Tell Me Again How It’s “For My Own Good”

Lara Frater wrote about this and I wanted to boost the signal.  The Rudd Center recently came out with a study (PDF link) showing that weight stigma affects the stress hormone cortisol.

Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.

It doesn’t require being fat to have this kind of reaction, by the way. Both the lean and overweight women “were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.”

What’s cortisol? Some highlights from Wikipedia:

Cortisol, known more formally as hydrocortisone is a steroid hormone [...] released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat, protein and carbohydrate  metabolism.  [...] Cortisol counteracts insulin, contributes to hyperglycemia-causing hepaticgluconeogenesis and inhibits the peripheral utilization of glucose (insulin resistance). [...] Cortisol can weaken the activity of the immune system.

Being fat (“excess weight”) is considered a cause of insulin resistance.  And it appears that weight stigma increases cortisol … which increases insulin resistance.  Which is the chicken? Which is the egg?

This isn’t necessarily new.  Weight stigma  has been tied to weight gain before.  What this study highlights is one mechanism.  There may be others.  We know that fat bias prevents fat people from getting jobs, from getting raises, and from getting proper healthcare treatment.   Fat people are also often paid less and harassed more than similar-qualified people who are thin.  None of this improves health.

So when I hear people saying that fat people just need more “tough talk” to lose weight “for their own good”? No, I don’t believe them.

Things to Read

You may have seen this poor as folk post on why poor people might not eat healthy.   There’s also a great post on why “healthy food vs junk food” infographics are inaccurate, misleading lies.

From Linda Bacon and Lucy Aphramor at the the Health At Every Size® Blog:

“Obesity-related” disease actually tracks your social status more than what size clothing you wear. In developed nations, data show, members of stigmatized groups, including those who are economically disadvantaged and people of color, are the most common victims of illnesses typically grouped under the “metabolic” umbrella. [...] With social status comes control over one’s circumstances – success at work, fostering loved ones’ well-being, being able to plan for the future, or even next week. The absence of those, no matter how punctilious our lifestyle habits, stresses our systems in disease-promoting ways. In contrast, being able to exert an influence over what matters to us is health-promoting.

And astronaut Karen Nyberg created a stuffed dinosaur in space.

Five Things Make A Post

1) I am sooo looking forward to tomorrow morning, when Mark Reads will post the second-to-last chapter of Deadline.   Mark Reads reviews books a chapter at a time, progressing through books every other weekday, and it’s been building to this OMG HUGE second-to-last chapter for weeks.  (Need I say “spoilers”?) Some of the books he’s done this with in the past are the Harry Potter books, The HobbitThe Lord of the Rings,  and The Hunger Games.  Deadline is the middle book of the Newsflesh trilogy & Mark’s reading the whole thing, starting with the first chapter of Feed here.

2) I got myself a Fitbit Zip to help me be more consistently active — I use it as a pedometer that does built-in recordkeeping, so I can get a sense of how active I am in general, not just a single day. Since I got it I’ve found myself at work focusing deeply for one to two hours and then getting up to walk and get water or coffee or tea or something.  I’d quit feeling guilty about it because I found that a brief break to walk and stretch lets me focus better afterward.  This article helps me rationalize it more ;)

3) A year ago today I signed my father’s hospice paperwork as his medical power of attorney.  The anniversary was a bit freaky this week.  At the moment I’m at peace with it all, but I know my reactions will likely continue to change.

4) I’ve been posting on fat discrimination at http://fatdiscrimination.tumblr.com. It’s not a subject I want to dive into a lot, so posts are somewhat sporadic.

5) Like Paul Campos, I probably wouldn’t vote for Chris Christie.  But it’s not about his weight.

Medical Things

Those following along on twitter know that I went to the Urgent Care near work to deal with a UTI. This, of course, brought up the “Seeing the doctor issues”.

So. Sitting at the urgent care near work about a possible uti. Filled out patient history. Waiting to be called. Panic state: anxious.Fortunately the actual appointment went well, with no weight fight.

Panic state: calming. I did get weighed. No comment on 425lb weight from providers. #wtf #relief #SadThatIAmRelieved

Then it was off to the pharmacy.  The nice part was that the UTI pain relief pills are over the counter now, so I could get them right away and not have to wait for the backed-up pharmacy.

