Peter Attia: Rethinking Diabetes and Obesity

Peter Attia reflects on the possibility that our understanding of diabetes and obesity is completely wrong in a recent talk for TEDMED 2013. As he does, he recalls the compassion he showed to a young women with the diagnosis of fatal advanced-stage pancreatic cancer early in his career and compares that to the compassionless care he offered a woman with type 2 diabetes and obesity. Her foot was amputated a day later. Looking back he asks himself what was driving his behavior.

His answer — that he had thought the second woman was fat and brought her disease on herself — leaves him ashamed. But it wasn’t until Attia himself was diagnosed with metabolic syndrome that he began to rethink his understanding of diabetes and obesity. He faced his condition despite a careful diet and regular exercise. So he began to question the near-universal assumption among doctors and the general public that people with obesity deserve our stern judgment because they bring their diseases on themselves.

Attia, as a part of his medical training, was taught to question every assumption and hold each to the highest possible scientific standards. Now he questions his own assumptions about the relationship between diabetes and obesity. The presumption in medicine then and now is that insulin resistance, the forerunner of diabetes, is a result of obesity. Reduce the obesity and you’ll reduce the insulin resistance.

But Attia started to wonder if, like a bruise protecting the body from further trauma, obesity was, in fact, a result of insulin resistance that was meant to protect the body from further damage. What if some underlying condition is causing the body to store fat rather than burn it  in response to insulin resistance? Could diabetes and obesity be related in a way very different from our current understanding? And if that were true, was he (and everyone else) blaming people with obesity for something that wasn’t their fault at all? Says Attia, when asked what he thinks is the greatest cause of obesity:

The greatest cause of obesity may be that we’re applying the wrong treatment. For about 40 years, health authorities have been telling people struggling with obesity to do the same thing over and over again: eat less and exercise more. This does not appear to be successful. This would suggest that either this treatment is incorrect or it is correct and no one can follow it. Either way it’s probably time for a new treatment.

According to Attia, who now studies the relationship between obesity and insulin resistance full time,  he can’t afford the luxury of arrogance anymore, nor the luxury of certainty. He says we must:

  • Keep an open mind
  • Have the courage to throw out yesterday’s knowledge when it’s no longer working
  • Remember that scientific truth isn’t final, it’s constantly evolving

Attia wishes that he could find the women with diabetes he judged so harshly and apologize to her. Visibly choked up, Attia imagines what he would say:

“I’d like to tell her how sorry I am. I’d say as a doctor I delivered the best clinical care I could, but as a human being, I let you down. You didn’t need my judgment and my contempt. You needed my empathy and compassion, and above all else, you needed a doctor to consider maybe you didn’t let the system down. Maybe the system, of which I was a part, was letting you down. If you’re watching this now, I hope you can forgive me.”

Click here to view Attia’s TEDMED Talk and here to read more about it on the TED blog.

Through Fog We See, photograph © Martin Gommel / flickr

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