Are People with Diabetes Marginalized?
Exploring what it means to live in a marginalized body isn't something we talk about, so we invited Patrilie Hernandez to share their lived experience and deeper understanding.
Recently, I met Patrilie Hernandez, founder of Embody Lib. Patrilie has over 15 years of experience as an educator, advocate, and policy analyst in the health and nutrition sector.
Patrilie explained, “My own disordered behaviors and thoughts around food, health, and bodies infiltrated all aspects of my life. I want to use my own lived experience as a higher-weight, multiracial, neuroatypical, queer femme of the Puerto Rican diaspora to disrupt the status quo of current health and wellness spaces, advocating for a weight-inclusive paradigm.”
Patrilie is interested in integrating interdisciplinary, multi-dimensional, and weight-inclusive strategies that improve the health and well-being of historically marginalized communities. “My background includes culinary arts, social sciences, JEDI (Justice, Equity, Diversity, and Inclusion) nonprofit management, public health, and nutrition.”
Patrilie’s website is packed with information. There was much to discuss, but our conversation focused on the following questions.
What does it mean to have a marginalized body?
How is interpersonal marginalization different from systemic marginalization?
How is intersectional stigma tied/linked to oppression/marginalization?
Can you share how this can impact people with diabetes?
Q: What does it mean to have a marginalized body?
A: To marginalize a person based on their body (including their social identities) means to treat them as insignificant or less than others, usually by pushing them to the margins of society, isolating them, or disempowering them.
Q: What is an example of a marginalized body?
A: Marginalizing intentionally maintains imbalanced power dynamics.
Q: Can you say more?
A: For example, if there is a group of people being excluded or exploited based on their identity while benefiting members of the perceived dominant group (i.e., cisgender, able-bodied, white, Western European descent, heteronormative, Christian), this experience would be marginalizing. Marginalized people live in their bodies, and this experience becomes incorporated into their mental, emotional, and physical being.
Interpersonal, institutional, and structural marginalization all emerge from this social fabric. Research demonstrates that consistently experiencing systemic marginalization is significant in adverse health outcomes.
IDC Article: The Invisible Barrier: Meet Seven Common Stigmas In Diabetes Care
Q: Are you speaking about Weathering and Age-Washing?
A: No, but these are additional issues for healthcare professionals to be aware of.
Below are the definitions of these terms from the book Weathering, A Geronimus.
“Weathering results from repeated or sustained activation of the physiological stress response over years and eventually decades. This means that a person’s health and life expectancy depend more on their experiences, their interactions with others and the physical environment they live in than on their DNA signature or lifestyle.”
Age-washing is a term coined by Dr. Arline T. Geronimus. She explains, “In the West, we tend to believe that there is a universally uniform growth and aging process that, barring premature death from an acute virulent infection, a genetically linked disease, or an accent, everyone will have a long health life 00 provided they make disciplined, doctor-sanctioned, health-promoting choices regarding diet, exercise, and lifestyle.” (Geronimus, Weathering 2023)
Resource:
HOW UNDERSTANDING RACISM AND DIET CULTURE HELPS CULTIVATE JOY AND BUILD COLLECTIVE FREEDOM By Chrissy King
Q: How is interpersonal marginalization different from systemic marginalization?
A: While a person who is discriminated against by another individual (also known as interpersonal marginalization) can experience mental, emotional, and physical distress, systemic marginalization negatively impacts entire groups of people.
Systemic marginalization is twofold:
1) At the INSTITUTIONAL level, where harmful policies and practices perpetuate oppression and
2) on a STRUCTURAL level, such as education, health, transportation, economy, etc., oppression is multifaceted and reinforced over time.
Q: Can you share how intersectional stigma is tied/linked to oppression/marginalization?
A: There is a clear relationship between individuals holding specific social identities and experiencing more pronounced negative health outcomes due to institutional and structural marginalization. This includes individuals who:
Live and experience the world in large bodies, especially those who identify as “Large Fat,” “Superfat,” or “Infinifat.”
Are racialized as Black, brown, or an Indigenous Person of Color (BBIPOC)
Are of historically marginalized genders, including, but not limited to, women, non-binary & gender non-conforming people, trans men
Identify as 2SLGBTQIA+
Experience generational poverty
Identify as having a mental illness, are neurodivergent, experience limited mobility, or otherwise identify as disabled.
Individuals who belong to three or more of these groups (social identities) are significantly impacted by the intersection of their experiences, facing compounded institutional and structural marginalization compared to those who belong to one or two of these identity groups.
Q: Can you share how this can impact people with diabetes?
Decades of research reveal that individuals with multiple intersecting marginalized social identities face disproportionately higher rates of complications and mortality from diabetes. This disparity is largely attributed to social and environmental factors, known as structural determinants of health, on an individual's ability to engage in behaviors that prevent or manage diabetes effectively.
Read: Belonging and Ease: Reducing Barriers to Diabetes Care
These factors include
socioeconomic status (such as education, income, and occupation)
neighborhood and physical environment (including housing quality and exposure to environmental toxins)
food environment (such as food insecurity and access to healthy food)
Healthcare accessibility, affordability, and quality,
social context (such as social cohesion, capital, and support networks).
Individuals with multiple marginalized social identities often experience inadequate access and support in these critical areas due to historical policies, beliefs, and practices that systematically excluded or marginalized these groups based on their identities. This lack of access and support significantly impedes their ability to manage diabetes effectively, contributing to disparities in diabetes prevention and management.
Q: Can you share your vision for Embody Lib and the course you offer with the reader?
A: Embody Lib wants to shift the current system into one that embraces an integrated, interdisciplinary, multidimensional, and weight-inclusive health paradigm. This paradigm supports systemically marginalized communities in establishing a solid foundation for working toward liberation, justice, and equity.
Q: You offer continuing professional education, CPE.
A: Yes. Here is a list of the most popular CPE courses offered.