Diabetes is a complex metabolic syndrome where blood sugar levels, also known as blood glucose increase to above the normal range. This is known as "hyperglycemia"- literally high blood glucose. It's normal for blood sugar to rise following a meal but if it remains high for prolonged periods it can cause some damage in the body. There are different types of diabetes. This article will exclusively focus on type 2 diabetes.
"Diabetes is a complex condition and a mixture of genetics and social determinants of health play a big role with a smaller responsibility lying on the individual"
Type 2 diabetes most commonly develops in adult years. It is thought that genetic predisposition plays a large role as well as lifestyle factors such as: stress, sleep, what we eat or don't eat, how much we move, alcohol intake and smoking.
In many ways, having diabetes has become stigmatised, largely due to campaigns putting the blame on the individual, however this is not the case. Diabetes is a complex condition and a mixture of genetics and social determinants of health play a big role with a smaller responsibility lying on the individual. That said, you can make some health changes to support your body to manage your diabetes.
Why step away from the scales to manage your diabetes?
You may associate type 2 diabetes in particular with people in larger bodies, and although there is an association it’s really a chicken and egg conundrum as to which predisposes the other. Despite this unknown, the majority of treatment programs and interventions focus solely on weight loss and medication. To some, the evidence may seem clear cut but there have been recent revelations that suggest our previous ideas and convictions about type 2 diabetes are largely based upon weight biases and expected results interpreted with weight stigma. This means we have been so focused on proving weight as a cause we have missed the bigger picture.
There is emerging evidence that type 2 diabetes can be managed through a non-weight focused approach and achieve better outcomes, with fewer negative repercussions. This means we see positive blood sugar improvements even with no weight change, while we avoid the negative effects of dieting, such as lowered self esteem, poorer life satisfaction and rebound weight gain (1).
So if you’ve been dieting and re-gaining those same pounds over the years, perhaps it is time to step away from the scale and look at a more holistic approach to managing your diabetes without enduring the weight cycling roller coaster? Which I hear has terrible reviews on TripAdvisor!
What is weight cycling and how does it relate to diabetes?
If you've ever tried to lose weight, chances are, you are one of the 95% of people who have gained it back within 2-5 years. You may also be one of up to two-thirds of those who regain even more than they have lost. With multiple diets, this leads to a weight cycling roller-coaster in which your mental health may be sitting up front (2). If this sounds familiar, take comfort in that you are not alone and your willpower is not to blame. Your body has strong biological and psychological mechanisms to prevent starvation by increasing your drive toward food- you are simply human with a body helping you survive.
"We know dieting leads to weight cycling much more commonly than it leads to long term weight loss and we know weight cycling is much worse for our health than a stable higher weight, so how helpful is a diet (weight) focused approach for managing diabetes?"
Weight cycling, or "yo-yo dieting" is known to be a bigger risk factor for development of chronic conditions than staying a stable higher weight (1). It is shown to increase inflammation in the body, which is associated with and contributes to high blood pressure, further insulin resistance (worse control of type 2 diabetes), and unhealthy levels of good and bad cholesterol circulating in the blood (1).
Although we know weight cycling is common in those of higher weights, studies rarely control for weight cycling. Evidence suggests that the associations between higher weight individuals and increased health risks could more accurately be attributed to weight cycling rather than larger fat stores in the first place (1).
We know dieting leads to weight cycling much more commonly than it leads to long term weight loss (through biochemical adaptations, not willpower!) and we know weight cycling is much worse for our health than a stable higher weight, so how helpful is a diet (weight)-focused approach for managing diabetes?
A non-diet approach supports the promotion of healthy behaviors- both mentally and physically. The goal being improved physical and mental health, emotion regulation and quality of life rather than weight.
We can think of this as a trail to "improved health and well-being" in which the signpost to "weight loss" is blocking the trail from view, pretending to be the trail that will lead to "improved health and well-being". As we commence our journey we are given shameful messages disguised as motivation until we reach "weight loss".
As we try continue our journey to "improved health and well-being" we find that the trail is blocked by biological and psychological responses" which are stronger than ever due to dieting so we usually end up having to turn back. Not because we are weak, but because it is biologically un-passable. We often endure even worse messages on our way back.
However, a little more patience at the start will mean we see a well maintained trail leading directly to "improved health and well-being", avoiding the "weight loss" path. Sure, there will be some twists and turns, we will likely get a bit lost, we may even end up in some mud, but in that process, with positive messages, we will learn something new and find our way back to the trail toward our ultimate goal.
