Podcast 172: Understanding Weight Concerns and Diabetes Self-Care

Rebecca Scritchfield, RDN: 0:00

This episode is brought to you by Self Care for Diabetes, a virtual online program that's doing diabetes care differently.

Glenys Oyston, RDN: 0:08

We don't tell you to lose weight. Instead, we help you create positive and meaningful changes that make your life with diabetes better than before. Visit SelfCareforDiabetes.com to learn more.

Rebecca Scritchfield, RDN: 0:19

Welcome to Body Kindness.

Glenys Oyston, RDN: 0:22

This is our special series on Self Care for Diabetes Concerns.

Rebecca Scritchfield, RDN: 0:25

I'm Rebecca Scritchfield.

Glenys Oyston, RDN: 0:27

And I'm Glenys Oyston.

Rebecca Scritchfield, RDN: 0:29

Let's bust some diabetes myths and spiral up together. Hey, Glenys,

Unknown Speaker 0:35

how you doing?

Glenys Oyston, RDN: 0:36

Hey, Rebecca, I'm good. How are you?

Rebecca Scritchfield, RDN: 0:38

Oh, I'm doing well. I always love getting to talk with you. And I'm really, really enjoying the work that we're doing with focus on Self Care for Diabetes. And I'm excited about our topic in the podcast today.

Glenys Oyston, RDN: 0:50

Oh, me too. This is this is one of the number one things that gets me fired up that I'd love to talk about. So what we're talking about today is this sort of myths that exists around weight and diabetes, it's it's the myth that dominates our world. And I think there's so much to unpack around it, this idea that you have to lose weight in order to manage your diabetes. And all the programs that I've ever seen in my entire life in my training, conferences, webinars, books, it's always weight centric, and says lose weight at the top recommendation for positive outcomes for diabetes. And it's frustrating, because we know that's not necessary or true. Even on their website, the American Diabetes Association who you know, I think is a very valuable organization and provides a lot of good information. And that's why this is frustrating. They'll say just lose a few pounds, I'm losing a few pounds is going to help you better manage diabetes in in it's literally in big bold letters lose weight for good on their website, and it just makes it look like weight loss is essential for for diabetes care if you're not doing it correctly. And that's just false. It's not true. And the frustrating part to me is that they also make it look like it's easy. It's a something you just lose weight, right? Like, okay, that's just a choice, right?

Rebecca Scritchfield, RDN: 2:12

This is all up to you. It's a choice.

Glenys Oyston, RDN: 2:14

Absolutely. You just you just naughty person who's not losing weight just to lose weight. And, and anybody who's been on diets knows that that is just so misleading, that it's not just, you know, eat less. And in terms of eating less, we were looking at this, this journal article from from the ADA, diabetes care, journal. And I don't even want to say the word but it's talking about the management of the treatment of type two diabetes. And the calorie recommendations just make they make me laugh out loud. When I see them. They are so low, I mean, the recommending for women. And I hope nobody takes this as something they should do, but like as low as 1200 calories. And we both know, that's something that you would maybe give a seven year old and I think I probably ate more than that as a seven year old. That's so ridiculously low and unsustainable for most people. Yeah, frustrating that somebody would just throw out a call recommendation. We don't do that. You know, we we want to trust people to know how much they need to eat.

Rebecca Scritchfield, RDN: 3:25

Mm hmm.

Glenys Oyston, RDN: 3:25

Yeah.

