Diabetes Fat Shaming in Healthcare: From Stigma to Strength

Dr. Jedha, Host, 01:18

Hello, wonderful people. Dr Jedha here and thanks for joining me for episode 40. Wow, episode 40. That’s a good milestone. I really like the sound of that. I’ve loved bringing every podcast to life and the great thing is there’s always more for us to explore. And one thing I do love exploring is the lived experience of our members and people in the DMP community. Of our members and people in the DMP community, Helen has been through the T2Diet program and has been with DMP a while now and, after struggling for a very long time to lose weight, she’s making great headway and on a completely different pathway in her life. Today we’ll be hearing from Helen about her fat shaming experience and we’ll be delving into this more because it’s a big issue, not an isolated one, unfortunately.

02:12

Back in episode 33 we covered the diabetes bloopers and Tim said he was told by his doctor that and I quote: 

“I wouldn’t have diabetes if I wasn’t fat. Even my doctor told me if I would just lose weight and go down to 150 pounds, it would cure the diabetes. She told me to get bariatric surgery to take 80% of my stomach out. I said no, thanks. Next time I saw her she said I see you like being fat since you decided not to get the surgery.” 

This response Tim received from his doctor is, unfortunately, a classic example of fat shaming in the medical community and, like I said, we’re hearing from Helen today about a very similar experience, so let’s hear from Helen now.

Helen, Guest, 03:11

I struggled with my doctor’s attitude, which was often just stop being fat, just stop being fat, just go home. What are you doing which is not helpful? Yeah, it has been a big problem and I’ve actually had meltdowns on him, like he’s had to watch me meltdown because I can’t handle his attitude. And actually it’s his unscientific dogma. Because he likes paleo he comes out with these trite little paleo sayings and I just want to slap him and I also have a history of eating disorders, so that’s another minefield. And I started having disordered thoughts again and that really frightened me because at this age, with a lot of the complications I already have from being overweight and having rubbish joints and diabetes and all that sort of thing, the last thing I need is to start abusing my body with disordered eating. And I went to my doctor and I said I don’t know what to do. I’m trying to stay out of this place, but I’m having a lot of disordered eating thoughts. And I went to the diabetes educator and I said I’m having the disorder. Nobody knew what to do, so I had to.

04:36

In a way, I had to just cope with that minefield and try and get through it without, you know, doing myself any damage, minefield and try and get through it without you know doing myself any damage. And it’s not like I can get like anorexia support at this weight. You can’t, they don’t. They don’t give you that sort of support when you’re a fat person, even when you know your thoughts are leading in that direction, like struggling to put food in your mouth because you know that it’s better for you to do that than to sit there and say, um, I’ve got to lose weight, I’ve got to do this, I’ve got to. I’ve got to control my blood sugar, I’ve got to, you know. And you’ve got those cacophony of disordered thoughts and they don’t creep, they hammer. And I’m being a little bit more unaccepting of the medical gaslighting and the carry-on that my GP goes on with, because you know he looks like a starving jazz player. So of course everybody should be able to lose weight. It’s not rocket science. So, yeah, I’ve gotten to know his little ways, I’m starting to stand up for myself and so and I’m calling him out on his misogyny, you know, yes, I’m fat, I’m crazy, I’m old and I’m a woman, but that doesn’t negate what I’ve come to talk to you about.

06:06

You know, I’ve been dieting since I was nine. I know a lot about trying to lose weight. I don’t know anything about being successful at losing weight. I often say I dieted myself up to 154 kilos because every time I dieted I’d lose a bit of weight and then I’d put it all back on again because it’s never sustainable. You can’t live on 800 calories a day for the rest of your life. I’ve tried it on 300 calories a day. That didn’t work well either. So it’s just. The constant promotion of unsustainable lifestyles is just ludicrous.

Dr. Jedha, Host, 06:51

It’s interesting that you’ve said you’ve never known how to be successful, but you’ve said now you’ve lost quite a bit of weight.

Helen, Guest, 06:58

Yes, yeah, I was about 154 kilos and at the moment I’m 128. I think the program came at the right time for me and I think that’s where the program sort of it was a safe food space and I think, that’s part of the methodology that you’ve put together. Is that it’s support?

