I’m going to tell you a story about Sara.
At Sara’s last doctor’s appointment, her doctor told her “you need to reverse your risk of prediabetes”; “lose weight and stay away from carbs”. The doctor gave her a handout as she walked out the door and wished her luck.
Sara grew up in a multi-generational home. Her father and grandmother both had diabetes.
She was constantly being told, “watch your weight”, and “if you eat sugar, you’ll end up with diabetes”. Now she’s terrified of ending up with diabetes and what could go wrong if she can’t control her blood sugars.
She’s thinking, “But all my life I’ve been watching what I eat and trying to lose weight – where did it get me? What else can I do?”
If Sara’s story sounds like a familiar one, join me in a new storyline. This is a story where you and Sara can shift focus away from weight to behaviors that will improve your health.
Let’s talk about how you can reverse your risk of prediabetes…without a diet!
The first topic to cover: what is prediabetes, exactly?
what is prediabetes?
When your sugar is higher than normal blood sugar levels but not high enough to be diagnosed with diabetes, it is prediabetes. Prediabetes is the gray zone between “normal” blood sugar and being high enough to have a diagnosis of diabetes.
Prediabetes is like a little flag, an early warning system, that’s telling you that your body is having a harder time than usual processing carbohydrates.
It may be easy to play the blame-and-shame game when you see that warning, but that’s just diet culture BS creeping in.
Your body is just giving you feedback – and intuitive eating LOVES for you to use body feedback. So why not take the feedback and use it?
If you’ve ever had your HbA1C levels checked by your doctor, you are getting feedback on the last 3 months of your average blood sugars. So when I work with clients, I help them consider what they can do consistently, and sustainably over 3 months.
Developing these sustainable habits brings the number down, and reduces your health risks (like developing diabetes) long term, AND as a positive side effect, you tend to feel better too!
what is diabetes?
Diabetes is a chronic health condition in which your body either doesn’t make enough insulin or can’t use insulin properly (or both) (1).
Insulin and sugar work together to provide energy to each and every cell in your body. This includes the energy for your brain to think, your digestive tract to digest, your lungs to breathe, and for your body to move.
When you eat carbohydrates your body breaks them down into sugar. In order for your body to use that sugar for energy, it needs to get into your cells.
Insulin holds the key to open the door to your cell and let sugar in.
When you have diabetes, the insulin key doesn’t fit quite right and it won’t open the door to your cells. If you don’t make enough insulin, there aren’t enough keys to open all the doors.
Sugar “lines up” outside the door of your cell and gets backed up, and like the lineup at Macy’s on Black Friday, the sugar accumulates in your blood.
Over time, this can cause serious health problems such as kidney disease, heart disease, and issues with eyesight.
But you can stay healthy with diabetes by being mindful of lifestyle choices (not weight) that impact blood sugar.
Given that there are multiple risk factors, why is everyone so obsessed with weight as a risk factor?
is diabetes your fault?
A resounding NO. Although the exact cause is unknown, you’ve likely heard of some common risk factors – family history, age, prediabetes, being overweight, and race or ethnicity.
Let me expand on the “being overweight” risk factor.
Diabetes may be more common in higher-weight folks. HOWEVER, just because things are associated, it doesn’t mean one thing causes the other.
Some folks in bigger bodies have insulin resistance related to body composition, but many do not.
Insulin resistance can occur in “normal weight” folks too (2).
Being in a bigger body did not cause you to have prediabetes or diabetes.
Often a tool used by healthcare professionals is body mass index or BMI for short. It’s a measure of your weight-to-height ratio. Healthcare professionals are taught that higher BMI is associated with increased health risks.
But guess what…I think BMI is a bogus tool! It doesn’t take into account fitness, body composition, or genetic diversity so you can’t be assigned this number without knowing more about how it may apply (or not!).
You don’t need to fear your BMI – check out my blog post “Real talk: can you be obese and healthy?” here and learn more about how health is more than a number on a scale or a body mass calculation.
Now, what about race and ethnicity as risk factors? The healthcare community may be shifting and realizing that health differences between race and ethnic groups can be impacted by social determinants (3).
The social determinants of health are:
- Socioeconomic status: education, income, and occupation
- Physical environment: housing, environmental exposures, toxic exposures
- Food environment: access to food, food insecurity
- Availability of quality, affordable healthcare
- Social cohesion: how inclusive society is or how it discriminates against members of its society (3)
They are shaped by public policy and the distribution of money, power, and resources and are sometimes out of the control of the individual.
Unfortunately, these inequalities may cause a biased approach from healthcare providers.
