Your weight does not matter in diabetes care. Here is how to find a neutral doctor of the weight

“”[Health care] Has a very focused model, where people lose weight, it heals all their problems, “said Dr. Dodell. But we know that this is not always the case.

Why the weight is not important for diabetes care

Fletcher (among other neutral practitioners) understood that weight loss is not necessarily as important to manage diabetes as people are led to believe it. And there is evidence to support this.

She underlines a July 2013 study in The New England Journal of Medicinewho found that weight loss has done not Reduce the rate of heart problems in overweight people or obesity and type 2 diabetes.

Another January 2016 study in Plos a People with overweight and type 2 diabetes who have lost weight have not seen a reduction in their risk of overall mortality or risk of heart problems over a period of 13 years.

On the other hand, lifestyle habits such as exercise (without weight loss objective) have proved beneficial.

A November 2017 study in BMJ Open Diabetes Research and Care The exercise found can reduce the levels of A1C (a measure of the average blood sugar of a person in the last three months) even if it does not lose weight. “The exercise must be considered beneficial in itself, not only as a weight loss way,” concluded the authors of the study.

“There is a lot of research stressing that the simplistic views we have held around weight and weight loss are not really precise,” adds Fletcher.

3 advantages of neutral diabetes care in weight

For many people, the idea of ​​putting little emphasis on weight can be a welcome change – and again -.

In the past, when someone has been diagnosed with a prediabetes or type 2 diabetes, “the first recommendation of the mouth of many doctors would be to” lose weight “”, explains Erin Palinski-Wade, RD, CDCE, author of Diabetes at 2 days.

Here are the advantages of neutral diabetes care in weight:

1. The emphasis on general well-being

Neutral diabetes care for weight often means improving a person’s behavior to highlight well-being. This may include healthy eating habits, regular exercise and a good night’s sleep. Nor does it force, like weight loss.

“You cannot control a result,” explains Fletcher. “You can only control behavior.”

2. Patient empowerment

An approach based on well-being can be stimulating for some people with diabetes, especially those who have had trouble losing weight.

“Focusing on a number is not always practical for everyone,” said Palinski-Wade. “And for some people, it can be really defeated.” (Without forgetting that the maintenance of weight loss is difficult, and the revival of weight is typical, according to a study of January 2019 in North America medical clinics.)

3. Focus on diabetes management

A neutral approach to the weight of diabetes care also puts emphasis on other diabetes specific health markers. Two of them, says Palinski-Wade, are daily readings of fasting blood sugar and the A1C level.

That said, people with diabetes can also be at risk of other health problems, such as heart disease, so your doctor will want to keep an eye on your cholesterol and blood pressure, she also said.

Care in neutral diabetes and disorderly food

Taking weight of the equation can also help people like Turner, who – as well as 14 to 20% of people in the United States – find it difficult to disorder, by October 2019 study Jama.

“Many of my patients have a history of food disorders, and there is a lot of stigma concerning the weight,” said Dr. Dodell. “I think that [weight] can harm the visit. “”

Turner, who also helps to lead people through medical problems, says some of his customers, including those who have a history of disorder, say that their doctors remain hyper focused on weight.

“I heard stories of doctors who are not willing to treat patients because they have overweight or obesity,” she said. And this is even after the patients mentioned their past with food disorders and their desire to fight their diabetes.

Fletcher adds that if people with diabetes lose weight in an unhealthy way – by restricting their calories too much or going too long without eating – it can drop dangerously low blood sugar.

You also run the risk of malnutrition and low levels of vitamins such as thiamine (B1), an essential nutrient for people with diabetes, according to the National Institutes of Health (NIH).

“We are so focused on the weight. Doctors often say:” aren’t it great that they lose weight? “”, Said Fletcher. But weight loss is not useful if you engage in a disorderly diet.

If you have trouble obsessive thoughts around body image, food and weight loss, you are not alone. You can suffer from diet or a diet. Remember to seek online support through organizations such as the National Eating Disorders Association (NEDA). Neda’s assistance line (800) 931-2237. SMS and online cat options are available.

