CW/TW: Discussion of weight loss terms and mental/emotional health issues.
As a survivor of twenty-plus years of dieting, I’m here to tell you that a lot of the language we use around health management (particularly in relation to diabetes) is triggering and potentially harmful – because many of the terms used in regard to creating ideal conditions for the body to heal are the same terms as used in weight loss dieting. They are triggering words and terms that too often create an unhealthy relationship to food, to activity/movement, and ultimately, to one’s own body and life.
What am I talking about? Well, for starters, the word “diet.” I understand that the technical meaning of this word is basically what foods a person or animal consumes – but that’s not how the word lands for most of us. Usually, when people talk about “diet,” the “weight loss” in front of it may be silent, but that’s understood to be what it means. It is understood to involve restrictions on food intake, rules about food and lifestyle, and a goal of changing the body’s size/weight. Some people use “food plan” or “eating program” or something like that – these terms are almost inextricably linked to the concept of weight loss/management. I’m bringing this up because I’m trying to be aware on this blog about how I talk about my personal strategies for dealing with diabetes, wanting to be clear and accurate, but with the least possible amount of harm done.
Because of the diet industry and the deeply ingrained anti-fat bias in this country, the words used to describe health-promoting lifestyle choices have become intertwined and often synonymous with the shaming, moralizing, judgmental terms of the weight loss culture. When people are dieting and eat something they “shouldn’t,” the term most often used is “cheating.” Think about the implications of that – of the moralizing of “should’s” and the judgments against someone who isn’t following the rules. There is shame attached to “cheating” – including increased body shame, as well as shame for not having more “self-control.” This coincides with blame assigned to people for failing to be compliant, and thus “deserving” whatever is going “wrong” with our bodies, whether that be an actual disease process or a natural variation of body size, which medical charts do not reflect in ways that honor diversity and genetic realities.
Other problematic terms include “blowing it” and “falling off the (diet) wagon.” These ideas imply that one is either in compliance or not in compliance to an outside set of extreme “rules” – rather than offering a flexible, health-supportive set of guidelines that allow room to create balance and recovery when the most ideal choices aren’t always available or possible. The result of this approach often plays out as: I already failed, so I completely give up and will now proceed to do whatever I want without constraint. We are all the way “on” or all the way “off.” This type of thinking fosters an “all or nothing” approach to self-care, which is not at all conducive to overall well-being.
The problem with “diet talk” is that it has one goal and focus: to make a person’s body smaller/weigh less. The diet culture does not take into account a person’s actual health and wellness – physical, mental, emotional, psychological, or social. On the contrary, the words of diet culture, fashioned to create compliance by shame, contribute to the ongoing psychological damage of its victims, often triggering traumatic responses in the people that we are supposedly trying to “help” or “serve.” If one reads about The Minnesota Starvation Experiment, conducted by Ancel Keys in the 1940’s, this will undoubtedly prove illuminating as to the traumatic and profound psychological effects of food deprivation (dieting).
If we take the time to understand some of the complex psychology involved when we alter what people (are allowed to) eat, as well as the potential traumas that many people have already suffered from dieting, I believe it will become apparent that we need to create a new lexicon in which we are able to discuss the most supportive and health-beneficial steps that people can take, without creating shame, stress, or further harm – those things most often resulting in the exact opposite consequences of our goals or intentions to help.
On this blog, I am attempting to be very aware of the words I use to describe how I am managing my own diabetes and the struggles I’m having as I go. I catch myself using words that are potentially triggering and I work to switch those out with words that make my point understandable, without adding the unwanted aspects of criticism, judgment, or moralism. It’s not an easy task. I think I’ve referred to the “program” I’m following multiple times in this blog already. I’m going to be thinking about better words to use. It’s an evolving process for me.
The choice of foods that we eat is not a moral issue. Food, itself, does not have a morality. I agree with others who have written that it is harm-causing to refer to foods as “good” or “bad,” “healthy” or “unhealthy,” “clean” or … dirty? – what’s the term used for the opposite of that? “Junk”? All of the moralism of categorizations of foods, all of the condescending superiority of what constitutes “good” and “acceptable” choices in food consumption – that crap is toxic and damaging. Nobody feels supported or improves their health in an atmosphere of shame.
Also, the fact that doctors still heavily promote weight loss as the method to control diabetes is beyond problematic. Weight loss is not necessary to have improvement in blood sugar numbers, and a focus on weight loss is more likely to result in the opposite of the desired effect. A focus on weight loss is nearly always a losing proposition for the health and well-being of a person – body, mind, and spirit. It has been known and well-documented for decades that the vast majority (95-98%) of people who lose any amount of weight gain it back, often plus more, usually within 2-5 years. Just do a search about studies that show the percentage of people who lose weight and gain it back. Endless articles come up about this topic. Or check out the work of ASDAH (the Association for Size Diversity and Health) and HAES ® (Health at Every Size®). Read the book Health At Every Size: The Surprising Truth About Your Weight by Lindo Bacon for more detailed information and explanations. There are many factors to consider, and so much damage caused by a focus on weight loss.
