Liam Sartorius, Founder at Rebelfit argues the case for ending the stigmatisation of diabetes, including the mental health aspect in this vein
When you ask people about diabetes the common misconception is that it’s a disease brought on by the individual. A disease of lazy people, greedy people and people who are unable to discipline themselves to exercise or maintain healthy eating habits. This stigma attached to diabetes isn’t just unkind, but the feelings of guilt, shame, blame, embarrassment and isolation have been linked to the poorer management of the disease. (1)
Whilst both weight bias and obesity stigma are gaining growing recognition as driving forces in the obesity epidemic (2), to the point where World Obesity Day 2018 launched a campaign to “End The Stigma” (3), there appears to be far less movement or campaigning around ending the stigmatisation of diabetes.
Ending the stigma is key
Better education around diabetes not only has the potential to reduce rates of Type 2 diabetes, but also protect the mental and physical wellbeing of those with the disease. The first thing we need to do is educate people on the difference between Type 1 and Type 2 diabetes. This is a huge source of distress to Type 1 diabetics in particular due to public misunderstanding of the different conditions. (4)
If diabetes was a road accident, then Type 1 diabetes would be an accident caused by a malfunction in your car, such as the brakes not working or the steering wheel locking, over which you have no control. Type 2 diabetes would be an accident where the driving environment caused the accident, such as heavy traffic or icy roads, rather than a malfunction in the car itself.
In both examples, the individual is not to blame.
Type 1 diabetes is not the individual’s fault because it is an autoimmune disease affecting insulin production that often strikes with no warning. Type 2 diabetes is not the individual’s fault because it is a disease driven primarily by the “diabetogenic” environment we live in. A food environment where highly processed, highly palatable, highly addictive carbohydrates are cheap, readily available and even delivered to your door.
To put this in perspective, in the space of your body burning 20 calories of carbohydrate at rest, you could have ordered and have eaten 2000. And it is this change of food environment, from low carbohydrate/high physical activity to high carbohydrate/low physical activity that explains why rates of Type 2 diabetes are rocketing. Bodies and bloodstreams are being flooded with carbohydrate and sugar, without the physical exertion required to metabolise it.
New research suggests that people who live in cities with a high density of food outlets such as takeaways, restaurants and fast-food vendors have an 11% higher risk of developing Type 2 diabetes than those who live far from an instant meal (5). Although 11% may seem small, it is significant enough to prove that it is our environment we should be blaming, rather than individuals.
The advice to “eat less, exercise more” has also contributed to this diabetogenic environment, by encouraging a whole generation to avoid high-fat foods in favour of processed carbohydrates and sugars, whilst putting that same generation off exercise by pushing recommendations that feel unachievable. We’re all familiar with people starting diets and joining gyms in January, then throwing the towel in by February. This fall out rate could be instantly reduced by changing the advice to “eat a bit better, exercise a bit more”, removing the pressure to maintain an unrealistic lifestyle.
We need a three-pronged approach
Rather than blaming people with Type 2 diabetes for being “bad drivers”…
- We should be putting speed limits on our motorways (environment focused);
- We should be teaching people how to be better drivers (behaviour focused);
- We should be encouraging people to slow down (mental health focused).
Putting speed limits on our motorways means legislating to change our food environment, such as limiting how many fast food outlets can be open in one area. Becoming a better driver means educating people about nutrition and fitness, and in particular how very small changes in your carbohydrate intake and exercise habits can dramatically reduce your risk of Type 2 diabetes. And encouraging people to slow down means teaching people to be more mindful, take more rest and be more present, rather than rushing around.
At the end of the day, Type 2 diabetes is a disease of speed. Primarily fast-food facilitating chronically elevated blood sugar. Approaching diabetes in the same way we approach driving safety has the potential to dramatically improve rates of Type 2 diabetes, in the same way speed limits, driving tests and the repeated advice to “slow down” has improved our roads.
(1) Stigma in People With Type 1 or Type 2 Diabetes. http://clinical.diabetesjournals.org/content/35/1/27
(2) Weight bias and obesity stigma: considerations for the WHO European
Region (2017). http://www.euro.who.int/__data/assets/pdf_file/0017/351026/WeightBias.pdf
(4) Diabetes stigma and discrimination: finding the right words
(5) Are exposures to ready-to-eat food environments associated with type 2 diabetes? A cross-sectional study of 347,551 UK Biobank adult participants https://www.thelancet.com/journals/lanpla/article/PIIS2542-5196(18)30208-0/fulltext
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