It's the Patient's Fault: Not

A lot of doctors don't understand how difficult it is to make major lifestyle changes of the sort that most everyone agrees will help to control type 2 diabetes. "Lose weight!" they'll say, although you may have been trying to lose weight for most of your life and not succeeding. "Get more exercise!" they'll say, even if you've been going to the gym religiously every day.

But one doctor is trying to teach medical students how difficult it is to be a type 2 diabetes patient. In  an editorial in Clinical Diabetes, Stephen Brunton describes how he tried to train medical students by asking them to give up something they loved for just one month. Just one month! Only 2 of the 40 who took part were able to comply. That means 95% failed.

Yet physicians and other medical people routinely tell diabetes patients to give up certain foods or certain behaviors not for a month, but for the rest of their lives. Is it surprising that many don't succeed?

Of course, not everyone says to newly diagnosed patients that they'll never be able to eat a doughnut again, but it's implied when they are told to eat a turkey sandwich on whole-grain bread and an apple (the favorite of nutrition writers) instead of the burgers and fries and pie that they love.

Brunton's approach isn't going to make being a type 2 diabetes patient easy. But I think patients are more apt to work with health care people who understand the problems. "Lose weight" isn't useful. Better would be to suggest keeping a food log and then looking for ways to cut back on unhealthy foods.

I once met a health care worker from Missippi who was making a booklet designed to help overweight people lose weight. She had a "before" photo of a big burger and a big order of fries, the meal taking up the whole plate. Then the booklet had a photo of what the patient should eat instead: a tiny burger and three fries, most of the plate empty. But to anyone with a huge appetite who has always eaten huge meals, a tiny burger and three fries would seem like a punishment. And they'd still be hungry. She apparently didn't understand what it was like to live with a huge appetite.

I wondered if it would work better to show a big burger without the bun and a huge mound of green beans, or some other vegetable that the patient enjoyed. That way, the meal would still take up the whole plate and would also take up room in the stomach, helping to dampen hunger.

Whatever, I think if more physicians tried to look at the problems of living with diabetes from the point of view of the patient rather than just wondering why the patients didn't improve, we'd see more progress.

"She just won't lose weight." Maybe she can't. Maybe there's something wrong with her appetite control so she's ravenously hungry all the time. It's almost impossible to not eat when you're ravenously hungry.
"He doesn't exercise." Maybe he works two jobs and commutes for two hours and just doesn't have the time or energy for formal exercise.
"I doubt that he takes his meds." Maybe he can't afford them.

Feeling that your physician understood your struggles would help a lot more than just being told to do this and give up that. No one really understands how difficult it is to live with diabetes unless it happens to them, but at least Dr Brunton is trying. Let's hope his editorial motivates some physicians to change their approach.