When we make choices that aren’t necessarily in alignment with the best interests of our body’s health, we are not “cheating” or “being bad.” We are simply living, being human. Yes, we want to support our health, of course – but there’s so much more going on than just physiology and biological processes. Human beings are incredibly complex – and there are all kinds of factors that play into health and wellness and well-being. We must take into account a myriad of other factors – personal and social history, support systems, financial/economic security, food deprivation (voluntary and/or involuntary), food availability/security, culture, traumas, mental/emotional/psychological health, balance and well-being, happiness, quality of life, family, work schedules, time schedules, obligations, energy levels, and so much more. We can’t just look at a human being and say, “do this” without taking into account all of the factors that influence their actual ability to do that! Or how doing that impacts all of the other areas of their life. We need a holistic approach that considers the entirety of each unique, individual human life.
So, what is the answer? First of all, take “weight loss” and all of its related terms completely off the table. Second, develop a language of inherent respect for every human being and all of these various aspects of their lives. Third, offer flexibility, options, and above all, compassion. It is not easy having to deal with health issues. It’s scary and stressful. It is not easy having to eat differently from your family and friends. It’s depressing and can feel like we’re being excluded from things everyone else gets to enjoy. That’s where flexibility becomes so important. Sometimes, we have a psychological need to be included, to share in what everyone else is getting to do. Can we create a balance between making choices that are beneficial for our bodies and making choices that are beneficial for our mental/emotional health – particularly if the two are at odds? And can we do this in a way that isn’t critical, judgmental, or belittling of our humanity and our needs and desires?
I’d like to share a personal example. One of the clearest memories of my childhood is sitting in a booth at a Howard Johnson’s restaurant with my family on a road trip. I was 10, and although an average sized child, I had decided – with the help of “women’s magazines” and social pressures – that I was “too fat.” So, I sat in the booth, miserable and crying, and secretly starting to hate myself and my life, as everyone else in my family enjoyed a dessert of strawberry shortcake. I was denying myself something that I really wanted because I had condemned my body as being unacceptable. That was the first of many imprints of shame, self-judgment, and even self-hatred. It was a long, painful road that I went down for over 20 years of self-denial, self-negation, and self-inflicted (although also socially inflicted and supported) psychological torment.
Thanks to the size acceptance movement, which later became known as the body liberation movement, fat lib, fat celebration, and other terms, I was able to heal a lot of the damage and trauma from those years. I was able to learn to love and accept my body and myself as I am. I was able to develop a conflict-free relationship with food, which was a joyous head and heart space to be in. Then I got my diabetes diagnosis and was forced back into a more complicated relationship with food. In learning how to best handle my health condition, I was once again exposed to the toxic attitudes about bodies and weight that are prevalent in diet and medical culture. I have not succumbed to the old shame or anything like that, but I have noticed some triggering of old traumas. I have felt stress, anger, frustration, and even despair about … all of it.
I’m fighting now for my own wellness, balance, and peace of mind. When I first started strategies to balance my blood sugar, I went extreme and overboard. Much like the patterns of my younger years when I engaged in a nearly constant stream of weight loss dieting. That was a neural pathway that I knew too well. The challenge I face now is to step off of that pathway and find a new way – one that incorporates necessary information along with my own complex human needs at every level.
I made a BBQ chicken pizza on Naan bread the other night for dinner. I shared a bottle of wine with my friend. Theoretically, those choices were not the “ideal” for my blood sugar levels. But I felt happy and satisfied – and my blood sugar the next morning was actually improved over that of the previous morning, when my food choices had been more in line with the guidelines I’m (mostly) following. I’m still experimenting and trying to figure all of this out, but this I know for sure: I have to keep a perspective of caring as much for my own happiness and emotional health in my life as I do about my physical health. Denying myself my favorite foods messes with my head and emotions – and is never going to work long-term for me, so I continue my search for balance.
I’m trying to find some grace for myself (and others) in the words and terms we use that point us in the direction in which we want to be heading – and also the words and terms we use when there are discrepancies/differences between what is deemed to be the “ideal” versus what is our lived reality, as well as what is beneficial to our entire being. I’ll be talking a lot more about finding balance in some of my upcoming blog posts. Stay tuned!
Disclaimer: Please be advised that I am not a medical professional nor a dietician. This site is not in any way, shape, or form providing any sort of diagnosis, advice, cures, or recommendations for medical or dietary treatments. I am simply sharing my own journey and experiences. Nothing I say is intended to replace proper medical care.
One thought on “We Need Better Language to Talk About Diabetes Management”
Love this point of view! As a registered nurse of 30 years, I know firsthand how healthcare is steeped in weight bias and stigmatization. As a person living with diabetes, the diet culture is just around every corner. As a person who helps people with chronic illness learn to accept themselves right where they are, I know what a challenge this can be. I have chosen to become a disrupter of weight bias in healthcare and the culture at large, one conversation at a time. Thank you for doing the same!