How to Balance Body Positivity, Weight and Diabetes
Struggling with body positivity, overweight, and diabetes can be overwhelming. But it's possible to balance all three and improve your overall well-being.
In high school, when Samantha Puff was working at an amusement park, she remembers telling a coworker that she had diabetes. The guy stepped back, looked her up and down, and said, “Huh. But you’re not that fat.” In that moment, she realized that to some people, there’s a “look” to having diabetes, she explains.
Puff, now 34 and living in Cincinnati, said she continues to battle body image issues around having diabetes, especially in a culture that promotes mixed messages around bodies — embrace your body as it is (but don’t be too fat). Curves are beautiful (but not too curvy).
These messages can be even more complicated with diabetes in a culture where even the medical field sometimes promotes weight loss as a way to improve diabetes management and overall health.
For example, the American Diabetes Association writes on its webpage for people with diabetes who need to lose weight: “Break the cycle. By losing just a few pounds with healthy eating and exercise, you’ll start to feel better. You’ll have more energy. And it will get easier to manage your diabetes, all while reducing your risk of developing other related problems.”
Puff said that hearing messages like that felt discouraging.
“I know I definitely struggled with body image throughout my life because I've never been skinny. As a teenager, I was extremely active and had more of an athletic build,” Puff says. “It was hard for me to feel good about myself when I was sick with something that had a stigma of being overweight, even though I was very active and fit.”
People with and without diabetes are exposed to messages such as singer Lizzo’s attempts to normalize bigger bodies, pushing against the norm that smaller frames and thighs are the only beautiful images, among her other messages. “I want to normalize my body,” she said in a 2020 Vogue cover story. But for people with diabetes, being above an ideal weight can be dangerous, increasing the odds of complications.
“We definitely live in a culture where being ‘healthy’ is synonymous with ‘skinny.’” Puff said, adding that this message can be even more difficult to hear for people with diabetes. “We can't just cut everything out of our diet. If we're hungry, we have to eat or else put ourselves at risk of getting a bad low. We have to be careful with exercise because our bodies react differently to it.”
She explains that she enjoys working out, but it can sometimes have adverse effects on her body. “It's never as easy as just grabbing my keys, heading to the gym, working out for an hour and calling it a day,” she said. “I have to make sure I test my sugar beforehand, lower my basal rate so I don't drop, and make sure I have snacks and juice on hand at all times.”
Diabetes educator Crystal Scott with Top Nutrition Coaching explains that social media contributes to this mixed messaging of telling people with diabetes, and others, that they should feel comfortable in their bodies, but at the same time they should lose weight to be healthier.
“Social media can be great, and it can also be toxic and lead to very unhealthy relationships with food,” she said. Instead, she works with clients through transparent conversations about “being comfortable” in their bodies at each stage, but also focusing on goals that promote health.
Getting real about the risks of excess weight with diabetes
Nobody needs a “friend” telling them about the latest weight loss fad while they navigate day-to-day life with diabetes. “My favorite part is when the non-diabetics tell us to ‘just do keto’ and the weight will ‘fall right off.’ For a ‘normal’ person, keto can be okay, but for a diabetic, the keto diet could put us in the hospital,” Puff said. She said she’s glad to see diabulimia finally recognized as an eating disorder.
Weight loss can be a major struggle for people with diabetes, and body acceptance is still essential at any weight. Scott says she does counsel her clients with diabetes on the potential effects of carrying too much weight. “It can lead to other things,” she said, “such as high cholesterol, high blood pressure, cardiovascular disease, chronic kidney disease.”
Your weight is a complex equation, of which diet and exercise only make up one part. You can be healthy at many different sizes. "Losing weight" alone can be hard (and impossible in some cases) but improving health by making small changes is the key. Things like sleep, stress, mental health, access to affordable healthcare are also part of the equation. A cohesive plan should focus on more than weight, Scott said: “How’s your sleep? How’s your energy? How do you feel? Where’s your mental and emotional space?”
Janet Zappe, a certified diabetes educator with The Ohio State University Wexner Medical Center, explained that it only takes a small reduction in weight to make an impact on diabetes health, and it might not even change your “look” that much anyway.
“A healthy body is a beautiful body,” she said. “Bodies come in all shapes and sizes, and we want people to honor their bodies. If a person is overweight, losing 7% of their body weight yields tremendous health benefits with their pre-diabetes.”
She added that in most cases, 7% is not going to take people down to a size six or some idealized version of thin, and that skinny does not equal healthy.
Taking active steps toward improved body image at any size
Even in the face of trying to improve your overall health with your diabetes care team, mixed messages might mean accepting two realities at once.
Zappe’s colleague at Wexner Medical Center, psychologist Sophie Lazarus, said, “Acknowledge that sometimes messages that seem oppositional can both be true; for instance, your body being beautiful and acceptable does not depend on its size, and losing weight or increasing exercise can improve your health outcomes.”
Lazarus and Zappe have a few tips for tackling this challenge of accepting your body and improving your health:
Start by working on loving and accepting your body for its uniqueness right now
Set boundaries around media or other sources telling you something different
Prioritize friendships, which are important for weight management and activity levels, especially spending time with like-minded people who have similar goals and values
Attend to emotional distress associated with diabetes, and the burden that can come with managing it by building coping skills
Make time to learn about diabetes and your health to feel more in control
Find new ways to address stress such as social support, prayer, meditation, and exercise
Finally, remember you are far from alone in struggling with body image issues with diabetes.