Eat, Love, Diabetes

If you answered "c," feel free to stop reading--and may I interest you in further coverage of Tim Tebow's insomnia?

If you did not answer "c," I'm guessing you had trouble deciding between "a" and "b"--that you wish free-spirited, over-the-top indulgence, particularly in a woman, didn't have to be followed by negative consequences--but that it, inevitably, is.

A caveat before I continue: Ms. Deen says that she has always eaten rich foods in moderation. I am not her doctor, have never met her, and have no knowledge at all about whether her eating habits have anything to do with her diagnosis, three years ago, of type II diabetes.

What I do know is that her on-screen persona is that of someone who derives great joy from food and that this persona has now collided head-on with a decidedly un-joyful disease. Bacon cheeseburgers on doughnuts=fun. Insulin, finger sticks, diabetic leg ulcers=not fun.

Welcome to one of the most challenging and under-recognized conflicts in medicine: people like doing stuff that's not good for them. Just yesterday I asked a man why he had so little motivation to stop smoking. "Because it makes me happy," he replied.

With women, I'd like to propose, there's an added layer of complication: we're more likely to see illness as a punishment for joy. Yes, it's a generalization, but I can tell you that my female patients say things like "I've been cheating" or "I've been bad" or "Go ahead, yell at me"--equating unhealthy behaviors with immorality--way more often than my male patients do.

Why do women do this? Centuries of denial of women's rights--including our right to pleasure--no doubt contribute. American literature, for example, is full of heroines whose appetites lead them to ruin. Think Hester Prynne in The Scarlet Letter and Scarlett O'Hara in Gone With The Wind. In 1900, Theodore Dreiser's novel Sister Carrie caused a stir because many felt its title character's ambitious and pleasure-seeking behavior didn't result in enough misfortune.

Let's not turn diabetes into an abstraction. It's a dreadful, increasingly common, and often preventable disease.

But when we hear that Paula Deen has diabetes, let's ask ourselves if we really acknowledge how much pleasure we derive from eating, or even watching TV shows, about "forbidden" foods--and about whether we consciously or unconsciously think that, particularly for women, poor health is a just punishment for that pleasure.

These realities--no less than taxation of junk foods or government farm subsidies, should be part of our national conversation about food and health.