aaron says:

              According to the CDC, about 5-10% of gestational diabetes cases result in post-pregnancy Type II diabetes. Which is not to say that moderating your diet won’t help you avoid ending up in that 5-10%, but it suggests that there’s a lot more to the picture. (The CDC also says that women who develop gestational diabetes have a 35-60% of developing Type II diabetes in the next 10-20 years.)

              The lack of specificity in the CDC’s figures suggest that their data on gestational diabetes is not very good.

              • Nigel says:

                That was the medical advice we received, and we were assured that it pertained, post-pregnancy, to reducing the likelihood of the onset of Type II later in life. It seemed to work. She even took part in a study to that effect (though I don’t know if the results have ever been published.). Reduced carbohydrates and careful monitoring of blood-sugar levels are a prescribed method for reducing the risk of Type II AND for keeping it under control when you have it.

  8. todd. says:

    I admit that I believed, until I clicked through to the study in the other piece, that a high fat diet was causal. That’s pretty interesting.

    My understanding, though, is that altering one’s diet after contracting diabetes can help control the symptoms and advance of the disease. Is this also a misapprehension? If not, wouldn’t it still be appropriate for Deen (as a celebrity with opinions on food) to address these dietary considerations?

  9. TL says:

    “First, there’s no evidence that a high-fat diet plays any role in causing type 2 diabetes.”

    Yes, but there is a strong correlation between a diet high in sugar and simple carbohydrates and diabetes, both of which are abundant in Deen’s cuisine.

    Also, claiming that “Bourdain has always been thin—an attribute that appears to have nothing whatsoever to do with his lifestyle” is incorrect. Bourdain’s choice to live as a heavy smoker undoubtedly plays a role in keeping him thin (even if the health risks of smoking far out weigh those of overweight).

  10. SeanP says:

    Mr. Campos,
    Please provide evidence to back up your statement “The belief that one can significantly lessen the risk for developing diabetes by avoiding certain foods has no scientific basis” as my admittedly cursory and quick review of peer reviewed studies suggests otherwise.

  11. Cian says:

    The belief that one can significantly lessen the risk for developing diabetes by avoiding certain foods has no scientific basis, but since it fits in so well with our general tendency to moralize illness and our specific fear and loathing of both dietary and body fat, it’s extremely commonplace.

    Well that and the fairly good scientific evidence showing a link between certain foods (worst offender corn-syrup – a product of the US agro-industry and sugar protectionism. Thank your congressman) and type-2; but the link between being over-weight and type-2. Is it the only contributor. No. Are you considerably more likely to develop type-2 diabetes if you eat sugary foods and are fat. Yes. Is this a moral issue? Mostly no, its a socio-economic issue. Which you seemed to have entirely missed in your effort to defend Paula Deen.

    • thisdave says:

      Right. The second part of Paul’s statement is well-taken, but not in the context of the first part. There’s plenty of data supporting a belief that avoiding some types of food can decrease one’s likelihood of developing adult onset diabetes, and that changing one’s diet can sometimes result in the remission of adult onset diabetes.

      And, is there anything wrong with encouraging people to eat better foods in order to help avoid illnesses? Or trying to discourage poor diets for the same reason?

      • Aaron says:

        If the issue is that we’re dealing with a condition that is predicated upon certain genetic markers, then yes, there is a problem with waggling our collective fingers at people who are not at all likely to develop Type II diabetes and lecturing them about how they’re going to develop that condition if they don’t watch their weight.

        Weight loss may be appropriate for other reasons (hypertension, loss of mobility, etc.), but the lectures should at a minimum be focused on what’s real for the patient. And if it’s easier to resolve the health issues by focusing on such factors as diet (what you eat, not how many calories) or fitness (people are terrible at maintaining weight loss, but they can nonetheless improve cardiovascular performance and put on muscle), then the focus should be on what might work as a solution as opposed to “I know our past years of lectures about weight loss haven’t resulted in any, but perhaps if I give you the same lecture again this time will be different.”

    • There’s no point in bothering with that. Campos is the king of rhetorical hand-waving when it comes to these things.

