Negative body image can have an impact on your health. If you live with diabetes, learning how to take a more body-positive approach may help.
The long-term effects of negative body image can be severe. And what worries experts is that it only takes one comment to send someone down a dangerous road. If diabetes is involved, the effects can be compounded.
“It’s the well-meaning doctor who says something like ‘You better clean up your act or you’re going to have type 2 diabetes,’” Nicole Patience, a nutrition and diabetes educator and eating disorders specialist at Joslin Diabetes Center in Boston, tells Healthline.
Dr. Samar Hafida, staff physician at Joslin, agrees. She is the assistant medical director of global education and care and a weight management and clinical nutrition specialist.
“It’s not uncommon; in fact, a majority of people have had this experience,” she tells Healthline. “A person comes in [to their medical provider] with a non-weight-connected complaint, and the suggestion is ‘Lose weight and you’ll feel better.’
“The result of those kinds of experiences, compounded by the world’s focus on thin as beautiful, can be the proving ground for depression, self-loathing, and eating disorders. That’s an impact that can hit anyone in society,” she says.
For someone with diabetes, this can be devastating — as they may also face blame over their disease from an uneducated general public, comments from the medical field about how weight reduction or diet change is the center of everything, and the challenge of living with a body that they may feel is failing them.
Could a new focus on body positivity be the solution?
Experts feel that this movement can and will help people with diabetes to feel better about themselves psychologically and become healthier overall.
While it may feel like a new buzz phrase to some, the body positivity movement has been around since the late 1960s, when women first started pushing back on the notion that all women should be thin.
It has taken off in recent years for many reasons.
First, in the late ’90s, a psychotherapist named Connie Sobczak, who was experiencing an eating disorder, combined her professional her background and personal experience to create www.thebodypositive.org, a site dedicated to helping people with self-acceptance.
Patience explains that it’s all about “taking care of the body you live in. It’s about respecting it and recognizing how it serves you in very positive ways.”
What body positivity is not, she says, is a call to ignore healthy suggestions and interventions that you may need.
“Some see it as a double-edged sword,” explains Hafida. “Some worry that embracing oneself as you are will block people from accepting [medical help]. But it’s not an either/or concept. Being body positive should not mean you’re not receptive to taking advice and taking action.”
What it does mean is this: Loving the body you are in as it is in this moment leads to better health outcomes overall.
It’s a difficult thing to embrace for people who are overweight, Hafida says.
“Society tells us we need to look a certain way, be a certain way. That’s hard to overcome.”
When you have diabetes, the challenge of finding body positivity may be intensified by the need to wear medical devices, the challenges you might experience with weight management, the possibility of scarring on your body, and just the feeling, overall, that your body has failed you.
There is also, of course, the stigma and “blame” that the general public associates with diabetes, particularly type 2 diabetes.
She points out that her first step with a patient is reminding them that type 1 or type 2 diabetes is not their fault.
“There is no reason to blame yourself,” she says. “Body size is not a direct indication of whether you take care of yourself or not.”
There are other specific body image challenges that can come with diabetes, she adds, pointing to these as just a few:
- visible devices that draw attention to the person or their body
- how clothes fall on the body around those devices
- scarring, such as lipohypertrophy from years of shots and insulin pump sites, which, while not always visible to the world, is visible to the person who has it
Since 2005, Marcia Meier, program manager at the Patient Services International Diabetes Center in St. Louis Park, Minnesota, has treated over 500 patients with diabetes who also had eating disorders and other body-related difficulties.
The reality, she tells Healthline, is that the impact of negative body image on people with diabetes, particularly women, can be profound.
For instance, research has found that 20% to 40% of adolescents with type 1 diabetes have manipulated insulin to avoid gaining weight. Researchers have also found that this behavior is common in adults with diabetes.
“There is this concept of insulin use equals fat, and right there, you’ve got a predisposition to some of those problems,” Meier says.
Meier traces the issue back to the general public, of course, but also to a place that may surprise many: the endocrinology office.
“Just about every article you read, all that you can pick up right in your endocrinology office, clearly says that insulin causes weight gain,” she says. However, this conclusion is
Insulin misuse
“Most women want to be a body size that is smaller than they are, diabetes or not,” Meier says.
Of the patients she’s treated, she says negative body image “has been a part of [the experience] of every single one of them.”
Meier reported that she’s had a diabetes patient who purposely let her glucose levels run low because “she only gave herself permission to eat when low.”
