Although they are not overweight, they have terrible eating habits. I went to the supermarket with one of them and watched as she loaded her cart with pancake mix, syrup, diet soda and several boxes of processed frozen dinners that were advertised as healthy but contained huge amounts of sodium.

Her concession to the fact that she has diabetes was buying light syrup and some bananas. She did not have a single vegetable other than what was included in her frozen meals. She also leads a sedentary life.

She is constantly complaining about her “bad genes.” When I suggested that her diabetes might be due to her eating and exercise habits, she explained that she is not obese and therefore did not cause herself to become diabetic.

I don’t know what her doctor has told her regarding lifestyle, but in general it does seem to me that type 2 diabetes is looked upon as your fault if you are heavy but beyond your control and the result of “bad genes” if you are thin. I think this is a dangerous mentality and also quite untrue.

DEAR READER: Absolutely. Type 2 is the most common form of diabetes. It is commonly associated with being overweight, but this does not mean that simply being overweight will cause you to develop diabetes. Rather, excess weight is simply a risk factor. Other risk factors include a family history, leading a sedentary life, age, ethnicity and more. Diabetes may be associated with other health conditions, such as high blood pressure and abnormal cholesterol levels.

Type 2 diabetes is caused when cells become resistant to insulin and the pancreas is unable to make enough insulin to overcome the resistance. When this occurs, the cells no longer take in sugar, causing it to build up in the bloodstream. The exact reason why this happens is unknown.

Symptoms can include increased thirst, extreme hunger, slow-healing sores, frequent urination, unexplained weight loss, fatigue, frequent infections and blurred vision.

Complications can arise from untreated or poorly managed diabetes. Short-term complications need to be addressed immediately because, if left untreated, they can lead to seizures and/or coma. Short-term issues include hyperglycemia (high blood sugar), hypoglycemia (low blood sugar) and increased ketones (potentially toxic acids) in the urine.

Long-term complications develop gradually. If the diabetes is left untreated or poorly treated, these can become permanent or life-threatening. Long-term issues include cardiovascular disease, bone and joint problems, skin and mouth conditions, and nerve, eye or kidney damage.

Type 2 diabetes is often preventable if proper steps are taken to manage risk factors. It is important to maintain a healthful diet and exercise routine. Remember to include plenty of fruits, vegetables and whole grains while reducing your intake of animal products and sweets. Simply substituting sugar-free products for normally sugar-laden treats is not helpful. Any excessive intake of simple or complex sugars (carbohydrates) can result in high blood-sugar levels. A registered dietician is an excellent resource in developing a meal plan.

Exercise can lower blood sugar and decrease insulin resistance. For those with diabetes, aerobic exercise is the most beneficial and should be included most days of the week for at least 30 minutes per day.

In those who develop the condition regardless of lifestyle changes, treatment is available. These include medication to stimulate the pancreas to produce more insulin, inhibit the production and release of glucose causing cells to need less insulin to transport sugar, block the action of enzymes that break down carbohydrates, or make tissues more sensitive to insulin and insulin injections.

As you can see, simply being overweight isn’t enough to cause diabetes. While your friends may be thin, they likely have risk factors for developing diabetes and have, thus far, failed to make the necessary changes. They are accountable for their health, and blaming “bad genes” is just an excuse. They must change their lifestyles and not rely only on medication to solve this problem.

People who are overweight can benefit greatly from losing weight, and in some cases, that may be all that is necessary to improve or even reverse type 2 diabetes (or high cholesterol or high blood pressure). Those with normal weights still need to be accountable and make changes.

To provide related information, I am sending you a copy of my Health Report “Living with Diabetes.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

More specifically, I am 65 and probably an alcoholic — the result of a lifetime of bad choices and a couple of bad marriages. I live (by choice) in a fairly remote part of Michigan’s Upper Peninsula, where medical advice is hard to come by. I also have a history of oral cancer, despite not having smoked for more than 20 years. The only ENT doc available to me has decided that the “cut it out and biopsy it” approach every three months or so is the proper one.

While I quite understand that his approach is the most conservative one, I am barely healed up by the time I need to go see him again. A second opinion is not available to me up here, and I am truly miserable for the time it takes for my mouth to heal. Do you have any suggestions on an alternative approach?

DEAR READER: I was immediately struck by your straightforward, no-nonsense summation. It is both healthful and refreshing.

Let’s take things a step at a time. My approach to weight loss expects that you might falter. That’s the beauty of it. If you choose to go out for a great pasta dinner, do it. There shouldn’t be any guilt involved, but simply a wish to diversify briefly. You can get back on track and take up where your diet left off. Unfortunately, pounds have a way of creeping back on rather quickly, so it’s important you don’t splurge too often.

If you think you “may be” an alcoholic, you probably are. People often feel they are stuck in a rut. It becomes quite easy to pick up a drink in an attempt to pass the day rather than think of taking a walk, sketching in a book, going bowling or playing a game of solitaire. However, even in remote areas of the country, there are AA meetings and support groups available if you are truly motivated.

Oral cancer can form in any part of the mouth. The risk of acquiring it increases with tobacco use, the consumption of alcohol, in males over the age of 40, for those with a family history; for those with HIV and those exposed to radiation.

A dentist may choose to perform a painless oral brush biopsy that involves taking a sample of tissue for analysis. If the tissue remains suspicious, a scalpel biopsy may be performed under local anesthesia that can be performed by a dentist or specialist. A surgeon may believe the best method of control is through surgery, such as you have had, perhaps followed by radiation, chemotherapy or a combination thereof.

Present these options to your surgeon or dentist for his or her review. If you disagree with what you are told, locate the nearest teaching hospital, make an appointment, get a second opinion and carry on from there. You’ve made it clear this will be an imposition because of your location, but you owe it to yourself.

DEAR READER: PCOS is a hormonal disorder that commonly begins when a female begins menstruation; however, it can develop later in life.

Obesity presents in nearly half of all patients with PCOS and is often the initial complaint. Abnormalities in the menstrual cycle, infertility, pre or type II diabetes and the presence of polycystic ovaries diagnosed through ultrasound are but a few of the other symptoms. It should be noted, however, that having polycystic ovaries is not a firm indication of PCOS.

There is no specific testing for diagnosis. Rather, it is one of exclusion, meaning that a physician will rule out a number of related possibilities prior to deciding on PCOS. The disorder makes other conditions, such as type II diabetes, hypertension and sleep apnea, more likely to occur.

Only you and your granddaughter can determine the sequence of events. When was she diagnosed? Could the PCOS be a result of her obesity? Is that issue under control? I cannot tie in high-cholesterol levels with her excess weight; however, thyroid disorders are often linked with obesity, elevated cholesterol and menstruation abnormalities.

There is help and hope that focuses primarily on her major symptoms. She should exercise and become involved with a regular weight-control program.

Diet modification appears essential. There is some initial evidence of success on a low-carbohydrate diet without discrimination between carbs on either end of the glycemic index. Her caloric intake should be reduced. She should avoid simple carbohydrates such as soda, sugary drinks, doughnuts, cakes and pastries. Any carb intake might focus on choices high in fiber, such as brown rice, whole-grain breads, fortified cereals and beans.

Her physician might decide to place her on low-dose birth control as a means of regulating her menstrual cycles.

She should continue to see her primary-care physician and endocrinologist on a regular basis.

To provide related information, I am sending you a copy of my Health Report “A Strategy for Losing Weight: Introduction to the No Flour, No Sugar Diet.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.