Jack Frost

How Weight Bias Infects Diabetes Care

Bias and stigma are not confined to obesity. And in fact, a considerable body of research tells us that far too many people with diabetes experience it and it is greatest in people who require insulin, have more difficulty controlling the disease, and have a higher BMI. Though stigma can be a problem for people with any form of diabetes, the association of type 2 with obesity brings weight bias into play for diabetes care.

The World Health Organization recently held an informal consultation on people living with diabetes. In this three-day meeting, T’ara Smith gave a compelling account of the bias she encountered from health professionals in diabetes care.

A “Full-Blown” Diagnosis

“Unfortunately, my doctor who diagnosed me with type 2 diabetes was not in service to me, the patient. I remember his words very clearly. ‘Well, you have full-blown diabetes now.’ As if I had won the lottery and tried to develop diabetes. I can confirm that I did not try to get diabetes, but I am trying to win the lottery. Because I think it would be nice to have a little extra cash in my pocket.

“With an A1C of nearly 16 percent and a blood sugar reading of 556, he gave me what I call the basic three. Medication – I was on insulin and metformin. General nutrition advice – I was studying nutrition education in graduate school at the time of my diagnosis. And a warning of the consequences of not controlling my diabetes well. Then he sent me on my way back into the world with a life-changing diagnosis and a note to see him again in three months. Absolutely no guidance.”

Coming Up Empty on Support

“For nearly two years I searched for a type 2 diabetes community that went beyond just recommending keto or saying that I could cure my diabetes with some herbal drink or whatever someone was selling. I wanted someone to show me what it was like to live a healthy, happy, quality life with diabetes. But at that time, I realized I was going to have to be my own example. Because I couldn’t find anyone else out there like me.

“Also at the time, I was unaware of the different types of insulins, type-2-specific drugs, and diabetes technology that can make living with diabetes easier. When I learned about these options, it only added to the inferiority that I felt as a type 2 patient. By then, I had already seen several healthcare providers. None of them had bothered to tell me about these options.”

Everything Changes with a New Diagnosis

“However, this changed after an endocrinologist heard my story and had me tested for type 1. Then I found out that I had LADA [latent autoimmune diabetes in adults]. Little did I know, but my treatment from healthcare providers was about to change.

“Suddenly the recommendation of pumps and all this tech and mealtime insulin and learning what bolus and basal insulin mean, as well as getting a continuous glucose monitor – it was all on the table. It felt like an overnight transformation. Suddenly, all of these providers were of service to me, the patient.

“My emotions ranged from relief to frustration. Relief for getting the right care. But frustration at knowing I had received different treatment because of a type 2 diagnosis.”

Stigma Harms Health

Smith’s experience vividly explains how stigma can profoundly harm a person’s health and quality of life. Research on stigma in diabetes tells us that the patients with the greatest needs experience the greatest stigma. In diabetes and in obesity, bias and stigma are huge stumbling blocks to progress.

Click here to hear Smith’s presentation, here, here, and here for more on bias and stigma in diabetes.

Jack Frost, photograph © Neil Moralee / flickr

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March 16, 2021