'People First' -- Ending Weight Bias in Diabetes Care

Rebecca M. Puhl, PhD


July 21, 2016

In This Article

Weight Bias in Diabetes Care

Efforts to address weight bias in obesity care have increased, with the acknowledgement that weight bias is an obstacle that can impair effective obesity prevention and treatment. Only recently, however, has dialogue emerged about the need to address this form of bias in diabetes management. Clinical guidelines for diabetes treatment increasingly include an emphasis on the assessment and management of body weight in assessment. The 2015 Standards of Medical Care in Diabetes from the American Diabetes Association recommend a patient-centered approach in the management of diabetes.[16] Adopting a strategy to address obesity in diabetes care first and foremost requires an increased awareness of weight bias and its consequences for patients' health.

Weight-based stereotyping of people with obesity, including attributions of personal blame or lack of discipline, extends to those with type 2 diabetes.[17,18,19] A recent study documented the negative health implications of weight discrimination on diabetes-specific outcomes. In a sample of 185 adults with poorly controlled type 2 diabetes, researchers found that patients who reported experiencing weight discrimination had significantly higher A1c levels and diabetes-related distress, and poorer diabetes-related self-care behaviors (including eating habits, physical activity, and glucose testing).[19] These findings held even after controlling for BMI, overall discrimination, depressive symptoms, and demographic characteristics.

Although research in this area is still in its infancy, initial evidence suggests that weight stigma is present toward patients with type 2 diabetes and that it may contribute to poor diabetes outcomes. Given that previous research has already documented adverse physiologic stress responses and increased weight gain in reaction to weight stigma, further examination of links between weight stigma and diabetes outcomes is warranted.


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