By: Billie Karel, MPH, RD, LDN, CDCES
People with diabetes are at dramatically higher risk for eating disorders than the general population, and it should come as no surprise: diabetes is (still!) a heavily stigmatized health condition, mostly because of the ways it overlaps with weight stigma and diet culture.
Lutz, Alexander & Associates Nutrition Therapy has a team of four dietitians who specialize in weight-inclusive care for people with all types of diabetes – types one and two, prediabetes, LADA, MODY, gestational diabetes, and other types of diabetes in pregnancy. Our specialists have experience helping folks learn to care for their diabetes with creativity and self-compassion. They are also skilled eating disorders dietitians who can help people with both conditions resolve the false tension between diabetes care and a healthy relationship with food.
Our team of diabetes-specialized dietitians is unique.
The goal of any diabetes self-care education (DSME) is to help people feel better informed and more confident in their diabetes-related self care and day-to-day decision making. What is different about the weight-inclusive diabetes care that our team provides, and who might benefit most from this approach?
Weight-inclusive diabetes care meets each person where they’re at, in the body they have. Wherever someone is in their journey with food, movement, glucose monitoring, and medications, we will meet and accept them right where they are, in the bodies they have, without judgment.
- Each individual has particular talents and quirks, and particular mental and physical health needs. One-size-fits-all diabetes care won’t work, at least not for very long!
- We help each person understand their available options and experiment with different approaches to find what works best for them.
- As they grow and change, so will their diabetes, along with the tools available to manage it. Learning to meet and accept themselves right where they are will help with diabetes management through every stage of life!
Weight-inclusive diabetes care looks at the big picture and the long haul. We are not interested in quick-fix diets and “lifestyle plans” that may lower blood glucose in the short term, but aren’t sustainable. Undereating will ultimately harm someone’s health and wellbeing over time. We want the whole person to be well supported, along with their blood glucose!
Weight-inclusive diabetes care supports a healthy relationship with food. Taking pleasure from eating is a normal and wonderful part of being a human being, and we believe that can and should remain true for people with diabetes. We draw on the evidence-based constructs of Intuitive Eating, Eating Competence, and Mindful Eating to help people with diabetes nourish themselves with care and intention, and avoid rigid or restrictive all-or-nothing frameworks for food.
Weight-inclusive diabetes care does not seek to intentionally change body weight. While someone’s weight may change in response to changes in self-care behaviors, glycemic control, medications, or other factors, we don’t seek to change it intentionally, and we don’t track it as an outcome or measure of progress. Here’s why:
- Intentional weight loss or dieting is the single biggest predictor of disordered eating and eating disorders. (1)
- The most likely outcome of intentional weight loss efforts is weight regain. A pattern of repeated weight loss and regain is known as “weight cycling,” and is independently associated with worsening metabolic and cardiovascular health. (2)
- Intentional weight loss programs are actually associated with higher rates of cardiovascular events for some people with diabetes. (3)
- Intentional weight loss goals can sometimes distract from or feel at odds with other health needs, like preventing and treating hypoglycemia promptly, eating adequately and consistently, and taking medication consistently.
Weight-inclusive diabetes care is eating-disorder informed. People with diabetes are at dramatically higher risk for disordered eating than the general population. (4)
- Many disordered eating, exercise, and medication behaviors make glucose management harder, while others may appear to be making it easier, at least in the short term. Regardless of their effect on glucose management (or lack thereof), disordered behaviors do more harm than good over time.
- Eating adequately and consistently to prevent or recover from an eating disorder can feel at odds with successful diabetes self-management. Someone who has both conditions can benefit a lot from working with providers who can speak to both and all the ways they interact, and help to resolve the false tension between the two.
- As weight-inclusive diabetes care dietitians, we help people learn to manage blood sugar without disordered behaviors, and break out of black-and-white, all-or-nothing thought patterns that enabled the eating disorder in the past.
Who may benefit most from seeing an RD offering weight-inclusive diabetes care?
- People who are struggling with feelings of shame and self-blame about their bodies and their health.
- People who are working to recover from an eating disorder, or who are concerned about their risk, and want a diabetes care clinician who can speak to both needs and all the ways they interact.
- People with high anxiety or distress about health, food, body image, or numbers, and need a gentle and creative approach with diabetes care.
- Anyone who enjoys eating intuitively and doesn’t want to give that up in order to manage their diabetes.
- Truly, anyone with diabetes!
Work with us!
We’d love to help you or a loved one with diabetes manage it with creativity and self-compassion. Get in touch!
Are you a healthcare provider who supports people with diabetes? We’d love to collaborate with you. Get in touch!
References:
- Hilbert et al. Risk factors across the eating disorders. Psychiatry Research, Volume 220, Issues 1–2, 15 December 2014, Pages 500-506.
- Swartz et al. Weight Trajectory Impacts Risk for Ten Distinct Cardiometabolic Diseases. J Clin Endocrinol Metab. 2025 Jun 11.
- De Vries et al. Heterogeneity of Treatment Effects From an Intensive Lifestyle Weight Loss Intervention on Cardiovascular Events in Patients With Type 2 Diabetes: Data From the Look AHEAD Trial. Diabetes Care 2019;42(10):1988–1994.
- Eating Disorders and Diabetes. National Eating Disorders Association.