Weight-Neutral Approach to Diabetes Care

Diabetes is a widespread chronic condition affecting millions worldwide. It's a complex condition to manage, and often, there's an emphasis on weight management as a core component of treatment. However, it's crucial to dispel the misconception that an individual's weight directly causes diabetes. In fact, diabetes can affect individuals of any body size. Various factors, including genetics and weight cycling (commonly known as yo-yo dieting), can contribute to diabetes.

While there is a correlation between weight and diabetes, weight is a symptom rather than the cause of diabetes. A characteristic of diabetes is insulin resistance. This happens when the body’s cells build up a tolerance to insulin, a hormone that turns glucose (sugar) into fuel, and requires more insulin to make fuel.  Insulin is a storage hormone and excess insulin floating around in the body can lead to weight gain. The main takeaway being weight can be correlated to diabetes but not the cause of it.  When providers focus on weight loss for their treatment plan (i.e. weight centric approach) there is a missed opportunity to individualize and tailor a plan that focuses on treating the insulin resistance. 

Studies have highlighted that a weight-centric approach, where body weight becomes the central focus of health management, is ultimately unsustainable.   This approach fosters weight sigma which refers to the negative attitudes, beliefs, and discriminatory actions directed towards individuals with diabetes based on their body weight or size.  It often involves the assumption that an individual's weight is the primary cause of their diabetes and the belief that they are solely responsible for their condition due to their weight. Weight stigma can have detrimental effects on individuals with diabetes, including stress, anxiety, avoidance of health care, disordered eating and poor diabetes self management.  In fact, research has found that disordered eating behaviors may affect up to 40% of patients with type 2 diabetes mellitus. 

In response to these concerns, a growing body of evidence supports a weight-neutral approach as a more sustainable and holistic approach for managing blood glucose levels and insulin resistance. This paradigm emphasizes sustainable health promoting behaviors that extend beyond weight alone. It encompasses managing stress levels, prioritizing adequate sleep, engaging in intuitive movement, staying properly hydrated, and, yes, nourishing the body. A weight-neutral paradigm recognizes that each of us has a unique genetic blueprint that we can't change.  Encouraging clients to focus on the aspects they can control, like health promoting behaviors, has demonstrated improved outcomes.

A weight neutral focus encourages balance and flexibility to health and stabilizing blood glucose while fostering a healthy and positive relationship with food. Additionally, it has been shown to have a profoundly positive impact on both physical and mental well-being.

If you're seeking a healthcare provider who aligns with this weight-neutral philosophy, check out our informative blog post to gain insight into what it's like to work with a dietitian at our practice. 

Citations 

García-Mayor, R.V., and García-Soidán. F.J. (2017). Eating disorders in type 2 diabetic people: Brief 12

review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11(3), 221–224. doi:10.1016/j.dsx.

2016.08.004

A call for a paradigm shift - weight centric vs weight neutral O’Hara et al. 2018 What’s Wrong With the ‘War on Obesity?’ A Narrative Review… SAGE Open.

Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62, 220-233.