  12. mpowell says:

    I’d be interested to know if Paul thinks there is a link between a diet rich in simple carbohydrates and weight gain or diabetes. It is unfortunate that we have been taught that fat=bad for you, because the opposite is probably the case, but it is worth talking about the implications of a diet rich in sugar, particular HFCS, because it may be a real health issue in our society.

  13. Jeffrey Beaumont says:

    I agree with the criticisms of Bordain, and the gender issues involved, but otherwise what are we arguing about? Eating, smoking, exercise, all contribute to how the diseases of old age affect us. Better to be healthy, always, even if some moralizing is involved.

    • Paul Campos says:

      It’s better to be healthy by definition, but that definition needs to be made more complex and holistic.

      Part of that complexity is recognizing that simplistic good/bad food dichotomies are generally more harmful than helpful.

      • David W. says:

        Yeah, but the problem with that reasoning is while eating a moderate amount of fat/sugar/alcohol is o.k. the real issue is that we’re encouraged to consume far more junk food than is good for our health, and it’s a fair cop to call Deen out for her part in fostering such over-consumption.

        • Meh, I don’t think that’s fair at all. People eat what they eat, and I don’t think anyone is particularly awful for putting together a cookbook full of fatty recipes or anything. It’s exploitative, I suppose (and probably moreso if she wasn’t actually willing to eat any of her own recipes), but at the same time people are smart enough by now to know you can’t eat Paula Deen meals every fucking night.

          But like I said above, it’s certainly fair to criticize the fact that her behavior re: disclosure is obviously motivated by nothing but generating more profits for herself.

          • David W. says:

            Nobody eats fast food burgers and fries every night either, but all those fast food ads certainly do contribute to our consuming more than is good for our health.

      • Dirk Gently says:

        See, on THIS I agree. It’s complex–you can be overweight your whole life and not be unhealthy. You can eat some unhealthy foods and not “poison” your body. But in aggregate it’s better not to be overweight and not to eat too much garbage–or perhaps, it’s better to crowd out the unhealthy foods with lots of fruits and vegetables.

        The obesity “myth” of which you speak smacks badly over rhetorical over-correction. Yeah, there’s lots of bad information out there, and incomplete science. But this shouldn’t give people carte blanche and push them into the arms of the sort of anti-science, reactionary mindset akin to climate science “hoaxes” and vaccine “conspiracies”.

    • Ed says:

      Better to be healthy, always, even if some moralizing is involved.

      The moralizing and outright shaming don’t contribute to better health but often make a bad situation worse. There is no excuse for waggling your finger at the obese and telling yourself that by doing so you’re just trying to make their lives better.

      • JoyfulA says:

        Certain medications pile on the weight, regardless of what the pill-taker eats. One of those medications is antidepressants.

        So the moralizing and shaming of the fat helps to deepen the depression and keep the fat person on the antidepressants that add to the fat belly.

        So the smug are helping to cause the problem they so santimoniously deplore.

  14. Corey says:

    Bourdain is also probably healthier because (IIRC) he lives in Manhattan and probably walks a lot more than most Americans.

    • Saurs says:

      Who said anything about Bourdain being healthier, or even healthy? We’ve no special access to his medical history and disclosing that history won’t make him much money because famous dudes’ bodies, weight, and health aren’t as closely scrutinized as women’s, which is why diet food and pharmaceutical companies hound female celebrities for well paid endorsements; the cinderella story of a fat woman becoming thin, and, therefore, “healthy” is both heartwarming and a none-too-subtle form of gendered body-policing, a warning to less affluent and privileged women that even money and fame can’t buy you a ticket out.

      All we know about Bourdain is what he chooses to tell us and that, subjectively, he’s a sort of thin guy.

    • JupiterPluvius says:

      I think Campos’s point is that we assume Bourdain is healthier than Deen simply because he’s slender. Which is silly.

    • Jeffrey Beaumont says:

      This point (Bordain walking in NYC) probably cannot be overstated. The French, Spanish, Greeks, and Italians, of the much hyped Mediterranean diets, all eat various types of sausage, salted pork, pressed meats, tons of cheese, cream-based sauces, etc. Their diet is, in short, not that healthy by most definitions (but fantastic none the less). But what they all do is live in urban areas, even the dense little towns, and they walk all the time. Especially the old people, who as far as I can tell, put on suits, walk to the park, frown at kids and swear at each other about politics. Which is far healthier than our car-based lives and lonely suburban isolation.

