Why am I told to lose weight when repeated dieting can cause diabetes?
It's time to clarify some questions about how a weight-inclusive approach helps you get quality diabetes care, no weight loss required.
Mike leans closer to the computer camera. His voice drops, which seems to indicate his mood has changed: “I guess I am disappointed. I had braced myself for this session, thinking it was going to be adversarial. I mean, not that you would be mean, but you would tell me that I was wrong for having diabetes, eating carbs, and being overweight.”
Susan shifts on the couch and pulls her hair away from her face before speaking, “Even though I have seen a dietitian many times to learn about carbohydrates, I have never talked to anyone about why I am eating.”
Kim simply states, “I feel wrong for eating.”
Like these clients, many people with diabetes assume that getting blamed for having elevated blood sugars because of their weight is part of diabetes care. This article will clarify some common questions about how a weight-inclusive approach to diabetes can reduce diabetes stigma and improve blood sugar and your health.
Q. How does this approach work for people with diabetes?
Answer: Even though dieting and weight loss are suggested for people with diabetes, it isn’t without risks. Dieting drives disordered eating and yo-yo dieting is associated with the development of type 2 diabetes. If you are thinking, “What?” Trying to lose weight over and over again is linked with type 2 diabetes. Here, the American Diabetes Association spills the tea, “Research shows that yo-yo dieting may increase insulin resistance, a condition that occurs when your body can’t efficiently use the insulin it naturally produces. Insulin resistance can lead to type 2 diabetes; for those who already have diabetes, it makes the condition far more difficult to manage.”
A recent research article published in 2022 In the Journal of Diabetes, “...Persistent weight reduction is often hard to maintain, with <6% of subjects able to achieve sustained weight loss during a 15-year follow-up.1 Current evidence suggests that repeated weight loss and subsequent gain, a phenomenon known as weight cycling or “yo-yo dieting,” exacerbates the risk for T2D and cardiovascular disease.”2
Bottom line: Research shows that weight is a poor indicator of health and that focusing on weight by engaging in a weight loss diet after a weight loss diet is harmful. There are dietitians like myself who can help you stop yo-yo dieting and find a personalized approach to diabetes care that supports your whole self.
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This 5-part video series and 25-page Weight-Inclusive Guidebook explains how to nourish your body without dieting.
Q. How is this different from other approaches?
Answer: Many people believe that understanding nutrition is the same as going on a diet. One of my clients shared, “I have never been taught about nutrition without trying to lose weight.” It is like nutrition and diet got switched. However, eating a nutritious, balanced diet and losing weight aren’t the same. The goal of nutrition is to improve your health by eating a variety of foods with adequate calories that provide optimal nutrition. This may result in weight loss, but it may not. You didn’t ‘fail’ because you didn’t lose weight. What you did do is nourish your body, and that is the goal.
Bottom Line: All dietitians try to help you improve your nutrition status. However, not all dietitians know how to do this without focusing on weight. Working with a weight-inclusive dietitian is about improving your energy, cholesterol, A1C, and overall well-being without counting calories or restricting your food intake.
Q. Does meeting with a dietitian who specializes in diabetes help?
Answer: While I wish this were a simple question, it isn’t. I think it is important to point out that most people with prediabetes and diabetes don’t see a dietitian or diabetes educator. (I happen to be both). This is really frustrating for four reasons.
Diabetes is a crappy condition that needs support, and I mean more than 15 or 30 minutes with your primary care doctor every 3-6 months. It also needs access to qualified professionals. You can’t get the care you need by “Googling.”
Diabetes is also a complicated condition. There isn’t a one-size-fits-all solution. I know that it is hard to hear, but weight loss doesn’t ‘cure’ diabetes. This means getting support, talking with knowledgeable professionals, and learning more about diabetes from credible sources is always helpful. Many dietitians at Nourish can help you, not just me. If you are unaware, Nourish is a virtual nutrition service that hires Registered Dietitians. Your insurance typically covers sessions with little to no out-of-pocket expenses.
It is hard to sort out what you have learned about diabetes and what you already know while managing your life. Knowing and doing are not the same thing, and this is why space, grace, and support are key.
Understanding how diet culture and weight stigma are connected is essential. Weight stigma refers to the devaluation and denigration of a person due to their weight, leading to negative attitudes, stereotypes, prejudice, and discrimination. When weight stigma has been internalized, it means that you believe you are not as good, worthy, or valuable because of your size. That belief needs to be challenged because it isn’t true. It harms you in ways you can’t see but feel deeply inside. Many times, weight stigma intersects with diabetes stigma and diabetes distress.
Bottom Line: Weight stigma is oppressive and perpetuates and reinforces barriers to accessing qualified medical care due to fear and judgment. It also impacts your health and well-being. Weight stigma is present in diabetes care, and you need support to begin to question and challenge these beliefs.
If a weight-inclusive approach to diabetes care sounds right, please book a one-on-one appointment with me via Nourish. Here is what clients are saying about working with me, “Megrette was amazing, so supportive and encouraging. She's a really great listener and helped me find some ideas going forward. “ Nourish Client
Paisey R, Daniels C, Howitt W, et al. Body weight, diabetes incidence vascular events and survival 15 years after very low calorie diet in community medical clinics in the UK. BMJ Nutr Prev Health 2022;5:55–61
Delahanty LM, Pan Q, Jablonski KA, et al.; Diabetes Prevention Program Research Group. Effects of weight loss, weight cycling, and weight loss maintenance on diabetes incidence and change in cardiometabolic traits in the Diabetes Prevention Program. Diabetes Care 2014;37:2738–2745