When I talk about diabetes with clients, one of the topics is weight. It is a tricky part of talking about diabetes, I can tell you. I have seen clients tense up and, if they could eye-roll, they would. I have to be mindful on how I approach this topic and I tend to skirt around it quickly if I can. How do you bring it up without causing too much offence?
Me: If you weighed less your diabetes would be better.
Client: Are you saying I’m fat?!
Me: People who lose weight often have better control of their diabetes.
Client: Do I need to lose weight?
It’s an awkward conversation for me, and I risk the client disengaging from the conversation. The moment may be lost. Rapport may be lost.
But who is this helping? Sure, I save the client’s feelings if I dance around the weight issue but ultimately it’s their health that suffers when I avoid the subject.
The brutal truth is that weight DOES matter when you have diabetes. People are often surprised when they are diagnosed with Type 2 diabetes and they are told to lose weight.
Research shows that there is a high-risk group of people who are diagnosed with Type 2 diabetes. They are over 40 years, have a sedentary lifestyle and their BMI (Body Mass Index) is above 30.
So what?
Research also shows that if people with Type 2 diabetes lost just 5% of their body weight, it would significantly improve their diabetes management. 5% for someone who weighs 100 kg is 5kg. Not a lot if you think about it, but the long-term gain is better overall health.
The science bit is that body fat (adipose tissue) acts as a barrier to insulin getting into the cells. It is called insulin resistance. Therefore, the less body fat you have, the better your body responds to your own hormone insulin.
The gain for the person with diabetes if they lose weight is better blood sugar levels, and the more weight that is lost, the fewer medications they may need to control their diabetes. Win, win!
No-one wants to take medications so the incentive to potentially take less medications is quite attractive.
Especially so if someone could stop injecting insulin if they lost enough weight.
I have clients who lost weight, got active, and not only stopped their insulin injections, but stopped their diabetes medications full stop. You could call it ‘diabetes remission’ but they call it freedom. So perhaps that awkward conversation about losing weight could be tied in with the goal of reducing a tiresome medication regime? The carrot and the stick.
Many people living with Type 2 diabetes avoid seeing a Dietitian or Diabetes Educator because they don’t want to be told to change their food choices or increase their activity levels. The fact is, that these two topics have a big effect on diabetes and getting the right information can be life-changing. However, make sure that you’re getting quality information from a health professional so that weight loss is sustainable. Yes, it’s hard to make changes to one’s lifestyle however if your health is being affected negatively, would you be prepared to make some changes?
So having a difficult conversation with a client about their weight is all about how I can phrase it so it becomes an attractive goal. Not so much of a criticism of a client’s weight, but a positive outcome if weight is reduced. Weight is lost, health is improved, and medications are reduced. Win-win. Or should that be win-win-win!