Realizing that I was freaked, but still needed to go, got me thinking.  The Urgent Care didn’t give me a bad time for being fat.  They had furniture that fit me.  There were multiple sizes of blood pressure cuffs in the exam room. There was not only a scale that could weigh me, but again, it was in the exam room, so privacy.  It wasn’t a bad experience at all – but it still stressed me out, because it was a medical situation, and my history is that medical situations are where I am judged, rejected, and hated.

And I started thinking about other medical things I’ve been putting off.   I have a referral to an allergist.  I’ve had it since spring.   I’ve been putting off scheduling a physical longer.

Yes, I also have a work schedule that puts a large lake between my work and my doc.  I’m finishing my father’s estate. And so on.  But I’m wondering, again, just how much that one extra thing tends to result in people not getting standard, basic care.

Game of Thrones Season 2 Leaked

If you are a Game of Thrones fan it may interest you to know that season 2 has been leaked in great detail. According to Tor.com “[n]otorious author George R. R. Martin has immediately taken credit for the leaked information becoming public.”  Tor also quotes “an unnamed HBO exec” as saying “Reading is for people who want to be confused. We never do it. Why should our viewers?”  Ah, April 1st.

(Most of my friends who are watching Game of Thrones had already read all the books published so far in the series before the HBO adaptation started, so I doubt they’re worried.)

Thus far I haven’t watched it.  Partly it’s that the trailers give me no reason to watch – generally they’re showing the characters.  This is great if you have read the books and know who you’re looking at. If you haven’t, well, why should I care, you know?

This is often my response to TV and movies, by the way.  Why should I care?  I will note I grew up in a house in the 70s and 80s where the TV was turned off on very rare occasions.  I am well experienced in the tropes of  cop shows, sitcoms, soap operas and action-adventure stories.  (To this day I can recall more of the General Hospital and Dallas plotlines than I would prefer.)  I hate procedurals, Law & Order most of all.  I am bored by many sitcoms. I find cop shows  are predictable and/or trying to hard to push my emotional buttons. (It’s not just a dead victim, it’s a dead victim who was a child molester and killed by a victim’s mother!  Etc.)  Then, if I do start to get into the story, the commercials kick me out of the narrative to shout about diets, cars, beer, sales, and other minutiae — often with a side of women-hating and self-loathing for the win.

I do like humor. I do like stories.  There’s a reason I bought Daria and Coupling on DVD.   I did go see The Hunger Games in the theater, even though I knew going in that the movie had a longer run time than it took to read the book.

There’s another factor, and that has to do with what do I want in my brain.

Sherlock Holmes: Listen: [gets up and points to his head] This is my harddrive, and it only makes sense to put things in there that are useful. Really useful. Ordinary people fill their heads with all kinds of rubbish, and that makes it hard to get at the stuff that matters! Do you see?

- Sherlock BBC, Episode 3: The Great Game

I have enough stress from real life.  I don’t need stress from entertainment. I don’t want Biggest Loser or Fat March or Extreme Makeover: Weight Loss Edition or Hydroxycut commercials in my brain.  I don’t need to compare my body to “Hollywood normal”.   I also don’t claim to only be spending time on things that are perfect or useful.  I want my leisure time to be spent on things I enjoy and that help me relieve stress.  Sherlock makes me laugh.  Rosemary and Thyme is beautiful and I can’t always spot whodunit. More often, I curl up with something like Murder With Peacocks or The Adept or Murder Must Advertise or Discount Armageddon, and … I smile.

Doctors, Doctors, Doctors

One of the things I expected in dealing with my father’s medical odyssey was “weight talks” or fat shaming — not of him, but of me.  You know, the “Well, you should take care of yourself by being thin” talk.   It actually hasn’t happened.  I think it’s partly because the patient weighs 175lbs and partly that his primary health problem is strongly linked to smoking.  “You don’t smoke?  Good for you” tends to cover that.

I have new reason to be glad of this.  See, a couple weeks ago I visited an in-law in the hospital.  The reason she was in the hospital wasn’t related to her diabetes, but an HbA1c test was run and her results were high.  During the time I was visiting a diabetes educator stopped by to discuss blood sugar control, including testing, meal composition, activity, stress reduction, and weight loss—a pretty typical “weight talk”. About an hour later a hospital dietitian came in to discuss the hospital food, diet, and, again, a weight talk. And both pointed out that weight loss can cure type 2 diabetes! (Maybe.)

