How To Untangle Weight-Centered Diabetes Care
You want to learn about weight science. You want to untangle weight from health, but where do you begin? This article will review the two major problems with diabetes care and offer current research that supports separating weight from diabetes.
Problem #1: Most individuals with diabetes are not getting care.
Despite the benefits of DSMES, the 2017 National Diabetes Self-Management Education and Support report found less than 5 percent of Medicare benefits for DSMT and MNT are being utilized. This was only slightly higher at 7 percent for private insurance.
[Li, Rui (2014). Diabetes Self-Management Education and Training Among Privately Insured Persons with Newly Diagnosed Diabetes - United States, 2011-2012. Morbidity and Mortality Weekly Report. 63. 1045-1049.]
Problem #2: Weight or weight loss messaging increases the complexity of diabetes care.
When weight is the focus of diabetes care, several complex problems, including weight bias, stigma, and disordered eating, create barriers to change and reinforce oppression that disproportionately impacts marginalized individuals. It is hard fully understand this problem which is why it is necessary to understand the research favoring weight-inclusive care. The following three articles detail the issues with weight-centered care.
Mauldin, K., May, M., & Clifford, D. (2022). The consequences of a weight‐centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutrition in Clinical Practice. https://doi.org/10.1002/ncp.10885
Gaesser, G. A., & Angadi, S. S. (2021). Obesity treatment: Weight Loss versus Increasing Fitness and Physical Activity for Reducing Health Risks. IScience, 24(10), 102995. https://doi.org/10.1016/j.isci.2021.102995
O'Hara, L., & Taylor, J. (2018). What's Wrong With the "War on Obesity?" A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift. SAGE Open, 8(2), 215824401877288. https://doi.org/10.1177/2158244018772888
Solution: Create Your Roadmap for Inclusive Diabetes Care
Identify and include Fat Acceptance stakeholders within your diabetes/nutrition organization. Ensure that stakeholders and information regarding weight inclusivity are free of bias. This means that resources are not produced by organizations benefiting financially from the weight loss industry. The Obesity Action Coalition, Obesity Society, and Weight Loss Surgery program are weight-centric organizations or efforts with existing bias. The National Association to Advance Fat Acceptance, NAAFA, Health At Every Size, and The Center for Mindful Eating are weight-inclusive organizations.
Look at the underlying intention regarding any project for weight bias. Is it to help your patients or to cause your fat patient to lose weight? See that these two intentions are not the same. The assumption that it is the weight change instead of behaviors that improve health is biased.
Seeing this nuanced but essential distinction allows you to shift language to decrease the weight oppressive wording and implement language changes throughout the organization. The ultimate goal of these changes extends beyond the language preference of individuals who identify as fat and acknowledge the oppressive nature of all biases (including weight, race, age, and economic).
Provide, practice, and engage in nonjudgmental counseling approaches, such as motivational interviewing, mindfulness-based training, and trauma-informed care.
Include training to identify, prevent and treat disordered eating in diabetes care.
Utilize Existing Weight Inclusive Teaching Diabetes
Many professionals are unaware that there are models that effectively teach diabetes care without reinforcing weight-centered messaging. These include:
Research:
Podcasts
Fat Joy Podcast:
The Full Plate Podcast:
Maintenance Phase podcast:
Curvy Culture Podcast:
The Air We Breathe: Stories of diet culture:
Share this post