Why We Self-Sabotage: Navigating The Inner Teenager in Diabetes Care!

Telling clients what to eat, reawakens the inner adolescent who lurks deep inside of all of us. Learn why diet culture energizes self-sabotaging behaviors especially in diabetes care.

Sorting has both power and magic. The power of sorting helps us decide what 'sparks joy.' Come on, who doesn't want to know what is or isn't joyful in life? The magic of sorting is its ability to help us determine which choice offers the most joy. Yet, like some late-night TV ad, when the announcer says, "But wait, there is more." The forgotten benefit of sorting and discernment is the ability to see the merit in any action.

"What is "merit"? It is a behavior or activity that offers value despite the outcome. If you are a fan of the TV show Ted Lasso, one of the show's foundational themes is the merit of trust and friendship. Ted reminds his co-workers in his distinct midwestern accent, "I don't care about winning and losing." He is more focused on the needs of the team itself. Merit, Ted demonstrates, acknowledges that some choices make your life better, even if you didn't achieve a specific outcome (like winning a game, lower A1C, or losing weight.) Let's examine how exploring the merit of a choice can help clients with diabetes.

Imagine that Ms. Makransky is trying to make a food decision. She knows which foods she dislikes, is neutral about, and enjoys. She is aware of which foods will likely raise her blood sugar, but still, she struggles with what to eat.

The dietitian asks, "If you like these foods equally, what foods will help your tomorrow?"

Ms. Makransky stares at her with a quizzical look and replies. "I'm not following you."

The dietitian pauses, “Let me rephrase, which has more carbohydrates? Iceberg lettuce or spinach?"

“They are the same,” Ms. Makransky answers.

“Exactly! The dietitian smiles and asks, "What does spinach have more of than iceberg lettuce?"

If you said vitamins and minerals, you are correct! People with diabetes are told to eat “diabetic foods” like wheat bread, sweet potato, brown rice, or skim milk. Yet these foods don't offer fewer carbohydrates, so the advantage isn't for immediate blood sugar control. For people with diabetes, it is easy to forget that everyone needs nutrition. There is merit in eating a nutrient-rich diet because eating nutrient-dense foods helps you poop and prevents problems like cancer, heart disease, high blood pressure, and digestive issues. This future benefit is often forgotten because the client relives a childhood memory.

While the idea of merit may feel new, you were likely introduced to this when you were tiny. Part of childhood is learning about delayed gratification. Like a broken record," “Wait for your dinner; don’t eat too much; you can't have that now!” these are common familiar parental scoldings surrounding food. It isn’t just food; it is a tangle of life lessons, some about nutrition, sharing, patience, and tolerance.

Release The Inner Teenager!

It takes time to understand our adolescents, and when a person is dealing with diabetes, many of these complex food messages re-emerge. Like the Kracken, our inner teenager lurks deep within us, and it can become an uncontrollable monster if left unchecked. The adolescent years are full of unresolved and conflicting feelings that can result in resentment and resistance. We all have stories of missed opportunities and a few "I told you so" mistakes from our younger days. When asked, many clients agree that diabetes has awakened their inner adolescent!

The emergence of our inner teenager brings out the ‘shoulds’ and the feeling that more can and has to be done. Over time self-sabotaging behaviors emerge. "I am making terrible decisions, and I know I shouldn't!" Confesses Ms. Makransky.

Using motivational interviewing can help clients understand the conflict. On one side, there is instant gratification. On the other is future merit. Setting up this complex reflection opens up many counseling conversations. These can be deepened by acknowledging how the social determinants of health change add to the discussion. The more safety and stability, the more our clients can imagine their life in 10, 20, or 30 years. Without basic needs and stability, our client’s future is measured by the minute, hour, day, or weeks.

The reality is that the merit of food choices is often tied to weight change or a weight-related virtue. Diet culture is everywhere in diabetes care, and whether we like it or not, it is easy to repeat common suggestions like, "Eat more protein will fill you up, so you eat less." or "This food is low in calories, so it is a good choice." or "Not eating at night prevents weight gain." The problem is this diet-culture-influenced association not only awakens the inner adolescent in all of us, but as Ms. MacKransky confessed, our inner teenager grabs the steering wheel of life!

Adopting a weight-inclusive view of diabetes care asks us to calmly come alongside our client's inner teenager. First, affirm their autonomy, "It is your choice." Second, remain curious by asking about other options, such as "What foods feel good in your body?" "What nutrient-rich foods would you consider adding?" or "What changes, if any, are you considering to improve your overall health?"

Inclusive Diabetes Care offers weight-inclusive professional education. Our interactive monthly courses explore how we can make diabetes care more welcoming. Become a member and gain access to all 12 programs!