Every now and then, when the endless brouhaha of U.S. culture and politics start wearing me down, I indulge in the mental fantasy of becoming an expatriate in Iceland. It’s one of those fantasies that’s almost completely divorced from reality: most of what I know about the country comes from seeing various friends’ vacation snapshots. I have absolutely zero understanding of what it would take to emigrate, and I presume that my professional skill set as a non-profit fund-raiser wouldn’t have much (any?) value on the Icelandic job market.

Still, any country that has such a well-established tradition of Christmas book-giving sounds like the sort of place that’d be right up my alley. So I continue to hold this Icelandic emigration fantasy—loosely, but holding onto it nonetheless.

Now it turns out that being in Iceland would also impact my recent diagnosis.

I stumbled across a fascinating article in the Guardian over the weekend. The whole thing is worth the read, but the main point is clearly summarized from the get-go:

Labelling people as having pre-diabetes could do more harm than good, experts have said, as research reveals that even some of those involved in coining the term now reject it.

This might have been useful context for my endocrinologist to share, don’tcha think?

But wait, it gets better!

Critics […] say the threshold the ADA sets for such levels makes patients out of healthy people. […] They also say only a small proportion of those labelled as pre-diabetic go on to develop diabetes, while such a diagnosis causes unnecessary worry and problems with health insurance and employment.

The World Health Organization has rejected pre-diabetes as a diagnosis, but it is still widely used, particularly in the US where Centers for Disease Control and Prevention (CDC) has adopted the ADA definition. […] The research highlights the fact that the ADA not only continues to use the term but in 2010 lowered the average blood glucose concentration required to label someone as pre-diabetic. The move went against the decision by other expert organisations, including the International Diabetes Federation, to reject the term pre-diabetes and set a higher threshold trigger[ing] preventive action.

Excuse me while I go tear some of my hair out in frustration.

Of course the US is standing alone in contrast to the rest of the civilized world around this.(1) And of course the US medical establishment moved the goalposts on this measure to be able to label more people as sick.(2) Of course there’s been concerns about this pattern of over-diagnosis for years,(3) and of course those concerns have included the conflict-of-interest caused by the ADA getting money from drug companies, and the counterproductive nature of taking an “individualist glucocentric approach” to what is, in many ways, a public health challenge. But hey, why work towards beneficial systems change when, instead, you can make individuals take on a disproportionate level of responsibility (and all the guilt) for their particular expression of human genetic variability.(4)

So after all my upset and self-doubt, it turns out that my shiny new diagnosis is only about halfway-legitimate. (If that.) Goddammit.

Now, my current plan isn’t to dive into a tub of ice cream and remain there for the next several months. That core insight about treating my responsibility to myself (through self-care and health) as seriously as I treat my responsibility to others is still one worth taking in and working on in my life. I’m planning to go back to that same beginner yoga class tomorrow that I attended last week, and I’m beginning to tap into some resources that might help me use this “diagnosis” as a prompt to heal my relationship with food and my tendencies towards disordered eating.

But believe you me, I plan to be a lot less cowed next I meet with Ms. Endocrinologist.

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(1) Medical fatphobia, gun control, the death penalty, educational inflexibility: just put it all into the great American melting pot of clusterfuck fondue…

(2) Just like with the BMI, however-many years ago.

(3) Here’s sources from 2014 and 2017.

(4) Hey, that sounds a lot like how we perpetuate diet culture instead of combating anti-fat bias. Don’t it?

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Image credit: Flickr user Reuben Stanton, via a Creative Commons Attribution-NonCommercial 2.0 Generic license.