he wished he could drop me in
the middle of the jungle so I
would have to hunt for my food
and get exercise,” recalls Lisa
Schieri, who was diagnosed with
type 2 diabetes 27 years ago.
Anastasia has felt stigmatised,
too. “My regular doctor is great
- he talks about diabetes
management, not weight. But
I had a painful cyst one time and
had to see a nurse instead,” she
recalls. “Out of the blue she says,
‘Have you ever thought about
losing weight?’ ‘No, that’s never
crossed my mind, lady. C’mon:
I live in today’s world and have
diabetes, what do you think?’
I cried in the car after.”
Such painful interactions
can erode the doctor/ patient
relationship and lead people
to avoid future medical care.
Stigmatising experiences about
weight may even contribute to
additional weight gain, says Puhl.
In a 2013 study of 6000 adults
with a range of BMIs, those who
experienced weight stigma were
up to three times more likely to
get or continue to have obesity
over time than people who didn’t
report any weight discrimination.
Physicians know it’s important
to counsel patients about their
weight, but most have little
direct education in nutrition
or behaviour change and are
juggling too many patients to
take the time to discuss real
solutions.
“The generic advice from a
doctor to ‘try again or try harder’
is not at all helpful,” says Dushay.
“If something is not working,
continuing on that path with
more conviction won’t force it to
work: if I don’t put the right fuel
in my car, even if I overflow the
tank with gallons of that fuel, the
car won’t run. People may benefit
from more nutrition education,
more specific advice about
shopping or planning meals,
or more access to higher-quality
food – all of which a good
registered dietitian can provide- yet there is very frequently
resistance to referring someone
to a dietitian.”
Healing from
weight stigmaBecause weight stigma is so
widespread – from healthcare
professionals, the diet industry
and family, to strangers – it can
be difficult to overcome, and
battling it is often a long-term
process. In some cases, this battle
can lead people of higher weight
to internalise the weight bias,
so there is literally no safe
harbour, even at home, says
Puhl. Here’s how to fight back
against weight bias in your life.Check your own internal bias
Find out just how many of
these negative attitudes you’ve
internalised by taking the
Weight Implicit Association
Test from Harvard University
researchers. The test is part
of their Project Implicit Social
Attitudes research and can be
accessed through Implicit.
(Visit implicit.harvard.edu/
implicit/australia/takeatest.html).
Then, challenge your
assumptions about size withDiabetes Australia suggests moderate
weight loss should be part of a
treatment plan for people with
diabetes who have a high body
mass index. But advice for weight
loss may convey shame and blame
- and can even be dangerous.
“I was sick for three years before my
diabetes diagnosis. I knew I was sick,
but since I passed my fasting blood
[glucose] check, the diabetes was
not caught by doctors. Instead, the
doctor told me I wasn’t dieting and
exercising hard enough,” says Lenza.
“I injured my knee pursuing this
doctor’s orders, and developed full-on
eating disorder behaviour, desperately
trying to starve myself [into being
healthier].”
“We’ve come to have this societal
expectation that losing weight should
be easy,” says Puhl. “We see so many
messages from the diet industry
and media that you can achieve
quick weight loss with a plethora of
conventional options, and doctors
and patients often have very
unrealistic expectations.”
Jody Dushay, endocrinologist and
director of the Wellpowered Wellness
and Weight Loss Program at Beth
Israel Deaconess Medical Center inweight loss
THE TRUTH
ABOUT
WEIGHT AND
DIABETES
110 NOVEMBER/DECEMBER 2019 diabetic living