Weight stigma in the doctor

Unfortunately, the weight bias is not uncommon among doctors, according to a study of November 2012 in Plos awho found a high prevalence of what was called “anti-fat attitudes”.

Palinski-Wade says that some of his clients would really cancel their regular exams with their doctor if they felt like they hadn’t lost enough weight. They knew they would feel ashamed. “This prevents people from getting the necessary care,” she adds.

These points of view also have consequences. A November 2016 study in Psychological sciences Discrimination in weights has been associated with an increase of almost 60% of mortality over a period of 4 years.

This means that weight stigma can be a serious threat to patient health.

Concerns about the care of neutral diabetes

There are still many medical associations that believe that weight loss is the cornerstone of diabetes care.

The American Diabetes Association (ADA), for example, recommends weight loss to overweight or obesity.

Studies also suggest Current opinion in endocrinology, diabetes and obesityBut researchers do not know exactly how or why, or if losing weight would affect resistance to insulin.

This is why some organizations like ADA believe that if weight loss is completely removed from the equation, this could be harmful to people with the condition that also have visceral fats.

Although more research is necessary, an intermediate approach can be the safest approach to weight in the context of diabetes care. Thought goes that the weight – or more precisely, the body composition and the waist – always count, but that it is preferable to focus on specific and exploitable steps that a person can control, like eating more fibers, sleeping more and reducing stress.

When people adopt this approach, they also tend to see a reduction in body fat, says Palinski-Wade.

How to practice neutral diabetes care

1. Concentrate on positive behavior

The purpose of this type of care, known as Fletcher, is that a patient and a supplier focus on positive behavior – eating balanced meals, exercising regularly, managing stress and sleeping enough – not the result of weight loss.

2. Be frank on your expectations

In order to put neutral care into practice, the patient and the doctor must be clear about what they expect from each other. When Turner visited her endocrinologist for the first time, she was clear that she wanted neutral care.

Doctors must also make sure to explain to patients why they practice neutral care and other health measures they use, such as blood sugar, A1C levels, blood pressure, etc.

3. Ask not to be weighed

“To date, my [doctor] I never gain my weight when I come to the office, “said Turner.” We really focus on what my blood panels look like according to what’s going on in my life, my mental health, that kind of things. We do not focus at all on the weight. “”

Do not be afraid to ask your doctor not to weigh. If they refuse, they may not be the right doctor for you.

4. Bring a card “Don’t weigh me”

If you feel anxious or you cannot verbally ask not to be weighed for any reason, there are laminated cards “don’t weigh me” that you can buy or get your appointments. Show the card to the doctor or the nurse before heading for the scale.

5. Ask for a “blind weighing”

If you are medically necessary to go up on the scale, ask doctors or nurses to be weighed against the scale, so that you do not see the number. You can also ask them not to say the number aloud and not show you a weight -oriented paperwork.

Turner calls this a “blind weighing”. Because she does not want to rewrite her food disorder, she asks for blinds weighs each visit.

If you feel comfortable, you can ask all practitioners, including your primary care doctor, to implement this practice.

6. Find out about neutral drugs at weight

If necessary, Fletcher also encourages diabetes doctors to prescribe neutral drugs by weight as much as possible – which means medication with less potential to cause weight loss or gain.

“We are trying to prescribe drugs that do not inhibit a person to listen to and respond to their own internal clues around food and food,” said Fletcher.

How to find a neutral diabetes care team

In the end, it is important that patients with diabetes feel seen and heard, says Fletcher.

This means that this can take some attempts to find a practitioner who will provide you with a neutral approach to weight – and you may first have to approach the subject.

The right thing about diabetes management is that, often you have an entire team at your disposal: a primary care doctor, an endocrinologist, a dietitian and more.

“Even if you only find a member of the team that is more inclusive, you will have more support when you go to other meetings to keep this conversation from the weight,” explains Palinski-Wade.

“You can say:” My weight is the same, but look, my blood sugar improves because I improve my sleep or get better management of “” stress, “she adds.

Once other practitioners see your improvement, they are likely to become more motivated by these figures, instead of simply your weight.