Challenging Stigmas in T2D Part 2: The Weight Stigma

If you live in a larger body, it’s likely you’ve experienced some weight stigma. Add type 2 diabetes into the mix, and you’re even more likely to see this happen. In fact, the recommendation to help people living with type 2 diabetes lose weight is written in many diabetes curricula and national standards. So, one could argue fixating on someone’s weight is seen as an “acceptable” way of managing type 2 diabetes.

What is weight bias/stigma?

It’s discriminating or stereotyping someone based on their weight. In a 2010 piece by Dr. Rebecca Puhls and colleague, weight stigma was estimated to be as prevalent as racial discrimination.¹ This means, weight stigma comes in many forms and can be found in all facets of life, including the medical world.

What does weight bias/stigma look like in the medical world?

Imagine two different people living with type 2 diabetes. One falls into the “normal” BMI range and the other falls into the “obese” BMI range. They are both struggling with higher blood sugars, despite eating healthy portions of a variety of foods and exercising on a regular basis.

The person in the “normal” weight range is prescribed medication to manage their blood sugars.

The person in the “obese” weight range is told to lose weight to manage their blood sugars.

The impact of weight bias/stigma on type 2 diabetes management

First, this means the heavier person will continue to be exposed to higher blood sugars for longer. Putting them at risk for complications down the road.

Second, weight loss is an outcome, or result, not an action. Asking someone to be more active, modify their eating and sleeping patterns, work on ways to reduce stress, all of those are actions. Which tend to result in improved health (and blood sugars) regardless of what someone’s weight does in response.

Now imagine you are the larger person in this scenario. Imagine having tried to lose weight over the years, only to regain it and then some. Or perhaps you were actively losing weight when you talked to your doctor about your unsafe blood sugars. Or maybe you like your body just the way it is! You may feel defeated or helpless in this situation. Here you have a diabetes problem with no reasonable solution.

What to do about weight bias/stigma with diabetes care?

Here are some ways to start combating weight stigma in your diabetes management:

Self-care behaviors instead of appearance

Request your medical team to focus on creating a diabetes management plan around self-care behaviors, rather than your appearance. You can start this process by refusing to be weighed at your medical appointments (this is your right!). This is sometimes a great place to start advocating for yourself. See how your medical team responds. If it doesn’t seem to be supporting your requests, you can find a healthcare professional that practices Health At Every Size.

Focus on actions instead of weight

Personally, focus on actions vs. weight as a way to improve or maintain your diabetes health--- as I mentioned above, many actions can improve blood sugar levels and your overall health, regardless of your body size.

Be compassionate with yourself

There’s a tremendous amount of research that demonstrates long term weight loss (long-term being five years) is very difficult to maintain for the majority of people. It seems our bodies like to be in a certain weight range (which is different for different people), and fight against sustained weight loss in ways we have little power over.

Avoid social media

Shield yourself from social media and news posts (unfollow and unfriend people---also your right!) fixating on the use of special diets and exercise plans as a means to improve health by achieving “ideal” body sizes.

Find like-minded folks

Find people that can relate to your experiences and what you’ve been through with diabetes and weight. You’re not alone.