HAES® Diabetes Approach
Weight loss has been the main recommendation for individuals with diabetes. But, how helpful has it been to pursue weight loss? We are breaking down all of the science and answering the question: Should you follow a HAES (health at every size)* approach to diabetes?
But before we jump in… let’s get this clear.
There is so much stigma around diabetes. The idea that people caused the disease by being lazy or by eating their way to diabetes… it is just wrong. Wrong. Wrong. Wrong. Someone can be diagnosed with diabetes at any size, any age, eating any kind of diet, with or without a family history. If you are here reading this as a person with prediabetes, type 1 diabetes, LADA, type 2 diabetes, please know that you did not cause your diabetes. End of story.
All information provided is intended to be used for informational purposes only. This article is not medical advice nor is it intended to replace medical advice.
HAES TYPE 2 DIABETES
After a diagnosis, the first thing people with type 2 diabetes are told is to lose weight… doctors push it, families start policing every bite of food, and friends start recommending every diet in the book… but why is there so much focus on weight?
There is a correlation between weight and diabetes. What came first? The chicken or the egg? Does weight gain cause diabetes or does diabetes cause weight gain?
Weight gain is a symptom, not a cause of diabetes.
One characteristic of Type 2 diabetes is insulin resistance. Research shows that high levels of insulin, as a result of insulin resistance, appear before weight gain (1, 2, 3, 4, 5, 6, 7, 8).
Why is this? Well…
—> Insulin resistance supports the storage of fat when food is available (8, 9).
—> Insulin resistance also slows energy usage, aka it slows the metabolism down, when food is less available.
—> High insulin levels also interfere with the hormone leptin, which signals the brain that the body has had enough to eat (10, 11).
Do you know?
Some scientists believe that diabetes is a genetic adaptation… that people with diabetes have an evolved gene that would help them survive in times of famine (8, 12, 13)! More research is needed to support this theory! But, it’s pretty interesting right?!?
Should I try and lose weight?
So, weight gain comes before diabetes. Will weight loss help?
Well, weight loss works… for a little while.
Studies have shown initial improvements in blood sugar control following weight loss. The problem is, the blood sugar returns back to its starting level within 6 to 18 months, even if weight loss was maintained (14 ).
Liposuction does not improve glucose levels, insulin levels, or insulin sensitivity (15).
It is estimated that pursuits of weight loss fail 90 to 97% of the time (16, 17, 18, 19, 20, 21). WOW!
This is why it is called yo-yo dieting. Diets cause initial weight loss and followed by rebound weight gain. This weight cycling impairs insulin sensitivity which leads to insulin resistance (22, 23).
You may be thinking… “Okay, weight loss isn’t helpful for my diabetes but I should still lose weight to help the blood pressure and cholesterol?”
Well, no.
High blood pressure is more common in larger bodies compared to lean bodies. BUT this has more to do with weight cycling (24). (Remember 90-97% of weight loss attempts lead to weight cycling).
The nutritional state of the body is more important than body weight change when it comes to blood pressure (25). Meaning, it’s more important to feed our bodies in a healthful way than to fast, cut out foods, over-exercise our way into a smaller body.
Studies have shown that individuals whose BMI is in the obese category who have never dieted were more likely to have normal blood pressure. Studies have also shown that amongst non-dieters there was no association between obesity and hypertension (26).
Atherosclerosis is the buildup of cholesterol-laden plaque of artery walls. Many studies show no relationship between weight and atherosclerosis and some studies found that a higher weight was associated with a lower chance of atherosclerosis (27).
So, weight loss doesn’t help in the long run, and pursuing weight loss can be very harmful. That leads us to our next question…
Can you be healthy at every size?
Okay… A high BMI isn’t the cause of health concerns and weight loss won’t help. Now what?
A Health At Every Size approach is evidence-based. People of all sizes can manage their diabetes by developing sustainable behaviors without weight loss (28, 29, 30).
Research has also shown that a health at every size approach led participants to increase physical activity, improved eating habits, reduced stress around eating, and improved body image (31). The approach also led to improved cardiovascular health (32).
While it wasn’t the focus, this study found that a health at every size approach led to significant decreases in body weight, body fat mass, and body fat percentage at the end of a year-long study (33).
A Health At Every Size approach emphasizes looking at the BIG PICTURE of health, not just one aspect, like weight loss. When health is the end goal, it gives us the opportunity to look at sleep, stress management, social life, hydration, moving the body in an enjoyable way, and yes, eating habits.
We can accomplish this by Eating Intuitively, managing stress, staying hydrated, getting enough sleep, moving in an enjoyable way, taking meditations, etc.
How to find a HAES medical provider
The first thing most physicians recommend for someone with diabetes is…weight loss. But, we just learned why that isn’t helpful. So, it is important to find a medical provider that is willing to look at the big picture.
Okay well… I don’t believe most health care providers think they are lying. They are just trying to help and don’t understand how to actually be helpful… There is just a TON of weight bias in the health care community.
You do not deserve to be told that weight loss is the only answer to any health problems. So, how do you find a HAES medical provider?
You can check out the Association for Size Diversity and Health - they have a registry of medical providers who take a HAES approach
Ask your friends for referrals!
Ask a medical provider’s attitude around weight before scheduling an appointment - it can be great to write a letter introducing yourself and explaining your needs!
What if you can’t find a new doctor?
Maybe you live in a small community or your insurance limits you from finding the right doctor. Try opening up the conversation. Here are a few phrases to try out:
“In our limited time together, I’d like to focus on what I came in for”
“Show me a study where a majority of the subjects succeeded at the amount of weight loss you are suggesting”
“I did not come here to discuss a diet, can we please move on.”
“How would you treat my condition for someone in a smaller body?”
Looking for a healthy at every size dietitian? I am currently accepting 1:1 clients. JUST BOOK A FREE CALL and let’s chat :-)
Let’s wrap it up
Research shows us that weight gain is a symptom, not a cause of diabetes
Weight loss may not be helpful in long-term blood glucose management
It is possible to be healthy at all sizes
Taking a Health At Every Size Approach has physiological and psychological benefits
Want to learn more about how to ditch dieting and embrace HAES? Check out our blog on Intuitive Eating for people with Diabetes.
Hang out with us on Instagram @DietFreeDiabetes
*Health At Every Size and HAES are registered trademarks of the Association for Size Diversity and Health and used with permission.