The good news is that healthcare providers are starting to approach healthcare differently in underserved communities and focus on policy change instead of blaming individuals.
All of this nuance makes us look at the correlation between higher weights and diabetes differently – BMI isn’t the problem in and of itself.
So we’ve identified that you’re not to blame for having diabetes.
Let’s address more about blame and shame for weight and if losing weight is even helpful for diabetes.
does weight loss help diabetes?
Nearly every health organization recommends 5-10% weight loss to help improve blood sugar management. Why?
Short-term studies show some benefits of weight loss and its effect on blood sugars, cardiovascular disease, and quality of life. BUT – it is unknown if weight loss has a long-lasting benefit (3).
Weight loss may be associated with blood sugar improvements (in the short term), but the recommendation is suspect. Instead, I think a little reframing may be in order.
As someone who works with folks with generational diet trauma, weight loss is often guided by fear and guilt. And this is not a path to permanent change.
Instead, you travel down a winding, zig-zaggy path of extremes and you’re depriving yourself, fighting your body biology.
Weight loss is not sustainable.
There was a massive randomized control trial (the best, strongest kind of study) called Look AHEAD (Action for Health in Diabetes) and it tried to prove that weight loss matters with diabetes.
They stopped the study early due to futility. Participants lost weight but started to gain it back after 1 year AND the intervention didn’t make a difference with cardiac events (4).
Since health improvement can occur without pursuing weight loss, I help my clients honor their mental and physical health by working on diabetes prevention and care with intuitive eating.
It’s a great match for you if you’ve had enough of guilt and shame and you know dieting just doesn’t work for you.
a better approach: focusing on behaviors with intuitive eating
You may lose weight with intuitive eating BUT it’s certainly not the focus. Shifting focus is a change in thinking for many, including health professionals.
Health professionals have long been focused on weight loss as a way to improve blood sugars but some good news is emerging – some new evidence shows that your sugars can be controlled without such a focus on weight (5).
As a dietitian in support of health at every size (HAES), I believe in shifting the focus away from weight and towards building healthy lifestyle habits to improve blood sugars.
When you change your focus from your weight to your behaviors, you can let go of guilt and shame and start to feel good. You will probably even improve your blood sugars while you’re at it.
So now you may wonder if you’re NOT focused on weight then what the heck DO you focus on?
here are the five behaviors I recommend you focus on instead of weight to reduce your risk of prediabetes (or to manage things if you do have that diagnosis).
movement
Getting movement in your day is one behavior that helps improve blood sugars.
The CDC recommends that adults have 150 minutes of moderate-intensity exercise each week (6).
Activity helps your body use sugar more effectively and improves muscle mass which can help insulin resistance.
You don’t have to go pump iron at the gym and run for hours. Your movement could simply be walking around the neighborhood.
The key here is that it has to be movement that you enjoy. In my practice, I help you consider how to do this joyfully, and progressively so you can make an impact on blood sugar based on your own history and ability with exercise.
Checking your blood sugars as you start a new routine will give you feedback along the way so you know the effect your behaviors are having.
It may be small changes at first but sustainable movement is more important than fast and perfect movement. Be sure you celebrate progress along the way!
Behaviors around food will also help with blood sugar control.
balancing and pairing foods
Have you received the blanket recommendation to “just stop eating carbs”? Take it from a Dietitian – you can eat carbs!
If you need a little more convincing on how carbs can ABSOLUTELY fit in your daily life, check out my blog post real facts about carbohydrates (from a dietitian) and get carbs back in your life!
The power is in learning how the food you eat affects your blood sugars so you can confidently choose foods (yes – carbs too) that work for you.
If you binge and restrict – sometimes eating a lot of carbs, and other times next to none at all – your body is going through major shifts in blood sugars.
It doesn’t know if you’re coming or going. Getting a hold on binges by eating consistently and without guilt will stop the carb dumps from binging and get your blood sugars in a more steady state.
Instead of taking away foods, think of what to add and how to combine foods so that blood sugars are more stable.
Adding protein, fat, and fiber to your carbohydrates will help keep your blood sugars more balanced. For example, instead of just a muffin, add some peanut butter and a piece of fruit.
Paying attention to body cues like hunger, fullness, and energy levels will help guide what, when, and how much food works for you.
Some foods may affect you differently from someone else. But if you are checking your blood sugars and thinking about your body’s response to the food you eat, you can see precisely what impact your food choices have.
If you work with a Registered Dietitian, you can get tailored advice on how to pair foods and eat consistently to find balance.
stress reduction and sleep
Getting a good night’s sleep and reducing your stress can not only make you feel better getting out of bed in the morning but can have an impact on your blood sugar management too.
