Addressing Stigma in Diabetes and Obesity Care
At a recent virtual panel, people with diabetes shared their powerful lived experiences on weight management, discrimination, and diabetes stigma both in and outside the healthcare system.
While diabetes care has seen tremendous advances in treatment and technology in recent years, challenges around diabetes stigma, discrimination, and mental health remain. Indeed, 76 percent of people with type 1 diabetes and 52 percent with type 2 diabetes reported experiencing diabetes stigma in one 2017 survey.
At diaTribe’s recent Musings panel, “Diabetes, Obesity, and Stigma: New Opportunities and Mixed Messages,” a panel of experts shared strategies to address stigma and discussed new weight management medications with hundreds of patient and non-profit advocates, healthcare professionals, and industry leaders.
The panel was moderated by Matthew Garza, senior manager of the Stigma Program at The diaTribe Foundation, and included:
Dr. Clare Lee, executive medical director at Lilly Diabetes and Obesity
Dr. Rebecca Pearl, assistant professor at the University of Florida College of Public Health and Health Professions
Michele Tedder, patient advocate and senior program manager of the Black Women’s Health Imperative
Virginia Valentine, certified diabetes care and education specialist at Clinica La Esperanza
Evolving treatments for type 2 diabetes and obesity
Panelists highlighted the wide range of medications that are now available to manage blood sugar and body weight in type 2 diabetes.
Dr. Clare Lee said the field has come a long way in the past decade from a time when bariatric surgery was the only way to achieve substantial weight loss. Now, with incretin therapies like GLP-1 agonists and GIP/GLP-1 agonists that mimic gut hormones, people are often able to lose 15 percent or more of their body weight, which in turn may improve overall health.
“It’s an exciting new era because we have the advent of highly effective treatments for people with type 2 diabetes and obesity that are, in part, taking the wisdom that [bariatric] surgery has taught us and showing us that hormones in the gut play an important role,” said Lee.
In a similar vein, Virginia Valentine discussed the 2023 ADA Standards of Care, which suggest aiming for 15 percent weight loss to improve glucose management and reduce cardiovascular complications. While this number may seem challenging to attain, Valentine said that with the help of GLP-1 agonists, we have the ability to get there.
Sharing her personal health journey over the past four decades, Valentine emphasized the importance of staying on weight management medications for life. She also spoke about the cardiovascular benefits of drugs like Wegovy, which were recently shown to help people with obesity who don’t have diabetes.
Looking ahead, Lee said that incretin therapies may streamline diabetes and obesity care by helping people achieve their glycemic and weight management goals with a simpler treatment plan. With demonstrated heart-related benefits and more studies in progress, these medications could also potentially delay or reduce the need for additional cardiovascular drugs, Lee said.
How stigma can affect diabetes management
Both within and beyond the healthcare system, panelists described structural barriers that prevent people with diabetes or obesity from accessing proper care.
For instance, Michele Tedder described her challenges seeking a breast reduction procedure following bariatric surgery. After receiving a clean bill of health (maintaining 25 percent weight loss and cholesterol, plus A1C levels within her goal range) from her weight management team and primary care provider, Tedder was all set for the procedure.
However, the surgery center did not allow the plastic surgeon to perform the procedure because Tedder’s body mass index (BMI) was 0.75 over the state limit. As a result, Tedder’s surgery had to be rescheduled at a hospital instead of a surgery center, which was an additional $2,500 out-of-pocket cost.
“If we really want to change the game and make sure that people have access to comprehensive care for their treatment (and they're looked at as individuals from a comprehensive standpoint), we will stop and fight to dismantle these types of things that create the space for implicit bias both internally and externally,” Tedder said.
Valentine touched on other barriers in the healthcare system, from waiting room chairs that are not wide enough to exam gowns that are not adequately sized. Outside of healthcare, these issues are often present in public transportation, for example, such as airplanes having short seatbelts and seats that are too narrow.
Meanwhile, Dr. Rebecca Pearl said she often sees stigma in the perception that taking medication for weight loss is an “easy way out” and avoids the hard work of diet and exercise. In reality, all weight management interventions – including medication or surgery – involve lifestyle changes, as well as counseling to promote behavior changes. Overall, Pearl encouraged people to view medications and surgeries as “an additional tool in people’s toolboxes.”
“[Obesity] is not any individual's fault. It's not some kind of moral failing,” Pearl said. “There are real biological and environmental challenges to managing weight, like with any health condition, that require comprehensive treatment and lifelong management.”
Self-advocating to address stigma
The main takeaway from the panel discussion was calling for positive counter-messages to combat harmful misconceptions about obesity and diabetes.
For instance, popular culture and the media often perpetuate stigma by focusing on weight loss from an appearance perspective, with being thin as a standard of beauty. Pearl said that the celebrity gossip regarding anti-obesity drugs “undermines the seriousness of these health conditions,” detracting from the real reasons why people need medication.
In order to address this stigma, Pearl called for shifting the narrative from looking thin to recognizing the health benefits of medication, such as a better quality of life. For instance, weight management drugs might allow a grandparent to have more strength and mobility to play with their grandchildren.
Speaking from personal experience, Tedder encouraged self-love and self-care as a foundation for good health.
“Part of loving yourself is advocating for yourself and being willing to demand that people treat you the way that you deserve to be treated,” Tedder said.
“There's a saying in my community that sometimes you have to teach people how to treat you,” Tedder said. “And so that is true in personal, professional, and healthcare relationships. If you don't understand something, you deserve an explanation. You deserve to be seen as an individual. And you deserve to be a partner in your own health care.”
Pearl echoed these recommendations around self-love and offered a helpful self-reflection exercise. For any stigmatizing thoughts (such as, “I’m lazy”), take a step back and consider all the roles you play in your family, job, and community. Then, Pearl suggested trying to shift the focus away from weight defining your worth and character – that is, “shrinking the weight of weight in your self-image.”
Instead, Pearl said it’s important to recognize that “everybody is a whole person, a complex person with lots of individual strengths and characteristics.