Anyway. The weight talk wasn’t with me this time; I reminded myself, repeatedly, that it wasn’t about me.  The in-law in question would like to lose some weight, slowly, and with an emphasis on maintaining it.  That is her choice, not mine.  No one told me that I should lose weight.  Cool, right?

…and then, last week, I put off calling to get an appointment despite chest tightness and needing to use my albuterol inhaler multiple times a day, after having had a cough and sinus stuffiness for a month.  Why? Because I didn’t feel able to deal with medical practitioners when I was tired and sick.  I feared the stress of “You’re fat and therefore you don’t deserve to be healthy” more than I feared the chest pains. (Granted, I put the pain at about a 2, and breathing shallowly or using albuterol relieved it.  But still.) When a friend urged me to get an appointment — which turned out to be with a new-to-me doc at my practice, because that’s who was available — memories of weight lectures past, and others’ bad experiences, caused me to bring the man of the house with me for support.

As it happens, the visit was fine; pneumonia was ruled out and I was given antibiotics for a respiratory infection with no fat-shaming or weight talk.  I was treated as a patient, not a fat patient, and I’m glad. I just wish it was that way for everyone.

Related:

Blog: First, Do No Harm

Huffington Post: When Doctors Judge Their Obese Patients

Prepared Patient: Larger Patients: In Search of Fewer Lectures, Better Health Care

American Medical News: The weight of obesity: Linking large people to care

Fat Friendly Professionals List

Five Things Makes a Post

  1. New job! I have a new job.  The place I was temping hired me in late December.  I’m not doing exactly the same job, which is both “new and scary” and “cool and interesting”.   It’s also been interesting to note that the things I was looking forward to ending with the contract (the commute, say) are now things I’m stuck with, and the things I was thinking I’d miss (the walkability of the neighborhood) are now things I get to enjoy longer.
  2. According to the New York Times, my household is in the top 48% for the Seattle-Everett area this year (based on my unemployment for the first 3 months + contract for 8.5 months + signing bonus + hubby’s temp gig.)
  3. Asthma has been kicking my butt lately.  My nurse practitioner upped my dose of Advair and OMG I had so! much! energy!  this! week!   I have been enjoying it but also crashing harder at the end of the day.
  4. A coworker was floored that I am able to pick up my father’s wheelchair and load it into my car.  I pointed out that once I remove the back and seat, it collapses into a big flatish bundle.  “But isn’t it heavy?”  About 40lbs, really … which doesn’t seem all that much to me.  So I guess the weightlifting is doing me good.
  5. I have been reading more about caregiver stress and considering support groups.  I feel a bit strange about doing it, since I’m not doing the daily hands-on care.  But I am taking him to doctor visits, making medical decisions, getting his mail, managing his money, and being a supportive daughter.

Bonus: The new blog banner is a chocolate doughnut with chocolate frosting and Sounders green and blue sprinkles.  These are sold by http://www.toppotdoughnuts.com/ at Seattle Sounders games.

Thankful Thursday

[an occasional exercise in gratitude]

  1. Things appear to be getting into “routine” with the parent, instead of “crisis-to-crisis”.
  2. I’ve also been able to cross some major tasks off my list, and more are in sight.
  3. Adding more tasks to my to-do list (managing the parent’s mail and bills, coordinating his care, etc) is making me focus on priorities more.
  4. I have a credit union I am happy with for checking, savings, mortgage, & credit card.
  5. My IRA is with The Vanguard Group, which is owned by the the investors.
  6. The man of the house, for being here.

 

What’s Important?

My mother was fat, though she lost weight shortly before she died.  My father, by contrast, was always thin and muscular.  Yes, he drank like the Navy seaman he’d been and smoked 1-2 packs a day, but he was strong and healthy.  He gained some weight when he retired and quit smoking, but not much.  Heck, he’s  lost some in the last few years. Why?

He wasn’t exercising as much.  Turns out he’s anemic.  Why?  Bleeding from a cancerous tumor.  Oh, and he has some short-term memory problems, which means he shouldn’t live alone.

I’ve been spending a fair amount of time in hospitals and nursing homes and doctor’s offices lately.  I keep expecting to hear “Oh, and you should lose weight because ___________” …. but I’m not.

Maybe it’s because I’m not the one who’s sick.

Maybe it’s because the main risk factor for his cancer is smoking, not weight.