Dr. Jedha, Host

07:32

After listening to Helen’s story, have you shared a similar experience? If you said yes, you certainly wouldn’t be alone. Societal weight stigma and weight discrimination is pervasive. The blaming and shaming, the cultural reinforcement of a slim ideal, anti-fat attitudes and internalized weight stereotypes are consistently perpetuated. This is an unfortunate reality but, as we heard from Helen’s story, it can be harmful. Helen shared her issues with dieting since she was nine years old and, as we heard, she had dealt with disordered eating, going through anorexia when she was younger. Diet after diet after diet, she shared how she dieted herself to 154 kilos or 340 pounds, all the while being blamed and shamed, spoken down to and unsupported. So here’s the thing: fat shaming can cause anxiety, depression and lead to decreased health motivation, and for Helen, it led to a minefield of triggers related to her previous eating disorders that she was left to navigate through on her own. We learned through Helen’s story this weight stigma can be damaging. Research shows us the impact can actually be profound, affecting people on many different levels. Weight stigma is linked to psychological distress, depression, anxiety, low self-esteem, body image disturbances, decreased health motivation, maladaptive coping motivation, maladaptive coping, avoidance of timely health care, social isolation, prolonged stress, disturbances in the body, reduced physical activity, disordered eating behaviors, increased food intake, eating in the absence of hunger, emotional distress, self-blame and self-devaluation, emotional eating, binge eating, increased risk for weight gain and obesity, sleep disturbance and even shortened life expectancy. That’s a very long list of impactful consequences, right? For Helen, she received these negative attitudes from her doctor.

10:12

Healthcare, unfortunately, is one of the most common contexts where weight stigmatization occurs, with physicians at the top of that list.

10:18

Unfortunately, though, it doesn’t stop at physicians, with evidence highlighting this is happening from all sorts of healthcare professionals Nurses, dieticians, psychologists, kinesiologists, students of these disciplines and even obesity specialists, which is just crazy. Of course, it’s not limited to healthcare. People experience stigma in workplaces, educational settings, among families and in the broader community at large, but when these judgments do come from a healthcare environment, research suggests they have deeper consequences. So why is this happening? As Dr Maria and I spoke about in episode 27, medicine and healthcare isn’t often humanized, but often people are treated like another number, just another patient with a whole set of symptoms. Professionals are well you know, they’re not always empathetic or considerate of the fact that you are a real person with a history and a story, and often there are many complexities to consider as well, for instance, Helen’s history of disordered eating. On the surface, it may be easy to judge her weight, but there is a deep story there and a person just wanted to be heard, understood and supported.

Dr. Jedha, Host, 12:17

Empathy is defined as the ability to understand the lived experience of another and to communicate that understanding, and clearly there is a lack of empathy. Instead, there are deeply embedded, pervasive attitudes which view overweight people as lazy, gluttonous, lacking motivation, willpower or self-discipline and lacking personal responsibility, as Helen touched on in her story with her doctor. These are all typical stereotypes and generalizations, but they are incredibly prevalent, much of it perpetuated by the media and social media. We all know of these types of stereotypes, and we may have even passed judgment on others ourselves during our lives because of lack of education and lack of empathy ourselves. These societal attitudes are pervasive, and we all do get affected by it as well. One of the issues, though, is that people take that stigma, that judgment, and internalize those things. The person then blames themselves for their perceived overweight, and they may engage in self-directed weight stigma, believing the common stereotypes, and, as Helen said, those internalized voices can hammer you. Not all experiences are as blatantly obvious as the experience that Helen shared. Sometimes these judgments can come more subtly. So let’s go over some various signs of fat shaming that you may encounter in a healthcare setting or in any other setting too.

13:59

Negative comments, so demeaning remarks about your weight or appearance. Assumptions, presuming your health issues are solely due to your weight, without thorough investigation. Dismissive attitudes focusing exclusively on, say, weight loss as the solution and ignoring other aspects of your health and ignoring other aspects of your health. Inappropriate humor, so jokes or sarcastic remarks about your weight, which are meant to be humorous but they’re actually hurtful and unprofessional. Body language can also be assigned, so non-verbal cues, such as eye rolling or not making eye contact, sighing or a dismissive attitude when discussing your weight or your health issues. That lack of empathy, so showing little to no understanding or compassion for the challenges that you face in managing your weight or your health. An overemphasis on BMI, so when people just focus exclusively on your BMI as an indicator of health, without considering other vital health markers and individual factors. Unsolicited diet advice offering unsolicited or often simplistic advice about dieting and weight loss, regardless of the reason for your visit, of the reason for your visit.