What has "weight stigma" got to do with diabetes?
It's no secret, larger bodies are marginalised and discriminated against in society (1). This does not reflect on the personality, health, worth, value, fitness, achievements, abilities or anything else of a person. Although, we are surrounded by messages that tell us certain bodies are "more worthy" than others while public spaces are better accommodating of certain body types than others. This stigma based on a person's weight is known as "weight stigma".
Weight-centered interventions for diabetes and general health increase societal weight stigma. This stigma is experienced differently by different people. Those who are acutely aware of weight stigma and discrimination, regardless of body size, tend to comfort eat more, avoid exercise and postpone or delay seeking medical care, exactly what these interventions tell us to do more. Weight stigma itself leads to worsened health behaviours, which impacts on physical health (1).
Existing in a body which feels excluded or wrong can lead to feeling weight stigma which is damaging to mental health. Increased feelings of shame, decreased self-esteem, increased dieting behaviours, increased disordered eating, food shame, food anxiety and less body confidence are some of the emotional side effects. People struggling with the usual nutrition interventions and treatments for type 2 diabetes report loss of pleasure around food, autonomy, and freedom to eat (3).
Feelings of weight stigma occur more frequently in those with larger bodies but again this is rarely accounted for in studies looking into weight and health outcomes. This means, some of the association between weight and poorer health outcomes in these studies could be accounted for by weight stigma rather than weight itself.
Non diet tips to improve diabetes!
Check in with the Lifestyle Basics: sleeping, eat regularly, movement
Check in: Are you nourishing your body with its basic needs regularly?
This may look like having a bed time routine that helps promote sleep, eating regularly throughout the day to reduce fluctuations in blood sugar (as well as cravings) and finding some movement you enjoy.
While we don't need any food rules (honestly you can trust your body to include all foods) having some awareness of how food feels in your body can be really helpful.
Try eating free of distractions so you can really tune in to the sensations (as well as the pleasures of eating). What do different foods feel like before, during and after eating? How does it feel when you are hungry and how does this start to change while you are eating? As you become more aware of your body's sensations, see if you can find that comfortable level of fullness. It's important to remember there are many other reasons to eat than simply hunger- such as for self care if appetite cues are off, knowing you won't be able to eat for the next few hours or for celebration, however most of the time eating when we have emerging hunger feels best.
Practicing mindful eating, and eating in response to hunger cues also reduces blood sugar levels when compared to weight loss alone (4) while eating intuitively improves glucose control (3) all without the stress of weight.
The less stress, the better outcome
Stress is damaging to health and typical weight loss interventions are known to increase stress. Ditching the focus on weight and making a shift to a focus on your health and well-being is a great first start although its not always easy.
A non-diet approach called intuitive eating helps you let-go of messages causing you stress and tune back in with your body's innate signals and messages to guide your eating, movement and rest. This approach improves overall well-being, body appreciation, self-esteem and life satisfaction as well as physical health markers such as cholesterol and blood pressure (4). It is also shown to improve blood sugar control in those with diabetes (3).
Other ways to help manage stress levels are enjoyable movement, meditation or yoga, de-cluttering of your mental or physical space, setting personal as well as work boundaries, journalling and dedicating some time to yourself whenever possible.
If you want support to work towards improved diabetes control or health outcomes without the psychological harm of dieting and weight control, you can learn more about how i work with clients here.
1. Bacon, L. & Aphramor, L. (2011) Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal. 10(9) .
2. Van Dyke, N. & Drinkwater, E.J. (2013) Relationships between intuitive eating and health indicators: literature review. Public Health Nutrition. 17(8) pp.1757-1766. → research demonstrates substantial and consistent associations between IE and both lower BMI and better psychological health,
3. Soares, F., Ramos, M., Gramelisch, M., Silva, R., Batista, J., Cattafesta, M. & Salaroli, L. (2020) Intuitive eating is associated with glycemic control in type 2 diabetes. Eating and Weight Disorders - Studies on Anorexia, Bulimia, and Obesity. 119(4) pp.652-658.
4. Miller, C., Kristeller, J., Headings, A., Nagaraja, H. & Miser, F. (2012) Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: Pilot study. Journal of the Academy of Nutrition and Dietetics. 112(11) pp.1835-1842.
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Emma is a UK Registered Dietitian and a Certified Intuitive Eating Counsellor. She acknowledges the complex nature of health and the equal importance of both physical and mental health. She works with women to overcome disordered eating to find freedom in food and life.
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