When your body is under stress, and your body is making more stress hormone (cortisol) it may be harder to sleep. And then long-term disruption and loss of sleep can hinder insulin secretion, resulting in higher blood sugars and a risk of diabetes (7).
Sticking to a good sleep routine in this busy world can be tough – there’s always something that needs doing! But getting in a 7-9 hour night’s sleep can do wonders for your body so you can start fresh the next day.
And of course – everything is connected! My clients work on improving their relationship with food (less guilt and stress), quality and timing of food, and movement – all which can aid better rest.
medication
Diabetes medication may be needed to help your body manage sugar and there’s no shame in it!
There are many different medications that your doctor may use to treat diabetes and they work in different ways in your body such as helping it make more insulin or helping it get rid of sugar.
You may need medication for a short time or a little longer to support your blood sugar management and that’s OK.
You can support the effects of your medications with the lifestyle habits you are working on.
It’s important to see your doctor regularly to monitor how things are going and make changes as needed.
regular health care screening
Higher blood sugars can impact your cardiovascular health so it’s important to go and get regular physical exams so you know your numbers.
But if you’ve been shamed for your weight at your doctor’s appointment, it can be hard to keep going back.
Know that you are not alone – weight stigma is real!
Dealing with it can be a challenge but is an important step so you can focus your visits on your true health and not your weight. Right?
Check out my “How to talk to your doctor about health at every size”, doctor’s visit guide here to help you start the conversation and get the most out of your next visit.
Shame at the doctor’s office may not be the only barrier to taking charge of your health so let’s keep moving through those roadblocks
common roadblocks
I often hear “I know what to do but I’m just not doing it”. Let’s break down what may be holding you back from improving your health.
Are you experiencing fear – you’re in fight, flight, freeze mode? You feel like your options are extreme. Either diet, let yourself go, or shut down. I can help you work through the fear and start moving in the right direction.
Part of the work I do is to help you manage this emotional response. (Which makes total sense, btw. Your health is important to you! And, many people have long traumatic histories that cause this fight-flight-freeze reaction.)
Together, we break things down and address your fears, strengthening your motivation for behaviors to improve your blood sugars.
Instead of extreme options, you see small manageable steps to reaching your goals. Positive steps in the right direction keep you moving toward positive changes. You think more flexibly about your options and not just in extremes.
Another roadblock holding you back could be guilt. You have a “good food, bad food” mentality, which leads to blaming and shame and can make managing blood sugars more challenging than it needs to be.
Remember from earlier, you can eat carbs, and work on balance and pairing of foods.
I want you to get to a calmer place so you can be more responsive vs. reactive. I will support you by addressing guilt at the root with intuitive eating skills. You will start to eat without guilt about your health.
If you’ve failed in the past, maybe you lack confidence and you’re afraid to fail again. Are you thinking that it’s not worth another try? Let me tell you it is!
Small changes make a world of difference and my job is to help you find those little things that are right for now. And better than that – small changes can be holistic. Yes, we want to improve your blood sugars. But that shouldn’t happen at the expense of your mental and social health!
Working with an intuitive eating dietitian can help empower you with skills to break through these roadblocks. You’ll have a fresh mindset and cope better emotionally.
On top of all of that, you’ll have tailored recommendations for nutrition and movement to make an impact on your blood sugar levels.
how I can help
I have a non-diet approach. Let me share why.
The single most important behavior that will impact your blood sugars is something that you can make part of your life consistently and sustainably.
Finding the behaviors that will work for you will involve a few steps:
- Defining health for yourself and your values surrounding your health
- Setting small goals linked to actual blood sugar changes long term such as movement, food pairing, stress reduction, sleep, medication
- Deprioritizing weight loss so you can finally find sustainability and effective management
I’ve had clients with prediabetes normalize their blood sugars in 3 months when they work through this process and have support to understand how their actions can improve their outcomes.
They feel better physically and mentally and have a more satisfying relationship with food. They aren’t “white-knuckling” in fear they won’t be able to keep up with the changes they’ve made.
One client told me she was shocked that she didn’t have to make drastic changes to see the impact – something she never would have believed before working with me.
In the past, she had tried crash diets, quit, and avoided addressing her diabetes. That made her feel awful. Now she feels in control and happy to have a plan that she can stick with.
Becoming an intuitive eater takes time but support from an intuitive eating dietitian can make that process easier.
If any of this is resonating with you, come work with me to get tailored step-by-step support.
What will it feel like to have someone in your corner, supporting you each step of the way?
Let’s talk soon!
