Health At Every Size Approach in Treating Diabetes

Diabetes… a term that carries so much stigma, but why?

The false assumption that personal lifestyle choices are to blame for developing diabetes is a major source of stigma around the condition. Diabetes occurs due to a malfunction in the body's ability to make or use its insulin correctly. This condition is highly influenced by genetics and social determinants of health. 

If you have diabetes or know someone who does, I bet you have heard that weight reduction, losing 5-10% of body weight, is a highly pushed intervention for managing the condition. It is quite interesting how one of the most popular recommendations for someone struggling with their health is to shame them into focusing on weight loss rather than addressing the effective ways to add to their overall health and wellbeing.

When we see weight loss recommendations, we see behaviors and symptoms including restriction, yo-yo dieting and weight cycling - all things that may worsen health rather than enhance it.

In fact, people who weight cycle or yo-yo diet are 78% more likely to develop type 2 diabetes over 5 years than people who remain the same weight, regardless of the number on the scale.

Another study found large body weight fluctuations to be an independent risk factors for type 2 diabetes. This is because yo-yo dieting may increase our body’s resistance to insulin, which results in decreased uptake of glucose from the bloodstream into the cell and can lead to type 2 diabetes. For those who already have diabetes, it makes controlling blood sugar much more difficult. Restrictive yo-yo dieting is also associated with high blood pressure, increased fat around the abdominal organs, changes in fatty acid composition, insulin resistance, and increased cholesterol.

Diabetes can be diagnosed at any body size, even people who are categorized as “underweight” or “normal weight” on the BMI chart. One should also question if the 5-10% of body weight loss advice is also given for people who live in smaller bodies or just for people in larger bodies.

Weight stigma can be mentally and emotionally harmful and weight-centric approaches to diabetes management are rarely successful. It is quite known that about 95% of diets fail and people are likely to gain back most, if not all or more of the weight. You may be asking what are some other ways to manage diabetes that aren’t focused on weight loss? The good news is that diabetes, regardless of someone’s body size, can be managed by developing sustainable health promoting behaviors, accumulated over time, rather than all-or-nothing changes and/or focusing on weight loss.

The Health At Every Size (HAES) principles and framework promote health equity, support ending weight discrimination, and improve access to quality healthcare regardless of size.

Research shows that a HAES approach to health can lead to healthier blood pressure, lower cholesterol, increased physically activity, and better body image compared to folks who were actively dieting. 

https://asdah.org/health-at-every-size-haes-approach/

Some ways to enhance health and manage diabetes that do not focus on weight include:

  • Medications as prescribed by a provider:

    • Diabetes medications work in various ways: improving insulin sensitivity, decreasing glucose production and reabsorption, increasing insulin production, slowing down digestion, etc. 

    • One thing to be aware of when it comes to medications is your provider's intentions behind prescribing them. You may need to ask if they would prescribe this medication to someone with a smaller body since some diabetes medications may lead to weight loss, and now, unfortunately, we see provider’s prescribing these medications solely for the intent of weight loss (be on the lookout for future blogs and newsletters on this exact topic!)

  • Hydration!

  • Food Pairings

    • Carbs are wonderful! They are essential and break down into glucose which is the brain's preferred source of energy. Protein, fat, and carbs all have different effects on blood sugar, satiety, digestion, and satisfaction. When carbs are eaten alone they are easily broken down and glucose is absorbed into the bloodstream quickly. However, when paired with protein and fat, the rate of absorption is slowed down, leading to more controlled blood sugar levels, longer feeling of fullness, and increased satisfaction. 

    • When picking meals, aim for a source of protein, carb, and fat. When deciding on snacks, aim for at least 2 categories of macronutrients: protein, fat, carb. No foods need to be removed from the diet nor do all meals and snacks have to be balanced every time! 

    • Another important nutrient to add to our diet is dietary fiber. Fiber found in foods can help avoid large spikes in blood sugar. 

  • Consistent Nutrition

    • Focus on consistent nutrition throughout the day so blood sugar levels don't get too low which may also lead to chaos around eating times. Pack some snacks to bring with you when you’re out of the house. Normal digestion in the stomach takes about 3-4 hours, so focus on planning out eating opportunities with this timeframe in-mind, or sooner if you’re hungry!

  • Adequate sleep

  • Joyful Movement

    • Physical activity, that you actually enjoy, can lead to better blood sugar control by expanding the storage capacity for blood sugar in the muscle and decreasing insulin resistance.

Marissa Johnson, MS, RD, LDNComment