Rebecca Scritchfield, RDN: 3:26

Yeah, yeah. We'll include the link to that journal article in the show notes. Because I think if it's something you could see what we're talking about, you know, and, you know, again, it's, there's so many flaws in research, I mean, so many flaws that we actually separately did a module about the, you know, flaws in medical care and research and kind of what's reputable and where there are gaps and things like that. Because, you know, if you think about how you get information, you might get it from the media or even from a physician that gots you know, something, but you know, it's like, science says this, or science says that and we don't always step back and question, you know, in the research and it's in this particular thing, that was Yeah, talking essentially about, quote, you know, weight management at those higher weights, those Oh, words and say, and, and in the study, you know, basically recommending, and, you know, these super low energy intakes, and you have to stop and question like, am, am I gonna get enough to eat? Am I really satisfied I'm able to live my life and feel good and have real positive mental health. And yet every time when there is a number shared, I think comparing it to like, so this is the growing needs of this tiny human. It can in some ways, help a listener be like, you know what, this isn't right. You know, and I think that that caution that pause is a really is a really good thing. And and certainly just hearing, hey, you have diabetes, do this, you know, it's like, everything sounds like so Such a bad punishment and it sounds hopeless. And that's why there's a shame spiral, right episode one. And it's just, you know, there's much, much better ways of handling it. But when I went to the website, the American Diabetes Association website, what I got frustrated about is seeing how they perpetuated confusion, right? So by pairing, quote, weight loss with eating an exercise, right, eating and exercise are behaviors, there are choices, there's flexible things that you could do that fit your life in there, right. But weight loss is not something that you control, but what they were doing is the lining. Right, if you know eating an exercise is going to result in weight loss, right as if any, and all changes to food and movement will right there. So I promise it will result in weight loss, and crediting that it was a weight loss that may diabetes better not necessarily eating an exercise. So what if you make change to your eating and exercise? And you don't lose weight? Is that that, you know, and we're really kind of hitting on what we've dealt with clients, and why we really needed to help people try something different. And absolutely, the truth is, regardless of what happens to your weight pot, it's the positive changes that you make in your eating exercise. Also other things like stress and sleep, but it literally is about the choices you have control over that they can have benefits to your health and well being regardless what happens to your body size, or that number on the scale, if even get on the scale. So when the ADA says lose weight for good, and those big bold letters, it's actually misleading and even harmful to mental health. And I just really wish these organizations would understand and acknowledge right, that there's poor evidence that people can lose weight and keep it off. And that those who do that it improves their health, that we believe it as a society, but there's actually not strong evidence that that is actually true. So we're going to get into all this today, I'd love to start with health care providers, because this is where the diabetes risk conversation or diagnosis begins. And this is where weight loss conversations can happen too.

Glenys Oyston, RDN: 7:14

Right. And, and the truth is that there are not that many weight neutral health care providers at all, let alone providers who focus on diabetes care without recommending weight loss. You know, the experience of somebody trying to find a doctor who's going to focus on their, on their actual self care, what would actually help is, it sort of goes like, first you have to find a doctor who won't press weight loss. And that's, you know, they've already tried, or folks have already tried weight loss. So to find a doctor who's not going to start out with that as though Hey, have you ever tried weight loss? Is it feels virtually impossible? I think there are doctors out there who will who will, you know, be open to the idea of I'm not focusing on weight loss, but almost always, it feels like they're going to start with that. And then the client has this, or the patient has to sort of spend time trying to figure out how to communicate their needs, right? Like, okay, what do I want, I want you to really pay attention to what I need here. You know, I've tried weight loss, you're not hearing me, this can't be the only way to take care of myself. And just you're having to reinforce these boundaries in a power dynamic that is just not in your favor. Right? Like, you know, this is all just to make sure you have to have your you know, that you get your needs met, rather than end up with terrible advice to lose weight that you've already had, that you've already tried. It's never worked in the past for very long, and is probably harmed you and that just I think tanks motivation for self care. In the end, I've had so many clients come kind of dysregulated after a doctor's appointment, like, I've been doing all this great stuff, my blood sugar's got better and they still said I had to lose weight, and it just feels like we go back to square one. And this is, you know, they go into that shame spiral that we talked so much about in our first episode on this in this series. And it's just, you know, it's just so hard for them to move forward after the voice of authority, is it gonna lose weight, and, you know, medical, you might lose some weight before your your diabetes diagnosis is a side effect of diabetes. And so weight gain with treatment might be about yourself care improving. And I've seen that and doctors are still saying, Oh, your blood sugars are better, but what about your weight? And that is just painful. That's a no, go through this.

Rebecca Scritchfield, RDN: 9:43

Yeah, I'm even thinking of people in our recent groups who have just talked about I think I might need to leave my doctor, you know, like, like so so much stress around the situation, right? Like, if you're lucky to have insurance and is you know, knowing that they're not I have someone whose Health at Every Size and form having so much fear, it's all this emotional labor around protecting themselves and you're so afraid of how is it going to go and even to your point, and, you know, I laughed inside my head too, because we, you know, it's, it's, and it's not like, haha, this is funny but like, this is a ridiculous right like kind of thing because it you know, was the doctor even listening when I set my boundaries or it was it that they wanted to check that box that says that they talked to me about it. And in the end, it just sometimes we end up having to help people, you know, pause and think about the bigger picture need to see the doctor and the benefit for that particular focus and how to just almost like you're in some sort of video game, right? And like, kind of shoot down their ideas? No, I'm here for this. I'm here for this.