Maybe it’s because I don’t have a history of drinking, and he does.

I can say it’s been interesting dealing with the medical profession in a situation where it’s not about my weight.

I can also say this sort of experience can help focus on what’s important to me.  I’ve alluded in the past to not having the world’s best relationship with my parents, but I’m also not willing to just walk away.  Making the time to deal with this has been challenging.  It’s also made me focus on organizing my life to help me stay sane enough to do what needs doing — priorities like

  • The man of the house.
  • Close friends.
  • Work.
  • Eating regularly.
  • Sleep.
  • Exercise.

These are things that help me stay sane and to have the energy to deal with the other stuff.  (Yes, there’s a reason I’ve been posting about managing stress lately.)  Even so, it’s still been getting me down.  About 2 months ago I saw my ARNP with “Hi, here’s what’s going on.”  We determined that yes, I’m having insomnia, anxiety, and depression symptoms.  She started me on ambien (to help me sleep) and celexa (for depression and anxiety).   The ambien helped almost immediately; the celexa, as is usual for SSRIs, took longer to kick in.   I am feeling more able to cope now, which is good.

Has this changed my priorities or my sense of what’s important?  Yes.  And no.  As is common when I’m stressed, I’m more focused on self-care; this has all narrowed my focus, often to just  “what tasks I need to get done today” and “what I need (to take of myself) so I CAN get through today.”   But the things that I most want to do, and that I find most rewarding, haven’t changed.

Thankful Thursday

[An occasional exercise in gratitude.]

At the moment I’m thankful for:

  1. My temp gig is continuing to go fairly well.
  2. My father is doing better.
  3. I got over my “but things can’t get better” thinking and saw my ARNP about my anxiety, insomnia, and depression symptoms.  My ARNP prescribed Celexa (for depression) and Ambien (for insomnia).
  4. Ambien does help me sleep.  Celexa does seem to help my depression.
  5. I am continuing to do other things to take care of myself.
  6. The man of the house loves me.
  7. Our friends are also supportive and helpful.

Overall: my life is not perfect. My life is not terrible.  I am coping — sometimes day by day, sometimes minute by minute, but coping.

How’s y’all?

QOTD: Nutrition, exercise, and sleep

It’s a stressful time in my household. Both I and the man of the house have temp gigs after months of unemployment.  A relative is ill, needs to move to an assisted living situation, and I’m organizing most of it.   The to-do list is long and getting longer.

But I need to take care of myself, too.  To do this, I’ve been focusing on getting enough sleep, some exercise, time with my “nucleus” and close friends.   So this bit on a reducing stress during times of change was rather reassuring:

[N]ow, more than ever, you must respect your body. Give it the best fuel you can, exercise it well, give it the rest it needs to run at its best. Nutrition, exercise and sleep are not luxuries; they are necessities.

Also essential in life is our humanity. We need to create bonds with family and friends to feel happy.

I also liked found this proportion-making:

Friendship, laughter and that human connection have no cost, yet they are priceless.

We need shelter, water and food for survival. Most Americans have access to all three. We have no war in our country. Our children enjoy opportunities many of the world’s children can’t even imagine.

I also periodically spend a bit of time taking deep breaths and reminding myself that it doesn’t all have to be done at once.

Things That’s Up

New job is going well.   It’s my first completely non-managerial job in years.  Even when I was a “department of one” I was was still doing a lot of project / process management. I’m enjoying just doing things.

I also like this “getting paid” thing.  ;)

My commute is about an hour each way, sometimes longer, depending on bus connections. This is longer than I’m used to, and I’m glad I get to read or noodle on the computer during the long bus ride.

On the fitness front, I’m adapting well to the daily walking-between-buses routine, even with my backpack weighing 16lbs once I add the work equipment I may need at home.  (I carried a heavier backpack in college, but I was more used to it then.  I’m being careful while I adapt now, and doing more tummy crunches and other core work.)

I’m also focusing on being sure I can do tomorrow what I did today — in other words, I’m totally agreeing with Noël on her recent “go hard or go home” rant.

My work desk situation isn’t perfect from an ergonomic point of view, but I’ve made some adjustments that help (raising the monitor & getting a mouse pad).  I also find getting up and walking around a bit every few hours does wonders.  I’m in a rather large office building, so a trip to the bathroom or to refill my water bottle tends to get the kinks out.

