November is National Diabetes Awareness Month--so what better way to bring awareness than blog about a weight neutral
non-diet approach for type 2 diabetes?! (1)
Weight centered paradigms prompt people to go on diets that are not realistic nor sustainable, and most individuals end up regaining more weight than lost. This is the same for individuals with type 2 diabetes, except they have the extra hardship of their medications causing weight gain. Also, skewed hormones mess with hunger and satiety cues leaving some feeling hungry
and never satisfied. Yet, many healthcare professionals and the individuals themselves place
the blame on the individual for not having more willpower when in fact, they are fighting
against something that is beyond their control. Obesity is very complex and a multifactorial
disease process and not completely understood. To complicate matters more, the individual
starts out each new weight loss attempt with less muscle and more fat which means it is even
more difficult to lose weight. The continued fight for that “perfect” weight is the perfect
playground for chronic disease.
There is a message in our culture that indicates we are in control of our health, but fails to
mention things like social determinants of health, economic status, and genetic makeup that
carry a much higher risk of poor health and chronic disease than a person’s weight. The diet
culture now is disguising themselves as health and wellness and attaches morality to it. It
suggests that if we are not actively pursuing health, we are bad people.
So, what would happen if we thought of weight loss as a side effect or a sign/symptom instead of a goal? I can tell you, the individual will then be free to focus on making sustainable
behavior changes that will support their well-being—which includes more than their physical
health. I also know that weight stigma, scaring people, shaming them, and weight centered
paradigm programs are highly unsuccessful and promote weight gain and poor health—yet they continue decade after decade.(2)
Health and well-being are completely individual and look different for everyone. By looking at
social media, it appears health only comes in one size, shape, color and you need to be drinking protein shakes and wearing fashionable overly priced exercise clothing to attain it. This could not be further from the truth. Furthermore, weight is not a sole indicator of health and a lot of the weight loss research is flawed, contributing more to the belief that weight is the primary and only factor in determining someone’s health and well-being. (3)
I propose we teach all individuals, not just those with chronic disease to choose foods primarily based on three criteria (not in any particular order): (4)
Nutrients (and this can be specific to their disease state such as diabetes, cardiovascular, just general health) that support their health.
Taste. It is possible to cook food that supports health that tastes good!
Body function. How does this food make you feel--Bloated, lethargic, or energetic, focused and functional?
The next very important thing to discuss is “play foods" or treat foods or less nutrient dense foods and how to incorporate them into a balanced diet. We all know it is not realistic to think we will never eat candy, cake, or chips again, so let us figure out how to make them work into our plan! People with diabetes can even have treat food! What happens when they are taught how to incorporate treat foods into their eating plan rather than avoiding and restricting those foods to a point that it ends in a binge?
I have absolutely nothing against weight loss if it is done in a way that promotes nutrient dense
foods and also has room for treat foods; is internally based and not external; AND the weight
loss helps the person come to their unique weight that is healthy for them and not defined by
BMI (which is not a scientific measure) or some other random chart AND the individual actually wants to purse this.
The better we are in tune with our body and how food makes us feel, the better we get at
actually wanting to eat foods that support our well-being but still save room for our treats.
Amen and pass the turkey, potatoes, and pumpkin pie.
1 Free Guide: A Professional Guide Embracing A Weight Neutral Approach for Type 2 Diabetes Care. Megrette Fletcher MED, RD, CDE. Published 2018. Accessed November 1, 2018.
2 O’Hara L, Taylor J. What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight- Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency Paradigm Shift. SAGE Open. 2018 April-June. Doi: 10.1177/2158244018772888.
3 8 RED FLAGS in Weight Loss Research: How to Spot Them and What They Mean. Published July 30, 2018. Accessed November 1, 2018.
4 Tribole E, Resch E. The Intuitive Eating Workbook. 10 Principles for Nourishing a Healthy Relationship with Food. New Harbinger Publications, Inc; 2017.
Blog provided by Alison St. Germain MS, RD, LD