And yeah, I mean, we, you know, we've learned in August, most doctors don't even ask about a trauma history or an eating disorder history, you know, let alone general permission, like, Hey, I was wondering if we could talk about your weight. Or if you want to give me a number and I'll report it or we could leave it blank if you want it like basic consent would be nice. So that patients had a chance to Oh, this is the opportunity to set some boundaries. And this is the history I'd like to give. And so it's, you know, just I think that, you know, there are these are things that we can relate to, and it's just a matter of recognizing, where is the problem, you know, I've had clients who've lied to doctors, they just felt so much shame didn't trust the doctor would understand them wouldn't judge them didn't believe that the doctor would do anything to make a change. You know, and obviously, if you can't be truthful to your doctor, how can you get the best possible care that you deserve? So we know it's a big problem. But I wanted to talk a little bit more like specifically about weight cycling, and diabetes, as the reality is many people will consider specific diets right despite I listened your pockets and was great. And then I tried this, right. So we're saying don't we don't recommend it. But we fully accept that some people will, right, they'll try something specific. Some of them might lose weight as part of the diet, it doesn't last, some won't even lose any weight, right? We've seen that too, or like I tried instilled in us anyway. So for those who don't know, weight cycling, is basically what happens. Like that's, that's kind of a term, right to use. What happens if you lose weight that wasn't natural for your body, and then you regain it. So like a cycle down and up, down and up. People tend to blame themselves rather than just biology, right? This was meant to be as biology. And so for example, they'll say, like, Oh, I did fill in the blank keto, right, for a few weeks, I lost x pounds, but I couldn't keep it up. And I regained everything I lost, you know. So you notice that if that's the sentence, the story in your mind, right, you're blaming yourself, you know, and not necessarily the fault of the restrictive plan. So that is an example of weight cycling, it's very common, when you don't take a weight neutral approach to habit changes. And I was hoping you would share with listeners more about the harms of weight cycling,

Glenys Oyston, RDN: 13:19

Right. And so it's the the up the down and up the down on the app that we're talking about with weight, you know, and this diet didn't work going in, you know, or it worked for a while, and then I couldn't keep it up. And then I try another one. And so, you know, we work with people who've done that quite a bit. And it is like, there's a lot of evidence on this now that that weight Cycling is actually harmful. And they're, you know, people are afraid if they don't lose weight, it'll get worse. So I don't blame people for going on that weight cycling journey, they've been told that it's really harmful for them to be at a higher weight. The media headlines are so dangerous. We found on one Web MD article that says just a little weight loss can put diabetes into remission. And that's so misleading. And not to mention, they say 10% of body weight, that's not a little weight loss. Although if you're at a higher weight, it's only a little weight loss and leaves you at a higher weight still. So it's very confusing, like, you know, the truth is there's no effective way to keep it off long term. And that restriction that leads to weight loss. It just actually masks the symptoms, the symptoms of diabetes, it doesn't make it go away. There's not really a way to put diabetes into remission. I hear that it's a very site Geist II thing that people are saying, and, you know, it's sort of like you can put it into remission as long as you just stop eating. It's like, yep, okay, that's reasonable. Um, the truth is, most people can't sustain that level of restriction that makes it seem like it's gone away. And it's not due to their failure, but it's just the nature of restriction and weight loss itself. The body doesn't want to do that. And so you You know, science doesn't know, like you said, if it's the weight loss that makes the difference, or the behavior change that leads to weight loss. But essentially, what we know is once you've gone on these weight cycles, you're looking at a lot of of harm. So it's muscle loss of muscle mass. And, you know, we know that better muscle mass actually helps improve blood sugar regulation, you always get that loss of lean body mass and muscle mass with with weight loss, you're going to end up with a suppressed metabolism. So you've got a body that naturally is going to store more of its intake as fat, you've got an increase in inflammation with restriction. We know that's true. You know, from various studies that people have done, Janet tomiyama comes to mind in her her study on cortisol on restriction. And, you know, diabetes is an inflammatory condition. So if you're increasing your inflammation, while you're restricting, it's like, of course, we're seeing worse, you know, blood sugar outcomes after all of that ends. And then of course, the weight regain, which is often more than was lost in the first place, and just a lot of disordered eating symptoms, after going on it, you know, on and then off a diet and those disordered eating symptoms just make blood sugar control, so much harder. So, you know, a lot of harms, to weight cycling.

