Level 1: The Power of a New Perspective: Incorporating Weight Neutrality into Diabetes Management

Traditional Diabetes Self-Management or Diabetes Prevention approaches are weight-centric, encouraging participants to ‘safely’ lose a particular percentage of their body weight in an effort to reduce risk of complications. This appealing tactic often results in a caloric restriction that eventuates in metabolic derangement and regain over time, guilt/shame which are poor motivators for behavior change, and stigmatization which impedes engagement in healthful dietary choices and physical movement. The complexity of research indicating positive benefits from with weight loss is problematic. Education on the detriments of weight-centric approach, providing insight into the alluring draw with diet culture, assuring PWD of the multitude of weight-neutral resources available for diabetes management, redefining health in morally neutral terms, allowing space for ambivalence, and cultivating creative opportunities for problem-solving skill development empowers patients in ways that are sustainable. Removing weight as a central focus or a necessity to improve health outcomes allows people to focus on self-care behaviors in alignment with their true values. This is crucial to the cultivation of a balanced life in which physical, mental, social and spiritual health are optimized.

• Distinguish between patient-centered and provider-centered diabetes-related health care
• List at least 3 problems that result from weight-based interventions to reduce risk for diabetes and its complications
• Explain how to implement a non-judgmental, weight-neutral approach to diabetes self-management

Level 2: Feeling the Weight of Expectation: Offer Support Not Stigma

Existing research overwhelmingly demonstrates that obesity stigma is an ineffective means by which to reduce the incidence of obesity and that it promotes weight-gain. However, how stigma associated with bodyweight and size gets under the skin and is felt in the flesh has received far less attention. To attend to this blind spot, the origins of obesity are outlined, the possibilities for ‘healthy obesity’ are considered and the unhelpfulness of weight-based stigma are highlighted. Specific examples from research with weight-loss groups whose members were predominantly overweight/obese and of low-socio-economic status help to demonstrate what/how obesity stigma made group members feel. This provides a useful platform from which to offer guidance on how best to provide patient-centred care that is supportive and not stigmatising. This includes the use of an evidence-based comic that explores the everyday experience of weight-management and weight stigma titled ‘The Weight of Expectation’.

• To appreciate the relationship between the social determinants of health, individual behavior and responsibility
• To understand the importance of treating obesity as a biopsychosocial phenomenon
• To develop awareness of the need to offer support to patients for weight stigma and how to provide this without stigmatizing them

Level 2: Why Diets Don't Work: How the Brain Fights Against Lasting Weight Loss

As concern about body size continues to be a primary focus among those interested in health, it is essential that healthcare professionals understand the role of the brain in weight regulation. The high long-term failure rate of dieting is driven largely by physiological and psychological changes that work to return an individual’s weight to its defended range or set point after substantial weight loss. Equally important is to recognize weight stigma, which is a driving factor for eating and weight struggles in many people. Finally, the link between obesity and poor health is much weaker than commonly believed. An alternative approach, Health at Every Size, is weight neutral and designed to promote both physical and mental health. This presentation will equip healthcare professionals with knowledge and tools to help their clients move beyond the thin ideal to make lifestyle choices that truly support their health and well-being.

• Describe two physiological changes that result from weight loss
• List four factors that influence health more strongly than obesity does
• Identify three ways that weight stigma contributes to poor health

Level 3: A Weight Neutral Way to Work with Medications and Potential Side-effects

In this presentation we will walk through the discussions that can take place when deciding which medications our clients are choosing to take as well as any “side-effects” (read weight fluctuations) that they might be experiencing through a weight-neutral lens. The onset of Type 1 diabetes is one that can lead to dramatic weight loss followed by rapid regain once insulin is initiated. Conversely those with Type 2 diabetes are often told to lose weight first before they are offered medications to bring down over all glycemic control. We need to be able to bring the bodies of our clients into the room with everything that they already carry from diet culture and discuss how they are experiencing their bodies with diabetes and if this is impacting them taking their medications as prescribed.

• Be able to use HAES principles when discussing the use of medications in your clientele to assist them to make educated decisions about medications that are not focused on weight
• Discuss how to bring the body into the room when reviewing the use of medications in diabetes care to better navigate how the client is feeling or responding at the time with regards to their body
• Demonstrate different ways that we can talk about insulin injection sites and giving injections to be more weight neutral in our response.