Shame and Diabetes: Practicing Resilience in a Culture of Weight Stigma, Disordered Eating and Healthism

Shame, weight stigma, and healthism has a negative impact on people living with diabetes, according to Nikki Estep, MPH, RDN, LD, CDE, and Allison Marek, LCSW, CDWF, who presented at AADE19 in Houston, TX.

According to the presentation, the presenters defined shame as “the intensely painful or experience of believing that we are flawed and therefore unworthy of love and belonging.” The feeling can produce increased body temperature, nausea, sweating, chest pains, low energy levels, a tingly/numb feeling in the limbs, muscle tightness, bad body posture, and the feeling of being “small.”

Shame is linked weight stigma, which the presentation defined as “the social devaluation and denigration of people perceived to carry excess weight that leads to prejudice, negative stereotyping and discrimination toward those people.” Weight stigma is a growing issue as weight discrimination has increased by 66% in the last decade, and has become a socially acceptable form of bias, affecting all people. In fact, among women, weight discrimination is more common than race discrimination.

Weight discrimination can also play a role in how patients are treated in a medical setting, as the presenters note that medical professionals perceive larger patients as lazy, lacking willpower, and are personally to blame for their weight problems. These medical providers often spend less time building rapport with overweight patients less time in appointments, provide less education, and are less likely to perform tests and screenings.

An online survey showed that the majority of diabetes patients reported a stigma that comes with the disease, and this stigma can disproportionately affect those with a higher body mass index (BMI), and poorer blood sugar control, “suggesting that those who need most help are also those most affected by stigma,” the presenters said.

Moreover, both shame and weight stigma are associated with cultural healthism, a belief system that ignores the impact of factors such as poverty, oppression, abuse, and environment can have on one’s weight. To combat these problems, the presenters suggest more weight inclusivity, better health advancements, more respectful care, refraining from blame, and a shift away from language that dehumanizes people with eating disorders and weight problems.

Estep N, Marek A. Shame and Diabetes: Practicing Resilience in a Culture of Weight Stigma, Disordered Eating, and Healthism.

Presented at the AADE19 Meeting; August 9-12, 2019; Houston, TX.