If something bad happens to you, it’s your own fault. Few beliefs are more precious to Americans than this one, especially in matters of health and sickness. Just look at the reaction to celebrity chef Paula Deen’s announcement that she has type 2 diabetes.
ABC News headlined its story “Paula Deen to Confess She Has Type 2 Diabetes,” as if she were admitting to a shameful secret, and other media outlets followed suit. The coverage has focused on Deen’s high-fat Southern cooking—which, in a society that sees fried chicken and buttered rolls as the dietary equivalents of heroin and crack cocaine—is assumed to be the cause of Deen’s condition.
“When your signature dish is a hamburger in between a doughnut, and you’ve been cheerfully selling this stuff knowing all along that you’ve got type 2 diabetes...It’s in bad taste if nothing else,” fellow celebrity chef Anthony Bourdain told Eater.com. (Deen revealed she has had the condition for three years.)
I’m a big fan of Anthony Bourdain’s work, especially his charming memoir Kitchen Confidential, but 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.
First, there’s no evidence that a high-fat diet plays any role in causing type 2 diabetes. The best demonstration of this is provided by an eight-year-long, randomized, controlled dietary modification trial involving nearly 50,000 American women, which cost $415 million, making it one of the most rigorously designed (and most expensive) health studies ever conducted. Nearly 20,000 of these women followed a strictly monitored low-fat diet, while the rest continued to eat the typical diet they were consuming before entering the study. The former group ended up consuming about 30 percent less fat, 40 percent less saturated fat, and 25 percent more fruits and vegetables than the women in the latter group. They also ate an average of 364 fewer calories a day than they had been eating prior to the study.
After eight years, there was no statistically significant difference in the rate at which type 2 diabetes occurred among women in the two groups. (The women who reduced their caloric intake weighed an average of four pounds less than they did at the beginning of the trial.) This study is the most powerful evidence yet that there simply is no causal relationship between dietary fat intake and developing type 2 diabetes.
When confronted with this evidence, anti-fat crusaders claim that while dietary fat doesn’t cause diabetes, eating a high-fat diet causes people to become fat, which in turn causes diabetes. The problem with this modified theory is that it, too, is unsupported by the medical and scientific literature. Consider that the French, who consume the high-fat cuisine that Bourdain has spent his life cooking in restaurants and celebrating in print, have one third the obesity rate of Americans, despite eating four times as much butter, three times as much pork, and 60 percent more cheese than we do. Just as there’s no good evidence that a high-fat diet causes diabetes, there’s no good evidence that a high-fat diet causes people to be fatter than they would otherwise be.
Indeed, diabetes is primarily a genetic disease. If one identical twin doesn’t develop diabetes, the odds are less than 1 percent that the other will, while if one such twin does have the disease, the odds are better than 75 percent that the other twin will develop it as well. It is also a disease of affluence and old age: in poor countries beset by chronic undernourishment, diabetes is unusual, in large part because most of the population dies before getting old enough to develop it.
It is true that there’s a strong correlation between higher weight and diabetes. This does not, however, mean that higher weight causes diabetes. Rather, it appears that both higher weight and higher diabetes risk are caused by the same underlying genetic mechanism: the so-called thrifty gene that leads some people to store caloric energy far more efficiently than others.
Ironically, Bourdain himself appears to be an excellent illustration of this phenomenon. Bourdain’s books are full of tales of the many gargantuan meals in which he indulges on a regular basis, and they contain no hint that he has seen the inside of a gym at any point of his adult life. Yet Bourdain has always been thin—an attribute that appears to have nothing whatsoever to do with his lifestyle.
Speaking of lifestyle choices, Kitchen Confidential contains various harrowing scenes from Bourdain’s past as a heroin and cocaine user, as well as copious documentation of his chain smoking. I don’t mean to suggest that Bourdain intended to glamorize these habits; indeed, he went out of his way not to. But the fact remains that, at least among certain trendy segments of society, a male celebrity chef with a serious drug habit in his past is, oddly enough, considered a less problematic spokesman on health matters than a matronly woman who does not disguise her affection for comfort food.
All of us have our bad habits, but an especially bad one is indulging in moralistic sanctimony when we encounter the misfortunes of others. As has been pointed out before, the worst aspect of this particular vice is that it so easily mistakes itself for virtue.