If you are like many healthcare professionals, it may be hard to imagine how encouraging small weight change, as little as 10%, could backfire when it comes to improving blood sugar control. However, more and more research is showing that weight-centered cures are not sustainable in the long-term and even promoting small weight change can negatively impact the care. What are the five reasons why encouraging weight loss makes diabetes worse?
- Occam’s Razor is a theory that states that the simplest answer is the correct answer yet when it comes to diabetes care, abiding by this theory creates a lot of confusion. Let me explain. If you ask people what causes diabetes, a common response would be ‘being fat’. This answer appeals to many people, especially the people that are ‘thin’ because it gives them comfort knowing they ‘won’t get diabetes’. However, what causes diabetes is far more complex than just being fat. In fact, genetics and age are the two greatest predictors of developing type 2 diabetes and we can’t hide from either of them. Additionally, when a complex chronic disease like diabetes is reduced to a single cause it is fear of the condition, not the desire to understand it, that is at play. Fear of diabetes becomes amplified by existing fatphobia, which fuels confusion, stigma, and self-blame. It becomes acceptable to blame people for getting diabetes rather than taking the time to understand what this complex disease is all about.
- Reducing diabetes to a single cause also devalues the need for education and support which magnifies the emotional harm and stigma of diabetes. Underutilization of Diabetes Self-Management Education and Support (DSMES) is so common that less than 10% of people that are eligible for education are accessing this very effective benefit.
- Failure to object to this simplistic view of diabetes is another pitfall of the Occam’s Razor approach. Since the “Diabosity” stereotype is so well accepted, it creates a bias for healthcare providers to assume that diabetes is just a ‘fat’ person’s problem. The truth is millions of people are at risk for diabetes, and that risk is not just solely based on weight. The factors include race, age, family history, medication, and medical history which is why assigning one ‘cause’ to diabetes makes it possible for more people to be part of the ‘8.1 million who have diabetes but don’t believe know it‘ club. When ‘thin’ people get diabetes everyone acts ‘surprised’ because it doesn’t fit our diabetes stereotype. However, diabetes touches everyone, old, young, rich, poor, fit, fat, happy and sad. There isn’t a ‘type’ when it comes to diabetes.
- One of the most heart-wrenching issues associating diabetes with weight is that many ‘fat’ clients tell me ‘now’ that they have pre-diabetes or diabetes, their body needs to be nourished. This is not only inaccurate, but it also points to another painful reality - fat bodies only deserve care when they are sick. We have to pause here and point out the hypocrisy of this subtle belief. All bodies regardless of size, illness or health need nutrition, regular enjoyable movement, self-care, and self-kindness. Having elevated blood sugars doesn’t change this fact. However, in our society, heavier bodies are often devalued and it isn’t until there is a medical reason, that self-care and self-kindness are even considered.
- Isn’t weight loss a type of self-care? The confusion surrounding self-care and weight loss are so complex, it has been coined by Podcaster and author Christy Harrison as ‘diet culture’. Harrison explains that the focus on weight and health is so ingrained and endorsed by a 61 billion dollar weight loss industry, it feels familiar and the collective culture of pursuing health by dieting now feels obvious, sane and normal! This familiarity reinforces the desire to ignore or minimize research which shows that restriction, under-eating, excessive exercise, yo-yo dieting and associating self-worth with size are not healthy, but it contributes to weight gain, weight stigma and can reenergize disordered eating behaviors.
Okay, so this makes sense but If weight loss is out, what am I supposed to say? The truth is you don’t have to say anything. Healthcare professionals feel pressure to share all the medical information they know. However, just listening and being present with the person before you is a huge gift that your clients will always appreciate. When you are asked about what to eat, it is safe to say that a diet that is balanced and enjoyable is the cornerstone of health. Eating a balanced diet doesn’t mean you have to lose weight. It means you are thinking about what your body needs and providing your body with those nutrients. For people with diabetes, eating a balanced diet that is moderate in carbohydrates is very helpful. Moderating carbohydrate intake doesn’t mean you have to go ‘keto’ or villainize all carbohydrates. It does require you to become aware of where carbs are in your diet, and if there are sustainable ways to disperse the carbs more evenly through the day.
As a dietitian and diabetes educator, my experience shifting to a weight neutral stance changes the discussion from weight loss to blood sugar management. This shift opens the door to create sustainable behavioral changes that are centered in self-care, not in weight change. Adopting a weight neutral approach to diabetes care also helps reduce perpetuating weight stigma, because it clearly explains that diabetes is a complex disease and it doesn’t have a single cause or cure. Furthermore, it explains that diabetes is not the fault of the client, which removes blame and invites the client to learn, engage, and connect with the health care community. For many people, understanding what a balanced diet is, without focusing on weight loss, requires them to unlearn a lot of nutrition myths. Clients are ‘shocked’ by how one or two small changes, from monitoring, diet, or eating pattern or movement, dramatically improves blood sugar and doesn’t require an ounce of dieting.
The WN4DC Symposium is an online educational program for health care providers which explores the intersection of diabetes care and disordered eating. This 16 CPE event is divided into four tracks, starting with Nuts and Bolts of diabetes care, Weight Neutral Diabetes Care, to help you better understanding weight science, Weight Neutral Counseling and Disordered Eating. This amazing event is 100% self-paced, and has brought 18 international speakers together into one learning event. You can purchase the WN4DC Symposium tracks separetly or get all 4 tracks Buy today - https://wn4dc-symposium-2019.teachable.com/
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