15:27

Using guilt or shame tactics, so employing guilt-inducing language or shaming tactics to try to motivate weight loss, which can be counterproductive and harmful in many cases. Patronizing language, speaking to you in a condescending manner, as if you lack knowledge or capability in managing your own health, and ignoring your input, dismissing or disregarding your own observations and experiences regarding your health and your treatment preferences. So these are just some examples, and for you it may have been a different experience entirely. Whatever the case, though, your experience is valid. Unfortunately, there is no clear way to end all weight stigma. There is more research and active awareness growing in the healthcare space, which is a good thing, but we’ve got a long way to go. At the end of the day, we are our best advocates with anything in life, and you do deserve to be treated with respect. So if something isn’t right, then respectfully say so.

16:32

As Helen said, she is trying to be more assertive, unaccepting of these attitudes and standing up for herself, calling her doctor out. I had asked asked Helen if she could see a different doctor, but there’s a lack of access to doctors where she is, which is the case for many people, so it’s not always that easy, right, but you can find support in other ways, such as Helen did with us at DMP and through the T2Diet program. As Helen shared, she hadn’t been successful at losing weight because she’d been on the dieting hamster wheel since she was a child. Her attempts had always backfired due to that dieting culture. It wasn’t until she took the T2Diet program that everything started to change for her. She was given education and empowered with choices, and she felt supported, respected and empowered to take positive steps forward for herself, which is exactly what she did and is now becoming successful in losing weight Losing 28 kilos or 62 pounds the last time we spoke, but I know it’s been more since. In any case, she is making great headway.

17:45

So my approach to weight loss has never been to think about dieting and losing weight, but to focus on wellness from the inside out and also on sustainability, which, if you’ve listened to the podcast, you’ll know I talk about a lot. If you focus solely on weight loss, you might try that diet and, yeah, it works. But as soon as you stop that diet, you put the weight back on plus some more. Yo-yo dieting is not healthy. But if you focus on health and wellness from the inside out and on sustainability, the way you go about things will be entirely different and you will achieve sustainable results as well.

18:29

If you listen to Wilma’s story in episode 7 and her update in episode 36, she’s lost around 79 pounds now. That’s 36 kilos, and she lost this without even thinking about it. For her it was effortless weight loss. Like Helen, Wilma had always had an issue with the weight, but for the first time in her life she feels so empowered because she’s been proactive with her health overall, and that’s what has sparked the weight loss. Wilma hasn’t thought about weight loss at all. It’s been a lovely consequence of the positive, sustainable changes that she’s made in her life overall. Helen has done exactly the same thing. She hasn’t thought about weight loss but has focused on re-engaging with her health.

19:20

And, as we learn from Helen, it’s about more than just food. Our health involves our emotions, our thoughts and sometimes deep complexities mixed up in our story that we have to navigate through step by step, and we all need support to do that. So here’s the thing: If you’re currently feeling a bit lost, struggling to make ground, tired of the stigma, and you’re seeking empathetic support, consider joining us as a member. You certainly don’t have to navigate this journey alone and we all need support to achieve our goals we all do. By becoming a member with us, you’ll gain access to trusted resources and ongoing support from me and the DMP team all year round, and together we’ll work towards a healthier, happier you, just like the lives of Helen and Wilma and many others have been transformed.

20:21

In any case, I hope you found Helen’s lived experience and the discussion we’ve had today enlightening. In next week’s episode, we’ll be exploring inflammation. Inflammation plays an intricate role in the development of health conditions, including in the development and progression of type 2 diabetes and pre-diabetes, including in the development and progression of type 2 diabetes and pre-diabetes. It’s a very fascinating topic, so please do tune in to discover more about it. 

Take care until then. 

Have a great week, Dr Jedha, over and out.