“It Is Unbelievably Easy To See Why Sustainability Self-care Isn’t Possible For Most People”

Learn how stigma and lack of ease make sustainable self-care out of reach and what you can do to interrupt this frustrating cycle.

Wendy explained, “You don’t understand; I need to lose weight. My A1C is now above target.”

Her comment came layered between a sense of urgency and frustration. 

My initial question, “What do you think changed?” helped me glimpse how sustainable self-care was out of reach for her and many people with elevated glucose. She went on a strict diet, cutting out carbs and exercising, resulting in a 40-pound weight loss. Then, injury, unemployment, financial stress, and different insurance made it impossible for her to return to her previous plan.

She explained, “Following a keto diet used to work. I don’t understand why it isn’t anymore.”

“You don’t think a lot has changed.” 

She nodded her head. To her, she was her same old self who could no longer manage her blood glucose or weight. Wendy never considered how the conditions in her life had radically changed.

It is easy to think that the changes that happened to Wendy are something she chose or that she has to fix. This assumption is the force behind healthism. Robert Crawford defined healthism in the 1980.  He explains, "Healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well.“  

The Inclusive Diabetes Care Pyramid helps you challenge healthism. It visually represents the barriers and bridges needed to see the profound impact of inclusion and belonging in diabetes care.

Looking back at Wendy’s situation, she had never considered how the changes in her life were filled with stigma and lacked a sense of ease. When asked, she agreed, “I feel judged for gaining weight and having my A1C increase. 

Inclusion Provides a Different View of Health

Wendy’s circumstance is common for people living with a chronic condition like diabetes. While the word ‘chronic’ means a continuous condition that doesn’t have a cure, diabetes is not depicted as the dynamic, continuously changing condition that it is. Missing is how these changes typically mirror the ups and downs of life. 

Society imagines diabetes as something that happened in the past. This assumption leads to the false belief that diabetes is “corrected” or “cured.” If someone is on target or well managed, their blood glucose is ‘always’ on target. The unintended consequence is the expectation that people with diabetes need to be perfect. The reality is that even when diabetes is well-managed, blood glucose levels are not always ‘in target.’

It helps to get curious about where Wendy’s belief that she had done something ‘wrong,’ causing her A1C to increase, comes from. The fix-it mindset prevents us from recognizing the many reasons, including weight cycling, stress, changes in activity, injury, and food quality that impact glucose.

It is also easy to forget that when diabetes worsens, it isn’t solely because of something the individual did. More often, it is because of something that the individual is experiencing.  The shift in the counseling focus isn’t “What are you doing?” but “What is happening?”

As Wendy spoke, her voice dropped lower. “Money has been tight. We can’t afford to follow that type of diet anymore.” She shared how her diet required her to incorporate lower-cost items, cut-out supplements, protein powders, and bars that she previously relied on.  Her typical week changed as she needed to shop at discount grocery stores. “They just don’t carry the foods we were eating.”

Using the IDC pyramid shows that Wendy’s previous sense of belonging has been replaced by financial, weight, and health stigma.  Ease has evaporated because of persistent economic stress that requires her to change where and what she purchases.  

“When I was losing weight, everyone was so encouraging. They were excited for me and cheering me on. Now that I have regained 40 pounds, people's reactions feel more like judgment, like I did something wrong. People don’t understand how hard our situation was.

Othering and the lack of ease, combined with not feeling seen and judgment surrounding weight gain, eroded the conditions needed for sustainable self-care.  This is why our session focused on untangling Wendy's multiple types of stigma. We did this by stepping back and looking at her situation through a lens of inclusion.

Belonging is the First Step for Inclusion

Rebuilding the conditions that support sustainable self-care starts with belonging. Using the IDC pyramid, Wendy began to recognize situations that felt othering; for example, bringing lunch to work created a sense that she was different from her co-workers. She became curious about weight stigma and how this also contributed to her sense of being othered. 

“I didn’t know much about diet culture, but I’m starting to see it now. It is new for me to believe I don’t have to lose weight to belong. I simply belong.” 

Focusing on the Conditions for Sustainable Self-care

Using the IDC pyramid provides a sense of direction. The more Wendy felt like she belonged, the more ease she felt. The more ease she felt, the more she felt seen and heard. Being with people who supported her as she was, not as someone who was ‘in control of her weight or diabetes’ helped her support herself. She started sharing some of her successes, including purchasing a used bike. “I found a group of people to ride with after work.” She joined an affordable gym and, once her insurance kicked in, started on a new diabetes medication.  

Wendy’s success didn’t come from changing herself via extreme dieting or exercise. It came from her finding support and resources that provided a more profound sense of belonging. During a recent session, she added, “I don’t have to do this alone. I feel like I belong again.” 

Belonging is a bridge to reduce healthism, stigma, and othering. Visualizing inclusion using the IDC Pyramid helps untangle the many types of stigma in diabetes care.