Challenging Stigmas in T2D Part 1: The “Lifestyle” Label

Have you ever noticed that “lifestyle” gets a lot of attention when it comes to diabetes? It can give the impression that a significant piece of developing diabetes was within your power, thus getting diabetes was mostly your fault.

And, managing diabetes? Welllll, “lifestyle” is seen as the ideal way to manage it. So, if you need medications, struggle with weight loss, or are constantly seeing high blood sugars, then you must be doing something wrong!

The lifestyle stigma

I typically see the “lifestyle” label played out in the form of stigmas that range from vilifying people for their eating and exercise habits to delays in medical care.

Stigmatizing and shaming even happens between those living with type 2 diabetes. Fighting about food choices, body sizes, exercise habits, and medication routines can be found all across social media and in real life. I recently “watched” a gentleman get berated for his food choices in an online support group (yikes!).

The media's role in creating stigmas

“Lifestyle” ideals and stigmas are often supported by the media, and even in diabetes research studies. Take the DIRECT study, a type 2 diabetes remission study focused on weight loss as a way to place diabetes in remission. It’s often highlighted in the media, as “promising” and attainable if people with diabetes are just “persistent” enough to “lose the fat.”

Far from promising, what’s often left out of the headlines is:

• Daily intake was limited to around 850 calories (in the form of supplements) for the first 6 months. By the way, this is equivalent to what a baby/toddler may need for daily nutrition.
• 48 people (out of 149) dropped out of the intervention group.
• Only a whopping 24% at year 1 (down to 11% at year 2), met the study’s weight loss goal of at least 15kg (33 lbs).¹

Which begs the question, if study subjects were “persistent” enough to complete the study’s requirements, why did so few folks “lose the fat"? Kinda contradicts the message that people’s dedication and persistence is the “problem”, doesn’t it?

There is no lifestyle quick fix

Despite this, the DIRECT study continues to hold a lot of media attention, and references to its “lifestyle” changes are discussed quite casually.  As if all people with T2D, with enough dedication, can lose weight and put diabetes in remission.

Stigmas create barriers

Stigmas are a significant barrier to people with T2D getting timely and appropriate medical care. Numerous studies demonstrate this. In fact, one reported, "In health facilities, the manifestations of stigma are widely documented...as a result, stigma is a barrier to care for people seeking services for disease prevention, treatment of acute or chronic conditions, or support to maintain a healthy quality of life."² This is compounded if you live in a larger body.

Lifestyle is such a small piece of the pie.  When we look at the impact of different factors on our health risks, lifestyle accounts for about 25%.³ Which is pretty similar to the impact of medical care on our health. And significantly less than the impacts of environmental and social factors.

Combatting stigmas

How do you combat a stigma that seems to be everywhere and in everything?  Challenge yourself, others, even your healthcare team to start thinking of a broader form of “lifestyle.”

• Lifestyle is doing the best you can with the resources you have.
• Lifestyle is moving your body in a way that you enjoy, in a way that leaves you feeling energized, powerful, and confident.
• Lifestyle is food you can afford.
• Lifestyle is food that you enjoy, that allows you to maintain social connections to others and important family traditions.
• Lifestyle is managing your diabetes in a way that results in healthy blood sugars, cholesterol and blood pressure with the least amount of time, energy, and effort from you. Diabetes management does not have to be your life’s work.

Take back the “lifestyle” label and make it your own - something freeing and empowering, rather than restrictive and stigmatizing.