She noted that other patients have omitted or reduced their insulin doses to induce weight loss despite the potential negative effects.
This drive to be thin does not necessarily stem from being raised in a household where you were judged. In fact, Meier says, even a person raised with all the right cues can fall prey to public comment.
“That’s a huge challenge I see. You can be raised [with body positivity] in your household and literally delve into an eating disorder from one thing a person says.”
It could be as simple as your aunt saying you should skip the dessert so you don’t get fatter and “worse with your diabetes” or a magazine spread with “plus-size models” who are actually a size 8 or 10. Or it could be a doctor who tells you that your weight is the cause of all your troubles.
One negative comment is all it takes, she says, to set a person down a dangerous road.
Like so many other things, this takes a village. People with diabetes need the world, the media, and yes, their own doctors to understand and embrace this, experts say. They also need to embrace it themselves.
Here are some ways to build body positivity:
Speak more kindly to your body
It starts with you. Patience says that when a person meets with her for the first time, she’s quick to strike down any self-negativity.
“People come in and make derogatory remarks about themselves because it’s been normalized so much,” she says. “I tell them right away: It’s not acceptable here.”
She helps those who are having difficulties with body image to learn, understand, and, most of all, embrace seeing that their body does many good things for them every day and that loving it for that helps their overall health.
Meier agrees, adding that while society needs change in this area, “I cannot change the world. What I can do is help them deal with those comments.
“They need to develop a belief system so that when things are said to them (even by doctors), they can recognize that — even if coming as well-intentioned — those comments may not be healthy for them, or even be the truth. It’s about not believing everything you hear and read.”
You don’t need to hide your diabetes
People with diabetes also need to recognize the good that their body does and that insulin does, Meier says, as well as the good that comes from any technology they may wear.
For example, beauty queen Sierra Sandison was a teenager when she received a type 1 diabetes diagnosis, and due to body image difficulties, she pushed off getting a pump and a continuous glucose monitor for a period of time.
“I was a senior in high school and already having a hard time with body image when I was diagnosed,” she tells Healthline. “I was angry at my body before that, and once I was diagnosed, I was angry at it for what I saw as failing me on the inside too.”
She decided to hide her diabetes until she heard about Miss America 1999 Nicole Johnson, who has type 1 diabetes and proudly displays it.
That led Sandison to make it into the 15 finalists for Miss America as Miss Idaho 2014, where she walked the stage in the bathing suit competition proudly showing her pump. Thousands followed her lead, making the hashtag #ShowMeYourPump go viral — and, more importantly, helping others heal as she did herself.
“Now I’m like: If someone does not want to date me because I have a pump, good riddance,” she says.
Find supportive healthcare professionals
Patience is one of more than 17,000 medical professionals who have signed on as part of the Health at Every Size movement, which provides resources and encourages healthcare professionals to take a pledge to be aware, respectful, and compassionate of all issues surrounding body size.
More and more healthcare professionals are adopting this approach, and Patience suggests that you seek them out or ask your doctor to check out the movement.
Hafida said it can be life-changing when you seek out a medical expert who understands that if you are a bit overweight, it makes no sense to focus on fault.
“Weight gain is a chronic disease,” she says. “No matter how many ‘mistakes’ you think you have made, it’s not your fault.”
She asks people to consider this: Some of our friends can gobble down all the goodies, barely work out, and be thin. Others walk daily, count carbs, and still have difficulties with their weight.
“Seeing someone who can understand is key,” she says.
Stay away from diet trends
Try to stay away from diet culture. Keto eating, for example, can be too extreme, particularly for children, Hafida said.
“That is absolutely not normal eating,” she explains, in large part because it is so difficult to maintain. “There are people who think you can eat that way for the rest of their life, but the reality is, much of our social structure centers around food.
“We celebrate with it; we gather around it. It’s not the best idea to raise a child to think they are failing if they enjoy those moments.”
Speak with a mental health professional
If you’re having difficulties with body image issues and have ever skipped insulin or starved yourself as a result, you may want to work with a therapist to help you build a better image of yourself.
That person could be any therapist you connect with, or they could be a trained expert in diabetes and body image.
In the end, learning to embrace our bodies as they are — big or small, dark or light, tall or short, whatever they are — is key to overall health, all agree.
“It’s important to understand, as I now do, that healthy looks different on everyone,” says Sandison. “We have to get past this ‘Skinny is healthy’ concept, and we should strive for all to do that.”