Rebecca Scritchfield, RDN: 16:21

Yeah, and like the diet was disordered behavior. And then, so technically, their symptoms then right, and then when you come off of it, as you're healing, you also see these other symptoms or things that look like negative side effects. But what what were they predicated on? Right? You know, they didn't, you know, if you lose muscle mass related to restriction, and then, you know, whereas we know, the better muscle mass, right, again, something you can do, you know, you don't have to be a bodybuilder, right. But we're talking like, some chair, shoulder presses with a resistance band, or, you know, very, very lightweight one pound weights even can make a difference in your muscle strength, endurance, and mass, which helps with blood sugar, without actually being well fueled for that, right.

Glenys Oyston, RDN: 17:14

Yeah, you know, people are acting as though these these diets have been gone or healthy eating. And I think we both know that they're anything but that. So the weight Cycling is all attributed to your stories associated with, you know, increased risk of diabetes, high blood pressure, high cholesterol, heart disease. So, you know, when people are thinking of going on another diet, really start to think about what are the long term risks here? Yeah. Yeah.

Rebecca Scritchfield, RDN: 17:46

You know, I thought that it would be helpful for listeners to share some great medical facts that should help you want to diet less urgently, instead, follow more of a self care approach, which is you know about being positive being kind to your body, trusting your preferences and your needs and your desires. So good friends of ours, Reagan, Chastain, well known speaker and fat activists. I'll make sure I include our podcast chat in the show notes for that. Love Reagan, and all the wonderful work. And Louise Metz, who is a medical doctor who practices from a Health at Every Size perspective. So she's a practicing medical doctor practicing from a Health at Every Size perspective. They created these new Health at Every Size or haze, health sheets, so haze health sheets, for information on common medical issues, and one of them is for diabetes. So this is an evidence based freebie PDF. With references, we're going to have a link to the website in our show notes, you could look at the different ones that they created. And you can see it on the web, you could download the PDF, it could be great to to find its way to your physician or family member who was recommending otherwise. But I wanted to read a snippet from it and just encourage you to go out and grab that link in our show notes. And check out the website and share it wherever you can have an impact on folks. The treatment of type two diabetes focuses on controlling blood sugar, you have many treatment options depending on the degree of elevated glucose. Some people choose to focus on behavioral interventions before starting medications. Some people choose to focus on medications rather than behavior changes, and some do a combination of the two. And just as a side note, our self-care for diabetes program is mostly behavioral, and we absolutely support at any and all medication choices too. And we, you know, we we cover meds, you know, somewhat in our program in the course but we definitely talk about it in our live groups as well. That we're not saying making any sort of this is the best med or do this or that type of advice as part of our program. But the more important thing to know is that we want to help you with your habits. And we we embrace all of your choice options, you know, throughout. And so I think what's really important to make make make known is that it is behaviors and meds that help manage diabetes, not attempted weight loss. In fact, weight loss interventions for diabetes have not been shown to improve cardiovascular complications and have been associated with a decrease in life expectancy. While it's not your fault, the fat phobia and stigma around type two diabetes can become a problem you may need to deal with. Perhaps most importantly, don't panic, there's no need to make massive changes to your lifestyle overnight. This is a condition that you can learn about and manage.

Glenys Oyston, RDN: 20:57

So end quote. So that's

Rebecca Scritchfield, RDN: 20:59

just the excerpt. That's part of that handout, say for my side note, just letting folks know about what we do on the combination of behavior and medication. So we definitely want folks to check that out. And hopefully, it helps you on your journey.

