People with type 2 diabetes face multiple forms of stigma, with concerning health implications
People with type 2 diabetes experience stigma because of both their diabetes and their weight, according to a new study published in Clinical Diabetes by researchers at the UConn Rudd Center for Food Policy and Obesity. Moreover, these stigmatizing experiences contribute to unhealthy eating behaviors, lower physical activity, and poorer health.
Specifically, individuals with type 2 diabetes who experience weight stigma in health care or differential treatment from others because of their diabetes are more likely to turn to food as a coping strategy and binge-eat, compared to those who have not experienced these forms of stigma. Additionally, when individuals with type 2 diabetes internalize the negative judgments they receive because of their diabetes and/or weight, they are more likely to binge-eat, engage in less physical activity, and report worse overall health.
"Despite increasing calls for efforts to address stigma in the diabetes field, there has been little research attention to stigma faced by people with type 2 diabetes," says Rebecca Puhl, lead author of the study and Deputy Director at the Rudd Center. "Given high rates of obesity among people with type 2 diabetes, these individuals are not only at risk of experiencing diabetes stigma, but also at risk of stigma because of their weight, both of which can have a detrimental effect on health."
To examine health links with diabetes stigma and weight stigma, researchers used an online, healthcare-focused research panel of 1,227 adults with type 2 diabetes. Survey questions asked respondents about their experiences of diabetes stigma and weight stigma, as well as their eating behaviors, levels of physical activity, and self-rated health.
Key findings include:
- Being treated differently by others because of one's diabetes and engaging in self-stigma were both associated with eating as a coping strategy and binge-eating.
- 53% of respondents reported they had been stigmatized for their weight, and 44% had experienced weight stigma from a healthcare provider on more than one occasion.
- Individuals who felt judged about their weight by doctors reported more frequent binge eating and were more likely to eat as a coping strategy in response to stress or negative emotions.
- Internalized stigma was associated with eating as a coping strategy, binge eating, lower physical activity, and worse perceived health.
Study authors encourage additional research on the topic, as these findings are among the first to highlight the important relationship between diabetes stigma and health behaviors. In addition, these findings are particularly important for healthcare providers who play a pivotal role in diabetes management.
"Initiatives to improve the health and well-being of individuals with type 2 diabetes must consider the harmful roles of diabetes stigma and weight stigma," says Puhl. "By bringing more attention to these forms of stigma in the diabetes field, progress can be made to identify effective approaches to support people with type 2 diabetes and reduce the harmful impacts of stigma on their health."
More information: Rebecca M. Puhl et al, Weight Stigma and Diabetes Stigma: Implications for Weight-Related Health Behaviors in Adults With Type 2 Diabetes, Clinical Diabetes (2021). DOI: 10.2337/cd20-0071