Obesity and Stigma in Type 2 diabetes

Mary Harrison, Diabetes Nurse Educator and Research Associate at Eden, shares with us her latest experience whilst attending the Cardio Renal Forum.

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“This tweet, is my most viewed tweet of all time and for good reason, it is shocking

At the time I felt like I was the only person in a room of healthcare professionals (HCPs) who was disgusted. This got me thinking, are these attitudes still widespread across HCPs?

We are lucky working in diabetes; the majority of HCPs I collaborate with are extremely aware and sensitive. They understand stigma and the impact language can have on people living with diabetes (#languageMatters).

 
People with diabetes internalise messages from the media, from those around them, but most of all from their healthcare providers. When these messages are perceived negatively, whether it is intended or not, this can lead to feelings of shame, guilt and resentment. People who are ashamed of a condition will find it much harder to engage and manage that condition proactively
— Language Matters DUK, 2019

The Language Matters document advocates that HCPs use language that is free from judgement or negative connotations, I think nothing is more judgemental or negative than using a picture of a character who’s name is “Fat Bast**d” to visually represent people living with diabetes.

There is an abundance of evidence about the negative effects of obesity shaming and stigma on mental health and well being, including depression, self-harm and even suicide.

(Faith et al, 2002; Puhl and Brownell, 2006; Vartanian and Shaprow, 2008; Puhl and Heuer, 2009)

 

People who are obese, face stigmatism because others view the condition as easily modifiable - reduced energy in vs. increased energy out (Flint, 2015).

It has been demonstrated that HCPs think this way and perpetuate obesity stigma (Swift et al, 2013).

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As we see from the Public Health England infographic, there are well known associative health risks to being obese. However, there is evidence that as patients’ BMI increases, HCPs loose their desire to care, seeing people with obesity as wasting their time (Hebl and Xu, 2001; Huizinga et al, 2009).

The debate over the best diet for people with obesity +/- type 2 diabetes will continue, but we can be fairly certain that fat shaming and stigmatising people doesn’t help, in fact it makes things worse.

Healthcare professionals who openly fat shame and perpetuate the stigma, end up looking unprofessional and rude.

 

Written by:

Mary Harrison

Eden diabetes nurse educator and research associate

 

Reference list and links

Faith, M.; Leone, M.; Ayers, T. et al (2002) Weight criticism during physical activity, coping skills, and reported physical activity in children. Pediatrics 110: p 23

Flint, S. (2015) Obesity stigma: Prevalence and impact in healthcare. British Journal of Obesity 1: p 14–18

Puhl, R. and Brownell, K. (2006) Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring) 14: p 1802–15

Puhl, R. and Heuer, C. (2009) The stigma of obesity: a review and update. Obesity (Silver Spring) 17: p 941–64

Swift, J.; Hanlon, S.; El-Redy, L. et al (2013) Weight bias among UK trainee dietitians, doctors, nurses and nutritionists. J Hum Nutr Diet 26: p 395–402

Vartanian, L. and Shaprow, J. (2008) Effects of weight stigma on exercise motivation and behavior: a preliminary investigation among college-aged females. J Health Psychol 13: p 131–8

Rachel Gardner