      • That can be a tricky argument to make, though, because it is generally the case that obesity, diabetes, and other health problems are more prevalent in the urban core than in the suburbs around it.

        This is a consequence of demographics, though. The inner city has more old people and poor people, so of course the aggregate stats are going to be skewed – but skewed they are. It’s very easy for anti-urbanists to simply throw up some statistics that appear to rebut the claim that urban development patters foster better health.

  15. themgt says:

    Joe Camel, founder of Camel’s cigarettes, announced today that he has had lung cancer for the last three years. Mr. Camel, a heavy smoker of his own brand, concealed his disease until now because of his worry that the diagnosis would add to public concern that tobacco smoke is carcinogenic

    Professor Campos, a strong supporter of nicotine addiction acceptance, stated that the addiction has a strong genetic and societal component, and therefore Mr. Camel is not to blame for his actions

  16. cdn says:

    You write, about Bourdain’s quote, that “this sort of reaction encapsulates the prejudice and ignorance that allows us to indulge in our national pastime of blaming the victims of misfortune for their plight.”

    My own reading of the quote is that not that he is “blaming” Deen for her diabetes but rather criticizing her for promoting a diet and lifestyle (and profiting from that promotion) of which she — because of her medical condition — could not partake. (I’d imagine that Bourdain would be similarly critical of himself if he was diagnosed with, say, cirrhosis, and continued to run a tv show about drinking excessively all over the globe.)
    And you haven’t even touched on the criticisms of Deen for her partnership with the drug that purportedly treats diabetes.

    I’d also add that most of your source material for Bourdain seems to be based upon Kitchen Confidential. I’ll just say that Bourdain has revised and complicated the self-portrait that he crafts in that text (now over 10 years old) in his subsequent work on tv and in print, and your caricature of his persona is overly reductive and simplistic. (Interesting, though, that the cartoonish and reductive caricatures of Deen remain, more or less, fairly accurate.)

    All in all, this is a disappointing take on the debate and the issues at stake for those critical of Deen.

  17. Ben says:

    The bottom line is that weight doesn’t matter. What matters is being healthy. And you be healthy at any size.

    • mpowell says:

      It may be true that weight doesn’t matter within a range that is much larger than the conventional wisdom holds, but making a claim like this that is patently untrue is probably not helpful. There are clearly unhealthy weights and they are not so extreme that we can say that effectively nobody is living at those weights.

  18. Malaclypse says:

    “From his humble beginnings as a street mime in Tupelo, Mississippi, Krusty climbed to the top of a personal mini-empire, with dozens of endorsements including his line own line of pork products. This may have led to one of television’s best-loved bloopers, his near fatal heart-attack, in 1986.”

    In before Norbiz!

    • Hogan says:

      “You know, there’s a conspiracy theory that, after the Civil War, the U.S. government spread false information about diabetes to keep the newly freed slaves sluggish and docile, which is why, to this date, most African Americans don’t understand that diabetes is caused by sleeping on your back.”

  19. wengler says:

    Fuck yes! This is close enough to count as a Campos BMI post.

    It was close but that internet tradition has been kept alive.

  20. LKS says:

    I don’t think there’s anything gender-based about Bourdain’s comments. Anyone who has followed his career closely would know he’d have made exactly the same comments if Deen were a man.

    If you think what he said about Deen is bad, read some of the stuff he’s said about Emeril Legasse.

    This is not to say that I agree with the general tenor of his remarks. I only dispute the “it must be sexist because the target is female” logic.

  21. McKingford says:

    Living in Canada, I have previously been immune from Paula Deen. But in the last couple weeks, the Food Network here has begun airing Paula Deen, and I have to say I find her show an abomination.

    Hell, her go-to ingredient is cake mix (if I want to know how to use cake mix I’ll read the back of the box, on the cold day in hell I buy cake mix).

    I am really at a loss to see how Paula Deen can be defended. Her cooking is uniformly and manifestly unhealthy. It is not that it is high fat, it is that it is entirely high caloric, with most carbohydrates coming in simple form, and with heavy doses of trans fats (both of which do lead to poor health outcomes.

