Are Weight Conversations in Diabetes Doing More Harm Than Good?

If you live in a larger body, it’s likely your diabetes care has included weight loss conversations at some point. And, if you’re like most people, weight loss attempts have delivered only fleeting results after a lot of hard work. That leaves you in a pickle to say the least— you’re being asked to lose weight to manage your diabetes, yet it’s an unsustainable plan.

In my experience, this is where many feel a sense of failure, throw in the towel, and give up on managing diabetes altogether. So, I’d like to take you on a three-part journey—one, exploring weight loss realities; two, exploring why weight fixation may cause more harm than good; three, how you can manage diabetes well without using weight as a gauge of success. Buckle up folks—some of what you read may just surprise you!

Journey One:  Weight Loss Realities

Weight loss is often touted as a pretty simple equation—“calories-in minus calories-out =weight.” Basically, what you eat minus how active you are determines your body size. The problem with this equation is that weight is a lot more complicated than that.

Weight is regulated by your body’s homeostasis system. Homeostasis ensures many different components of your body stay within certain ranges to maintain health and function (other examples include blood pressure, heart rate, and fluid balance). When it comes to weight, a small loss can trigger changes in your fullness cues, hunger cues and metabolism, all in an effort to help your body regain weight to its preferred range.

Additionally, body size is influenced by a number of non-food related factors like chronic stress, sleep disorders, genetics, medications, endocrine/hormone dysfunctions, and so on. As far as the “calories-out” piece, physical activity typically only accounts for 30% of your energy expenditure each day.  Most of your body’s energy is spent on everyday functioning (also known as metabolic processes) in which you have little to no control over.

Research studies show weight loss is difficult to sustain—particularly when it is related to strict dieting. In 2007, researchers from UCLA completed a comprehensive review of weight loss research in an effort to see if dieting lead to sustained weight loss. Their findings showed dieting was the largest predictor of weight gain.  That’s right—the very tool that most people used to lose weight actually had the opposite effect. It also highlighted that the majority of dieters regained their weight, with many regaining more weight than they lost.

Ultimately, these factors highlight just how complex body size can be, and the challenges that arise from trying to change it long-term.

Journey Two:  Weight Fixation—Harmful or Helpful?

A common message about health in general is that thinness is a sign of wellness, whereas “obesity” is a sign of poor health. Fixation on body size and weight loss naturally go hand in hand with this message. However, while perhaps well-intentioned, the impact of this messaging can be harmful.

Studies have linked weight swings from dieting (often referred to as “yo-yo dieting”) to an increased risk of heart-related events, including death. If you have a history of heart disease, those risks go up significantly.

Restrictive diets (many of which are touted as great for diabetes management) carry risks for nutritional deficiencies. Yet, in a Healthline survey of over 1,500 people living with T2D, over 50% reported never having met with a registered dietitian. The lack of medical oversight when someone tries restrictive eating patterns is concerning.

As an added layer, the impact of weight stigma in these conversations about wellness is often not considered. Weight stigma is an active form of discrimination or stereotyping based on someone’s body size.  It’s now estimated to be as prevalent as racial discrimination.  Weight stigma has been linked to chronic social stress (a risk factor for diabetes itself), along with increases in risk of death, cortisol levels, eating patterns, and weight, as well as a decrease in physical activity.

To go a step further, fixation on weight can make it harder to get the medical care you need, when you need it. From delayed joint replacement surgeries to delayed medication starts for diabetes care, I’ve heard many stories of inappropriate or delayed care for larger people. The research backs this up, showing that healthcare providers spend up to 28% less time with “obese” patients, and these patients are commonly viewed as “lazy, undisciplined and weak-willed.”

So, what is a person with diabetes, who lives in a larger body, to do?

Journey Three:  Diabetes Management That’s Not “Weighed” Down

A common mistake made in weight loss studies and programs is that credit is given to weight loss itself, rather than the change in health habits or routines made by study or program participants. This mistake is also made in diabetes care.

Research shows health habits have a positive impact on a person’s wellbeing, regardless of what they may weigh. One study (of 11,000 people) analyzed risk of death based on the number of healthy habits participants engaged in routinely, and then compared by body size. These habits included:

• Being physically active
• Not smoking
• Eating ≥5 vegetables/fruits daily
• Minimal alcohol intake

As the number of health habits increased, body size mattered less and less. In fact, “overweight” or “obese” participants who did all four healthy habits had a nearly identical risk of death as those with “normal” BMI!

Other studies show similar results, with a 2019 study concluding that “focusing on improving fitness may potentially provide a greater reduction in mortality [death] than weight-loss interventions.”

Bottom-line, actions are important and powerful. And lucky for you, there are many actions which can improve your overall diabetes health: increasing social connections, being more active, increasing your intake of fruits and veggies, improving your sleep patterns, using resources to decrease stress, taking medications consistently, attending your regular medical appointments, cutting out smoking, and so on.  These actions typically result in improved health (and blood sugars) regardless of what your weight does in response to them.

I can only imagine the challenges of living in a larger body with diabetes, given the number of stigmas that swirl around both diabetes and weight. Be compassionate with yourself. Work with medical teams who can look beyond your body size and support your self-care actions. Shift your energy from weight loss to self-care actions which improve or maintain your health. Find like-minded folks– people who can relate to your experiences and what you’ve been through with diabetes and weight. You’ve got this!