Written by Nicole Christina, LCSW
The combination of ageism, weight discrimination and judgement around a diabetes diagnosis is a perfect storm of shame. Aging already comes with challenges in a culture that idolizes youth. Older patients with Diabetes, especially at higher weights, can experience isolation in a culture that values youth, thinness, and self-determination. These three experiences combining can make it really tough for our patients. They may not even be aware of the trifecta of discriminations they are facing. They may just experience a vague sense of shame around not being “good enough”. Of course, these three versions of discrimination may also occur alongside sexual orientation, socio economic status, race, ethnicity, religion, ability and gender discrimination.
A healthy acceptance of the bodily changes due to aging is a foreign concept to many who might rather avoid the subject of aging altogether. An understanding of weight bias and the complexities of diabetes are not in the public psyche. Blame and judgement are more common in a world that fears mortality and tends to boil social problems down to personal failing.
The typical intervention for those with higher weights and Diabetes, is, of course, a diet. This is despite the fact we know with absolute certainty that diets don’t work and eventually contribute to a feeling of failure. Failing the diabetes diet leads to shame, and often another diet. The majority of diabetes advice promotes restrictive diets without much appreciation for the psychological and emotional aspects of eating. The shame of having Diabetes, being at a higher weight and feeling the effects of ageism may lead to coping responses that are problematic and can lead to isolation, depression, substance abuse, healthcare avoidance, or various presentations of disordered eating.
A diet prescription perpetuates the notion that growing old, being a higher weight, and developing diabetes are personal failings. It’s easy to fall into the trap of believing that with a little more willpower, one can overcome these conditions. Blaming the victim is easy and quick because our brains like shortcuts. A more nuanced understanding of a broken food system, for example, isn’t as appealing to most of us. And it comforts us to put these patients into an “other” category; the notion that as clinicians, we too will find ourselves victim to a similar fate eventually is a bit too close to home.
Patients with these apparent strikes against them may feel unattractive, broken and a drain on the medical system. They may feel depressed and useless. Visit a typical medical provider and leave with this unhelpful advice: “Exercise more, and eat less.” This simplistic and scientifically refuted prescription reinforces the shame patients already feel. They likely have already experienced going to a medical provider for an unrelated ailment, and been advised to lose weight. “It’s your fault” is the clear message.
If we are to truly care for our patients, we must recognize the kind of discrimination that exists for people who are older, possibly larger, and carrying a diabetes diagnosis. Understanding the shame trifecta can lead us to treating our patients with more empathy and understanding, as we continue to shed light on the discrimination they face.
Nicole Christina, LCSW is a psychotherapist of 30 years and specializes in food and weight issues. She teaches two online courses; The Wisdom of Mindful Eating and Zestful Aging: Simple and Sustainable Tools for Health and Longevity which can be accessed through NicoleChristina.com. Nicole hosts the podcast Zestful Aging, which is heard in 54 countries worldwide.