    • McKingford says:

      I should also point out that I can’t stand that accent, which is made infinitely worse by her heavy and obvious smoker’s voice (if we are talking about poor lifestyle choices).

    • “if I want to know how to use cake mix I’ll read the back of the box, on the cold day in hell I buy cake mix).”

      Always a good way to prove your not a dickish snob.

      • McKingford says:

        I dunno. What’s more condescending – someone hating on cake mix, or someone putting on a cooking show premised on the notion that people can’t read the back of a cake mix box?

    • Tom M says:

      Had my wife, 5’5″, 135 lbs and recently diagnosed with diabetes, not mentioned Paula Deen this morning as we got ready for work, I would have remained blessedly unaware of her.
      I have considered spiking my wife’s tea with HFCS as revenge for my inability to return to my previously innocent state but I won’t because that is one invidious product. I met quite a few diabetic amputees in rehab and for a number of them, once is not enough. Horrible disease with horrifying outcomes. Treat it like you mean it; best of luck.

    • Aaron says:

      I have some wonderful cookbooks for making baked goods, candy and confections. Arguably the authors of those books, who for the most part own bakeries and candy stores, are producing goods that are “uniformly and manifestly unhealthy”. But the actual issue is not whether “unhealthy” foods are available, it’s the level to which they’re incorporated into your diet.

      If I am going to create or eat something that’s on the “unhealthy” end of the food spectrum I want it to taste good and to be satisfying in a small portion. I know nothing about Deen beyond the present news frenzy, and am not interested in “baking” that starts with “buy a cake mix”, but I have absolutely no problem with people teaching others how to make food that is “uniformly and manifestly unhealthy”. Nobody makes you eat it.

  22. Randy Paul says:

    I’m going to post about this on my own site, but wanted to make a few points here. I just turned 55 and was diagnosed with type 2 diabetes sixteen months ago. My A1C level was 6.5, which made my diabetic under the American Endocrine Society guidelines, but only prediabetic under the American Diabetes Association guidelines. I have been taking metformin (the oldest diabetes medication) and have lost 35 pounds. I went from 6’2” and 227 lbs. to 192 lbs. My last A1C reading was 5.7. My mother, aunt and sister were all type 2 diabetics.

    I have always exercised regularly, but it wasn’t doing the trick before. I have given up a few things (beer, cookies and mangoes were the hardest), but the single most important thing that the diagnosis has done for me is that it has made me focus seriously on food. I read labels religiously. I think about whatever I’m going to eat before I eat it. I have actually seen my cholesterol lower as I’ve increased the amount of red meat I eat. I prioritize protein and high levels of fiber in my carbohydrates. I will never drink orange and most fruit juices again.

    Weight does matter, as does genetics. My endocrinologist believes that my insulin resistance may have abated, but I intend to continue with the metformin. I have actually increased the amount of gym visits and have no choice but to remain vigilant for the rest of my life.

    Deen, is a woman who has produced a cheeseburger on a Krispy Kreme donut. She has portrayed herself as someone who creates “Southern Cuisine,” but instead makes a mockery of it. I grew up in the South and I know that classic Southern Cuisine relies on elements from Africa, Southern Europe, Latin America and Native American traditions. Her idea of Southern Cuisine is a fucking Cracker Barrel franchise.

    What really offends me, however, is the fact that she is now shilling for a drug that costs $500/month (as opposed to generic metformin), simply because she was too goddamn lazy to acknowledge the gravity of her situation. I do not have enough words to describe the depth of contempt I feel for her.

    • This. You can most certainly not engage in fat shaming or think there’s nothing immoral about liking fried chicken and butter while also thinking that Paula Deen is an asshole of a human being.

    • Paul Campos says:

      I have no sympathy for Deen’s drug shilling, but the claim that she’s “lazy” is quite revealing.

      • Randy Paul says:

        Fine, I’ll amend it from lazy to greedy. She didn’t want to give up the golden goose without another golden goose to replace it. She had the illness for three years. Her continued pushing of her rankly unhealthy food during those three years is indefensible.

        When I was diagnosed, I immediately took the necessary steps to lose weight and amleiorate the situation. Diabetes is a Pandora’s Box of medical complications Given the possible consequences (neuoropathy, blindness, mputations, kidney failure amoing them) it was really a no-brainer.