I am also dealing with some family stuff.  My father’s been sick lately, and I finally convinced him to see a doctor, so I’ve been ferrying him to and from various appointments.  I wish he’d been willing to see a doctor before, when I was unemployed, but no.  Le sigh.   I’m also finding that being paid hourly makes me worry less about taking time off than when I salaried.  Interesting…

What is frustrating is that 8 hours of work + lunch + 2 (or more) hours of commute  = more of my day that I’d like.  Meeting the man of the house for dinner and a soccer game at the pub?  Fun.  Also takes up most of my “down” time.  My schedule has also been shifted earlier than I prefer.   The temptation to short myself on sleep is strong in the evening, but I know damn well I won’t be happy (or productive) if I do.

So. Off to sleep.  Be good, y’all.

Feeling Like A “Bad” Fatty

I haven’t been exercising.  I spent most of the weekend sitting or laying down. Sometimes I’d be breathing hard from the effort of sitting (compared to laying down).  Sunday I was so exhausted I literally laid down and cried.

I’ve got a cold, which does not combine well with asthma.  Plus I was helping run a small con, which meant quite a bit of adrenalin and the feeling that I “should” be walking around, checking in with our guests, seeing if other volunteers need help, and generally doing things.

You know the sort of “sick” where you feel fine as long as you don’t actually try to do things?  Yeah, that was me, most of the weekend — at least, once I had enough pills / etc that I could breathe regularly and stop coughing.

Yes, I took my preventative meds.  I also took time-release guaifenesin, supplemental antihistamines, and used my albuterol inhaler a lot.  I helped coordinate volunteers, I ran the tech equipment that the other volunteers don’t know or aren’t as skilled with, I helped keep guests organized.  I’m told a lot of folks didn’t realize I was sick.

And yet I feel I was a “bad fatty” because I spent a lot of time sitting.  Because I collapsed with my computer Monday instead of helping carry a bunch of equipment.  Because I didn’t get some borrowed equipment returned until Tuesday.  Because I should be performing feats of strength to prove I have worth, or that I’m capable despite being fat, or something.   Because only bad fats sit around all the time.

The idea that I should have to “prove” my body is okay is one I’d like to unlearn. My brain knows that attitude is insane.  Unfortunately I’m not there yet, and it bugs me.

Update: I did intend this post to be about “Gee, even though I’m legitimately sick, I keep feeling guilty for not doing enough and wondering if people think badly of me because I’m fat.  That’s screwed up.”   Sorry if that didn’t come through.

Things I Would Like To Not Care About

I would like to not worry about:

  • Whether a medical professional will consider my symptoms before making a diagnosis.
  • Whether a job interviewer will not hire me because I’m fat.
  • Whether the friend talking about her diet is doing so as a way of passive-aggressively commenting on my body size, eating habits, or perceived dieting status.
  • Whether I will be seen as an equal partner in my friendships and family relationships, or seen as “stuck” with whoever will have me.
  • Whether a bathroom stall will be wide enough for me bend over and wipe everything, or if I’ll end up squatting “sideways” in the stall.
  • Whether the person who keeps looking at me while I eat is actually engaging in voyeurism without my consent.

I’d like…

  • I’d like my breathing hard walking uphill to be seen as a function of exertion, not fatness.
  • I’d like my periodic wheezing to be seen as a symptom of asthma, not fatness.
  • I’d like the fact that I’m married to not be a shocker.
  • I’d like the fact that I have sex to not be a shocker.
  • I’d like people to treat my exercising as about function and pleasure, not as “a major life choice deserving of applause” OR about weight loss OR as a reason to shout insults at me.
  • I’d like my food choices to be about nourishing my body, about helping my body function well, and about pleasure — not about weight OR being a “bad fatty” OR being a “good fatty”.

I sometimes joke about having “dieting PTSD” from my teenage years, but really, a lot of these buttons were installed by my family (which is not at all uncommon).   I am trying to decouple weight from food and exercise.  I’m trying to decouple health from weight.  I’m not perfect, but I’m working on it.  Most of the time hearing other people talk about diets isn’t a problem, per se — it may be uninteresting, but doesn’t always and automatically start a round of self-recriminations or a visit from The Ghost of Failed Diets Past, and I consider that a win.

I also realize that some of these buttons — like someone commenting on my food choices — are going to get pressed, simply by living in this society, so I’m trying to “disconnect” them.  (This would be easier if there were an actual wire leading from the “button” to my brain that I could reroute or disconnect!)  Again, I’m not always successful, but I’m working on it.

