Diet Culture, Diabetes and Fear
Written by Larissa Ens, RD, CDE
A topic that comes up when discussing moving away from the pursuit of weight loss is the fear of chronic conditions that have long been said to be linked to weight. An example of this might be “My doctor said I have a high risk of developing diabetes because of my weight”.
We know that both society and our health care system’s focus on weight as the only indicator of health is very misleading and often the result of anti-fat bias, racism and misogyny.' The fear associated with chronic conditions, the false conflation of weight with health, and the use of scare tactics or shame within the healthcare system can be a barrier to healing our relationship with food and our body.
As a Certified Diabetes Educator, I would like to breakdown some of the common misinformation I encounter in my work with clients.
What Increases Risk for Type 2 Diabetes?
The narrative around the risk of developing type 2 diabetes is often focused on lifestyle choices or weight. The reality is that about 60% of the risk is related to genetics. The other social determinants of health, such as income, childhood experiences, racism, and physical environments also impact our risk and are largely out of our control.
So while lifestyle may have some impact on your risk, it is nowhere near the largest factor.
What about Prediabetes?
You may have been told that based on your bloodwork, you have prediabetes. The idea of prediabetes is highly contested, and groups such as the World Health Organization do not endorse this diagnosis. While this is a complex topic, the main reasons that it is contested are:
The concept was created by a group of doctors whose concern about BMI in the general population led to the fear based messaging (this particular group was funded by pharmaceutical companies that sell medications used to treat diabetes)
The bloodwork ranges used to diagnose prediabetes are not consistent between countries and organizations
While statistics are difficult to find (due to the previous point), larger scale data has shown that more than half of people with the diagnosis of "prediabetes" will not develop diabetes within a 10 year period
I’ve been told I have Type 2 Diabetes
If you are living with type 2 diabetes, there is nothing to be ashamed about, and this diagnosis should not be used by the medical system as a scare tactic. People living with diabetes are often warned to “control” their diet and weight, or else they may develop complications or require additional medications. The approach of using fear or shame in disease management is not only unethical, but also not evidence-based. While there can be health complications associated with diabetes, there are many options to support management that are not based in restriction, fear or shame.
So, What About the “Lifestyle Changes”?
As outlined, there is significant nuance in regards to the risk of developing diabetes, and lifestyle plays a relatively small role in that risk.
Even if lifestyle did have a significant impact, dieting and restriction is unlikely to reduce your health risks in the long term, for the following reasons:
Dieting often leads to weight cycling, which increases the risk of diabetes (and other chronic conditions) in the long term
Hyperfixation on lifestyle can be a significant contributor to stress, and increased stress (both acute and chronic) can actually increase the risk of developing diabetes (or increase blood sugars if you are living with diabetes)
We know that dieting is the primary risk factor for developing an eating disorder. Eating disorders have a significant impact on both physical and mental health.
The LookAHEAD trial is one of the longest trials looking at the impact of intensive lifestyle intervention (diet and exercise) on weight, blood sugar, and risk of heart disease. This trial found that by 8 years there was no difference between the group that had been prescribed a calorie-restricted diet and specific exercise goals and the group that received general diabetes education when it came to heart disease outcomes.
Part of my role as a dietitian is to help reduce some of the fear and misinformation that is so built into our culture when it comes to diabetes. It can be difficult to unlearn the messaging that is so engrained within the current health care system, and letting go of the shame-based approach may leave you wondering: “what can I do to care for myself?”. Pursuing peace with both your body and food can allow you to care for yourself in a compassionate manner without fear.
Remember - You deserve an approach to health that is kind, supportive, and focused on your overall wellbeing.
Do you want to feel empowered to understand how you can best care for your body? Consider joining our upcoming group - Diabetes without Diet Culture.