      • Randy Paul says:

        She also shills for the Smithfield corporation. I believe your co-blogger, Erik has written some good posts on Smithfield’s perfidy.

    • JupiterPluvius says:

      I’m glad your lifestyle choices have helped you manage your illness.

      I am not seeing where you know anything about how successful Deen has been in managing her illness. You just assume she isn’t having success with it because of her weight. That isn’t sound.

      • Randy Paul says:

        Given that she is now taking an expensive medicine that requires her to inject herself, I feel it is reasonable to assume that the first line medications did not work for her.

      • todd. says:

        She has continued to promote a lifestyle that would make it hard for others to manage the same illness. So she’s either encouraging others to eat food that she herself considers unsafe, or she is not taking the same level of care in her diet as Randy. Isn’t it pretty much one or the other.

    • Anonymous says:

      An A1C level of 6.5 is not really that high. It might not even be in your best interest to treat the diabetes. As with obesity (which should not even be classified as a “disease”) we’ve lowered the threshold of what constitutes a condition (and other conditions such as hypertension). The numbers needed to treat to see any reduction in bad outcomes are often enormous. This is to be expected as those who write the treatment algorithms often have financial ties to the makers of said treatments. It would not be such a problem if medications did not have side effects. But they do.

      • Anonymous says:

        how did this answer end up here? It could not possibly be my mistake.

      • Randy Paul says:

        I remember how badly my mother managed her condition, her neuropathy, diminished vision and other ailments, I decided to address it aggresively. Given that I take a fairly inexpensive generic drug for my condition, I don’t see what the basis is for bringing up any issues of financial considerations for my treatment costs.

        • Anonymous says:

          Side effects. I was talking about side effects. But financial considerations are important for some. Especially if they are not on one of the cheaper oral hypoglycemics.

          • Randy Paul says:

            By the way, I double checked and my A1C when I was diagnosed was 6.9, not 6.5.

          • Randy Paul says:

            The sole side effect I had with metformin was some mild diarrhea. I think when weighed against neuropathy, retinopathy and kidney failure, spending a day near a toilet was worth it.

            • Anonymous says:

              I’m sure you’re managing your medication fine– but soem people don’t do as well. There is one very serious side effect of all medications for diabetes of course.

                • Anonymous says:

                  You’re kidding– you can’t name one very emergent condition that can arise out of diabetes treatment?

                • Randy Paul says:

                  You mentioned all medications, so let me know narrow it down to one: what is the serious side effect of metformin? Lactic acidosis is rare as is lowered testosterone. There are no known links to cardiovascular problems with metformin, so please be specific and elaborate on what is the serious side effect behind metformin.

                • Anonymous says:

                  Hypoglycimic shock can occur with any diabetic medication and the right circumstances.

                  It is pretty serious.

                • Anonymous says:

                  Okay, since you mentioned papillary thyroid cancer, may I direct you to this book.
                  I am totally going to cop to reading something that confirms my biases. But my biases did come from experiences and my biases used to be very different.

              • Randy Paul says:

                It’s also easily prevented: I was told to eat meals at regular times and I keep a glucose tablets with me and have yet to use them.

                I also learned a valuable lesson from my mom. She didn’t eat regularly and there were plenty of times when she would start shaking so badly I could barely get orange juice down her.

                The worst that has happened to me is some irritability, but I take care of it asap.

                • Anonymous says:

                  And that is great for you, but your experiences may not be everyone’s. Tight glycemic control is not for everyone– especially those with more mild cases of diabetes. Those with more mild cases are less at risk for long term complications also. The benefits of treatment may not outweigh the risks. That is all I am saying.

                • Randy Paul says:

                  But this where a good doctor plays an important role in determining the course of treatment.

                • Anonymous says:

                  Yes, and I would add a doctor that has time to know her patient– whether they have barriers to compliance that need to be addressed, whether they are up to the challenges of this particular medication regimen, and whether this really is the most important thing in their life.
                  It is a lot to ask, and unfortunately primary care doctors don’t have the time.
                  I think we can both agree that that is a shame.

