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Making Diabetes UnLonely

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Lonely woman

Loneliness is a major public health issue that can increase a person’s risk for diabetes, as well as make managing diabetes more difficult. Dr. Jeremy Nobel, founder of The Foundation for Art & Healing and Project UnLonely, shares insights on loneliness and the work his organization does to combat it.

In 2023, U.S. Surgeon General Dr. Vivek Murthy released an advisory that called attention to the public health crisis of loneliness, isolation, and lack of connection in the country. Many Americans experience loneliness, and its impacts are catastrophic. 

In press conferences surrounding his advisory, Murthy cited research that likened the effects of loneliness to smoking 15 cigarettes a day. Studies have shown that for people experiencing chronic loneliness, physical health consequences include a 29% increased risk of heart disease, a 32% increased risk of stroke, and a 50% increased risk of developing dementia for older adults. 

Loneliness is a complex issue and becomes even more so for people living with a chronic health condition like diabetes. How exactly does loneliness affect diabetes? Is there anything we can do to solve this crisis? Here we explore all this and more. 

What is loneliness?

“It's really important that people understand loneliness is not the same thing as being alone,” said Dr. Jeremy Nobel, a primary care physician, public health practitioner, and award-winning poet. He’s also the founder and president of The Foundation for Art & Healing, which aims to harness the power of creative arts to improve personal and public health.

Nobel explained that being alone is an objective state that can be evaluated by the quality and number of social connections a person has. Loneliness, on the other hand, is a personal construction; you can think of loneliness as your body’s way of telling you it needs more human connection.

Loneliness is also more than just a feeling. Like stress, it can have damaging effects on the mind and body. Loneliness has been found to increase inflammation and the production of stress hormones like cortisol, while decreasing the production of “feel-good” hormones like serotonin and dopamine. In addition, it can make us more impulsive and less rational, as well as cause (or exacerbate) anxiety and depression

Loneliness can also make our immune systems less effective, and as mentioned earlier, raises the risk of heart problems, dementia, and even diabetes.

Loneliness and diabetes

The relationship between loneliness and diabetes is a two-way street. Experiencing high levels of loneliness has been shown to increase a person’s risk of developing type 2 diabetes, and having diabetes can put someone at greater risk of feeling lonely. 

This is because having a chronic health condition, especially one that is heavily stigmatized like diabetes, can make someone feel extremely isolated. If you have diabetes and are experiencing loneliness, it can make managing your condition that much harder. 

Feeling lonely can lower self-esteem and cause you to forgo health behaviors like checking glucose levels or taking medications. It can also cause you to withdraw socially from others – including your healthcare team. 

“As you become lonelier and detach both from the other people who care about you, as well as yourself, you're less likely to get the help you need when you need it,” said Nobel.

On the flip side, research shows that having strong social connections leads to better health outcomes and diabetes self-management.

How do we address loneliness?

Loneliness is clearly a problem that needs attention. The Foundation for Art & Healing is one organization working on implementing evidence-based strategies to raise awareness and combat loneliness with its Project UnLonely initiative. Nobel said that participating in creative and artistic expression can help reverse the damage done by loneliness. 

“The arts basically alter our brain physiology,” said Nobel. “The important thing to know is that how we make sense of the world, what psychologists call ‘social cognition,’ is personally constructed and shaped by our experiences, attitudes, and beliefs. That includes feeling lonely." 

"The great news is that anything that can be personally constructed in our mental image of the world, can also be personally reconstructed. That’s how we can move from being lonely to being unlonely,” he added. 

Studies have found that engaging in the arts can lower cortisol levels, boost dopamine, and increase our sense of connection to others. This can happen whether engaging in artistic expression alone or with others.

Nobel credits his unique background as a healthcare professional, public health expert, and poet for fueling his passion for this work. 

“I think it was the intersection of these three things that gave me some insight not just into the arts and how the arts can be such an important and vitalizing force, but specifically how it could help us be healthy and well,” he said.

“I started the Foundation after 9/11 because I was very impressed with how effective certain types of creative expression were in helping people recover from the trauma of that event,” said Nobel. 

While it wasn't clear how exactly it worked at the time, Nobel said he discovered that these types of creative interventions were effective at treating trauma partially because they helped address loneliness and isolation.

Nobel and other researchers set out to understand this better with a pilot study that looked at how creativity circles impacted the quality of life for a small group of African American women with type 2 diabetes in Boston. Participants attended six, 2.5-hour supportive group sessions that combined creative arts and storytelling. The results were overwhelmingly positive, with mental health improvements largely attributed to the increased social connection.

As a result of pilot programs like this, the foundation launched Project UnLonely in 2016, which aims to raise awareness, destigmatize, and create programs to address loneliness. Right now, Project UnLonely is focused on four main audiences: older adults, college students, working populations, and individuals within at-risk or marginalized communities. While each program is different, each makes use of a few key components, namely, mindfulness, creative expression, and storytelling. 

Project UnLonely Films

In addition to loneliness programs, Project UnLonely curates a collection of films each year that highlight the challenges of loneliness and social isolation and how to overcome them. 

“That really is the power of our Project UnLonely Film initiative,” said Nobel. “Before you know it, not only do you no longer feel alone, but you feel connected.”

This year, The Foundation for Art & Healing announced that celebrated actor and director Steve Buscemi will be co-hosting the launch of Season 8 of Project UnLonely Films on June 2, 2024 at 7 p.m. ET. The event will feature the filmmakers and their thoughts in a special video montage and a handful of the award-winning films will be screened.

The virtual launch event is free and open to the public (you can RSVP here). If you can’t attend the event live, all the films (including those from previous seasons) will be available to stream online.

Learn more about mental health and support systems for diabetes here: