A patient presented for outpatient diabetes education stating, “I really don’t know why I am here. I know I need to lose weight. I don’t know what else you can tell me.”
She was reassured when I told her that there are people who are a perfect weight, exercise regularly, eat very healthy and still have type 2 diabetes. She was even further surprised when I said that that there are people who do all of that and are still overweight. I informed her that studies show that people who followed healthy behavior lived longer (on average) regardless of their weight or BMI than those that did not follow healthy behavior. She started to understand that there was something more than the “lose weight” message that is often sent.
She told me that she had had gestational diabetes 15 years ago. I explained that type 2 diabetes is a progressive disease. There is a decrease in the ability to produce insulin, and an increase in need for insulin over time. I told her that 5-10% of women with gestational diabetes continue to have diabetes after the pregnancy and that 20-50% have type 2 within 10 years. It had been 15 years, so she had delayed it more than most. I told her that it is often said that we can “prevent” diabetes with weight loss. I explained to her that it would probably be better to say that we can “delay” diabetes with healthy behavior (that decreases insulin resistance). She agreed that when she was told that she can “prevent” diabetes with weight loss, the diagnosis of diabetes made her feel like a total failure even though she knew she had tried very hard to employ healthy behaviors. She feels much more successful and motivated now knowing that she has delayed her diabetes for 15 years and gotten a lot of health benefits as a result. This patient went on to successfully control her sugar, become more active, sleep better at night, decrease depression, and improve blood pressure and cholesterol. She even lost 15 pounds (without “trying to lose weight” when she had been “trying to lose weight” for 20 years). Fortunately, this patient did come for diabetes education, but how many have we missed due to feelings of failure?
If we really want to help promote health and wellness, we need to rethink the emphasis we place on weight loss and focus more on healthy behavior for all. Perhaps we could help people more by saying that we can delay diabetes rather than that we can prevent it.
Laurie Klipfel, RN, BC-ANP, CDE
SSM St. Clare Health Center
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