                • Randy Paul says:

                  I believe it also depends on how informed and well-motivated a patient is. My experience with my mom provided a good template for me.

                  FWIW, my endocrinologist spent a solid hour with me going over nutrition. I went back to my primary care physician and raved about her. My PCP told me that it was difficult fr her to devote that much time to a patient regarding diabetes.

                  When my wife had a bump on her thyroid, I referred her to my endocrinologist. The bump turned out to be papillary thyroid cancer, but she’s okay now.

  23. Anonymous says:

    I’m tired of all the pseudo science. Bad in another way is that modern day Wayne Wheeler, Michael Pollan. He actually said (when explaining his lean and hence morally superior) physique that even though he liked to eat he did not eat foods that “predisposed him to obesity” Whaaa? How does a food “predispose” you to obesity?

  24. brautigan says:

    The belief that one can significantly lessen the risk for developing diabetes by avoiding certain foods has no scientific basis


    There is a well-established, causal connection between obesity, which is the result of unhealthy lifestyles – including poor eating habits – and type II diabetes.

  25. Mrs Tilton says:

    Paul’s campaign against the law school scam is important and good and does him great credit. He should stick to that.

    • Dirk Gently says:

      I wonder how Dr. Campos would feel about Ph.D.’s in Human Nutrition, Health Science, etc. writing books and righteous blog posts about Constitutional law. Not that people can’t be extremely good at doing research outside their ostensible expertise, but shouldn’t specific kinds of training count for something?

      I guess I’m saying: I’m not trying to argue from authority, but what about your training/research has prepared you to be so assertive in your claims?

      • Aaron says:

        If you don’ think a legal education prepares you to be assertive in your claims, I don’t know what to tell you. ;-)

        If you get the facts right and get the law right, who cares what your credentials are. Wasn’t it Campos who recently commented on the increased numbers of non-JD law professors at the nation’s law schools?

        • Dirk Gently says:

          Sure, fair enough. But how do we know he has the facts right? I mean, anyone within the university system can access the appropriate literature. But does it not take certain kinds of training and the impartation of knowledge (not to mention lab research experience) in order to grant someone that expertise? Is being well-read and smart the only prerequisite to becoming a self-taught expert in the field? If that is the case, why are there doctoral research programs at all? Come to that, why should it take a J.D. to qualify one as an expert/practitioner in law? And I’ll have to look back on this to make sure, but wasn’t Campos’ position that non-J.D. holding law professors was a BAD thing?

          I guess my point is that I’m more willing to believe people I know who actually hold Ph.D.’s in this field over someone with a J.D. when it comes to issues such as these. I wouldn’t think of asking these acquaintances for their expert opinion on American jurisprudence.

  26. McKingford says:

    Paul is conflating a number of different things here to make his crusade work.

    To begin, while a high-fat diet may not be linked to Type 2 diabetes, obesity is (as is genetics, and smoking). A high-fat diet can (but need not necessarily) result in obesity. Paul wants to make this all about a high-fat diet so as to call out Bourdain for hypocrisy, but I don’t see anything in Bourdain’s criticism of Deen’s cooking as being restricted to its high fat nature.

    Rather, and this coincides with my own – albeit recent – limited – observation, it is that Deen’s cooking is *unhealthy*. Not only is it high in fat (and *trans* fat – the dire health consequences of which, quite unlike the debate over fat in general, are not really subject to much debate, as well as saturated fat, while low in healthy fats), it is very high in simple carbohydrates and calories in general.

    And even if we can’t agree that one’s diet can *lead* to diabetes, the Deen diet is exceptionally unhealthy for someone who, as Deen now discloses, *has* diabetes. Like CDN above, I agree in reading Bourdain’s comment as a criticism of her cooking in light of the fact that she knew she had diabetes, rather than blaming her for contributing to her illness in the first place.

    I also reject that there is anything moralizing or gender-based in Bourdain’s criticism. He speaks very highly of Ina Gartner, for instance, and she isn’t exactly a waif.

  27. ajay says:

    The belief that one can significantly lessen the risk for developing diabetes by avoiding certain foods has no scientific basis… Deen has diabetes for three reasons: her genes, her age, and her weight.