Some of these, like how employers perceive fat applicants or how medical professionals’ biases harm fat patients, do affect my life in very real ways.  I can advocate for myself, I can overdress to seem “more professional than thou”, but all I can do is the best I can.

What about you?  Does this strike a chord for you, or not?

Thankful Thursday

I think it’s time to do this again.  See, my job was eliminated.  Not fun, but I’m at the stage now where I’m thankful it happened, because:

1) Much less stress.  The old job was changing and had become a bad fit, and now it’s OVER.

2) I qualify for unemployment.

3) …also, we have money saved.  I’m touching wood as I type this, but we’re okay for a while.

4) …and, really? I didn’t want that job anymore anyway.  I started looking for a new job, sporadically—like once a month—in June.    Maybe if I’d rolled faster with the changes I’d still be there, but the “not wanting the job anymore” was a big part of why I didn’t roll with the changes well.  I didn’t mean to be obstructionist, but I became obstructionist because I didn’t want to do heavy lifting to change a job I didn’t want.   It became a negative spiral that I’m glad I’m not in anymore.

5)  Finally, I’ve been able to enjoy the time I spend with the man of the house more.  His support has really helped.

I’m also thankful that my blue blazer I got 5 or 6 years ago still fits and looks great with various tops.  ;)    I’ve had a few interviews, but no offers yet.

Dieting Changes How Bodies React To Stress?

At least that’s what seems to happen in mice.  As summarized in US News and World Report,

Shaving calories triggers molecular changes in the brain that make mice more susceptible to stress and binge eating long after the diet ends, researchers report in the Dec. 1 Journal of Neuroscience. The finding could explain part of the yo-yo dieting phenomenon, in which people repeatedly diet and lose weight but then subsequently regain even more than they lost.

Researchers found that the dieting mice were more stressed than the non-dieting mice.  They also found that even after ending the “diet” and regaining the weight, the former-dieting mice were more susceptible to stress than the non-dieters.

The team traced lower activity of the gene that makes CRF to a chemical modification called DNA methylation.  DNA methylation and other modifications to genes help to regulate gene activity. Dieting mice had lower levels of methylated DNA near the gene for CRF than did animals that continued on the high-fat diet or ones that ate as much regular chow as they wanted. This change was essentially locked in for the dieting mice. It did not increase even two months after the diet ended—a long time in the life of a mouse, and equivalent to years, maybe even decades, for a person.

Researchers mildly stressed the mice for a week with things like damp bedding, cage swaps or putting a marble in the cage—mice are not big fans of change—so that the animals didn’t know what was coming next. Under this mild, but chronic, stress the former dieters snarfed down far more of the high-fat food than the nondieters. And the ex-dieters also had higher levels of hormones that prompt eating.

I DID find it rather eye-rolling that the article suggests that “dieters may need to cut stress as well as calories”, given that being fat is itself stressful.  And, of course, it remains to be seen how much of this applies to humans.  But this may help explain the mechanisms by which dieters so often regain the lost weight.

Abstract is here.

Poverty’s Link to Diabetes

[C]onventional wisdom about Type 2 diabetes would suggest that once obesity, lack of physical activity and other lifestyle risk factors were taken into account, diabetes incidence rates would even out between lower- and higher-income groups….

[A recent study found that] for men, being in the lowest-income category (earning less than $15,000 per year), doubles the risk of developing Type 2 diabetes compared to being in one of the highest-income brackets (earning more than $80,000 per year). The risk remains the same when other risk factors are taken into account, such as education, body mass index and physical activity levels.

The findings are even more striking for women in the lowest-income category. For them, the risk of developing type 2 diabetes is more than triple the risk of women in the highest-income category. When education, body mass index and physical activity levels are taken into account, the risk is still well more than double. — CTV

Like other discussion of diabetes risk factors, this is looking at correlation. In looking at other risk factors, a family history of the disease doubles the risk as well.  Other diabetes risk factors that dovetail in with “not enough money” include: stress/cortisol; depression; inadequate sleep; lack of exercise (and while some living in poverty have very physical jobs, they may not get the relaxation and stress-relief benefits that tend to go with leisure-time exercise) and while it’s probably not an official risk factor I doubt that food insecurity would help prevent diabetes.