    Public health warning: the health advice of a professional academic lawyer should be treated with exactly the same degree of respect and trust as the thoughts of a professional endocrinologist on the law of landlord and tenant.

    • R Johnston says:

      Diabetes is a function of genetics, some balance of weight and cardiovascular health, and blind stinking luck. Avoiding certain foods has no causal relationship with any of those things.

      If you care to disagree, try an argument that isn’t an appeal to a lack of authority.

      • Paul Campos says:

        Further public (political) health warning: assuming a lawyer knows what he’s talking about when’s he talking about law can be as hazardous to your well-being as assuming a doctor knows what he’s talking about when the tells you you “need” to lose weight.

        Speaking of which, none of the experts in this thread ever mentioned that the cited study included the successful maintenance of a quite large average daily caloric reduction in the intervention group, which resulted in essentially no long-term weight loss. This is the little detail that always gets left out in these discussions: long-term caloric reduction does not result in significant long-term weight loss for most people who can maintain it.

        Nevertheless people will continue to repeat the same idiocy about how it’s all a simple matter of “calories in/calories out,” as if human beings were as simple as Toyota Corollas in regard to energy consumption.

        In sum, when it comes to this subject the underpants gnomes are always working full time:

        (1) Tell people they “need” to lose weight

        (2) ??????

        (3) Weight loss!

        • Dirk Gently says:

          But you’re conflating things here. Saying obesity is related to health problems such as diabetes is not the same as getting people to lose weight. You’re entirely right that it’s VERY hard to get people to safely lose weight and keep it off–all kinds of different diets and interventions have been tried, and most of the time they fail in that holy grail of getting people to gradually lose weight and keep it off. So you’re right: doctors can’t tell people they need to lose weight and then expect that to happen.

          That said: the correlation between obesity and diabetes is very significant. If you would prefer to call both obesity and diabetes symptoms of the same underlying condition, then fine. But you seem to be suggesting there is no meaningful relationship, when there absolutely is.

        • Nigel says:

          This is the little detail that always gets left out in these discussions: long-term caloric reduction does not result in significant long-term weight loss for most people who can maintain it.

          What? How is this relevant to the issue of obesity/diabetes? And who is ignoring this? Who is saying that just cutting your calorific intake alone will lead to sustained weight loss? Anyone who’s tried to lose a little weight knows you need to combine it with exercise to make any meaningful progress. Any advice I’ve ever read or received has stressed this. Who are you arguing with here? The underpants gnomes?

    • Anonymous says:

      This is just stupid. Endocrinologists do not have a monopoly on analyzing health data. I think it is useful to have people from outside the medical professions scrutinize it.
      As it has been stated before a lot of data dredging goes on.

      • Dirk Gently says:

        Climate scientists do not have a monopoly on analyzing climate science data. I think it is useful to have people from outside the field to analyze the data. Then we might finally be able to decide whether or not climate change is real.

      • Dirk Gently says:

        And to clarify, I’m not against open access to knowledge/data, or against people having a go at educating themselves on whatever topic. I’m against the idea that people who have not been educated within a field can become wholly self-taught experts in that field. I think expertise requires a bit more, including original research.

        • Anonymous says:

          You say that as if every “expert” in a field is conducting high quality original research.
          Would you make the same argument to someone such as Michael Pollan who often cites that stupid CDC study about obesity being responsible for something like 400,000 deaths a year (or something like that)
          Do you hold him to this high standard? Because as far as I can tell, his analysis of data is incredibly superficial.

          • Dirk Gently says:

            My point is that what grants people field expertise, typically, is years of experience via knowledge of the literature as well as conducting (or being involved in) original research. And so: who says Michael Pollan is an expert? Himself?

  28. EP says:

    Though I love both Tony and Paula, this brings up the persistent issue of “if a white man does it, it’s completely different.” Reminds me of this: ; it isn’t a valid argument or view point unless a white man backs it up. So Tony can eat/drink/shoot-up like a rock star, brag about it, and in doing so build up a dedicated fanbase (this also goes for people like Guy Fieri, Adam Richman, and Emeril who are all tubbier peddlers of terrible-for-you food but they enjoy the saving grace of being white men). Whereas Paula can “honey” and “suga” and “butta” you to death, and people will still poke fun of her weight.

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