Glenys Oyston, RDN: 21:15

Yeah, those those health sheets are so I just am so thrilled that they exist now. You know, for people to use? Yeah, definitely. Yeah. I want to talk a little bit about the mental health benefits of not centering weight loss goals, you know, for individuals, for families, and just how to help yourself feel better about this choice, because it can feel very lonely to feel like you're going against the grain. So, um, you know, first not centering on weight loss, is going to allow the joy in eating to return. And we know from a lot of studies on like intuitive eating and other non diet, eating models that the joy and eating is really important. We have to be able to like what we're eating to be able to feed ourselves reliably. And well. restriction just takes the joy out of eating period. So if you're thinking you're not going to get enough to eat and having to go hungry, that just takes the joy out of eating, and you're not going to want to feed yourself when we know is like regular meals actually help with blood sugar control. And you know, we've worked with people who are like, I can't even get a meal together for myself, because I feel like I have to eat this healthy thing. And not the thing I actually like. And there are so many ways to approach sort of in a joyful relationship to eating and eating the food you want. and managing your your blood sugar's that it is possible. And then you can feel better about that choice. Because as I said, the evidence is on your, on your side, we see great results in blood sugar control from the non diet way of eating and living. And from behavior changes that are actually doable, and achievable and a joy and enjoyable, we have seen this right in our practice, our practices, and families, Ben can support each other and behaviors that actually feel good rather than like the family turning into the police, you know, the weight and the food policing, which doesn't feel good for anyone. And we're so we're talking about sort of that spiral up kind of this is positive self care. And I just think it's, you know, centering weight loss feels like a failure when these diets are set up to make you fail. like nobody can really maintain these. I won't say nobody, but a tiny percentage of people maybe can, you know, continue these diets long term, most of us can't. And instead of feeling like a failure constantly, you're actually feeling like, hey, what I do matters to my health. And I can do this.

Rebecca Scritchfield, RDN: 24:01

Mm hmm. I am when I was listening to you, I just had a memory of in one of our groups where somebody was talking about the difference in like that burden of Oh, I can't do this because I have to do this like healthy thing around food. And when when they actually stopped and looked at there were certain veggies that they liked and some that they didn't like and when they focus on what they liked and said you know what, I'm I'm allowed to have a shorter less like that's, that that's just that's where my preferences are. And then then next went to like taste like oh, yeah, you know, that suddenly it that there was this shift, and that it was it was what was my thought process that lead to what was on my plate right following an external rule from a specific diet, which means that my taste preferences doesn't matter or my food preferences don't matter. You just gotta shut up and follow those rules. And the difference Right, and how we help people see, well, that is actually a healthy mindset, just by changing that approach and attitude, etc. So I really appreciate you saying that, you know, you know me, I love my tools and resources. Um, there's a lot of resources in the diabetes program. And if anything you add to contain me like Rebecca a little bit less. offer one here today for listeners. This is a reflection or a journaling prompt designed to get you closer to your desires, and consider the impact of your choice auctions. And I really love writing, it's a very important outlet to get in touch with and express your true feelings. So I really want to encourage you to try this out. Even if you're not much of a journal or, you know, it could be any piece of paper, you could write on the back of a junk mail envelope if you anything, but but try to grab a writing utensil and a piece of paper. Other than that, there's no one right or wrong way to do this. And you could get a sort of typed out version of this in our show notes with all the steps.

So the first thing that you're going to do is you're going to take three big and deep cleansing breaths, and just let yourself settle. So you might say inhale, exhale with each breath. You might say the word settle, right, but you're just taking a nice, big, slow and deep breaths.

And then when the three breaths feel complete, ask yourself, please allow me to approach this with a curious and open heart. The first question you're going to journal on, how will life be better for me? If I don't emphasize losing weight as a goal for diabetes care? So one more time, how will life be better for me, if I don't emphasize losing weight as a goal for diabetes care? And you'll want to just give yourself some time to really think about that you're trying to explore ways that life would be better. So even if your family member recommends losing weight, or Dr. Anybody that the choice option is yours to not emphasize it. And how would that make life better for me. And I do recommend you give it at least five minutes. If you have time, give it like a good 15 minutes to just think and write and just let yourself explore. Remember, this is about kind of getting to your truths into your facts. The other journaling prompt that I wanted to offer is How could my life be more difficult if I choose to diet? So How could my life be more difficult if I choose to diet? And I'm sure you're listening, pay those two questions go together? Yes, they kind of do. But you could pick one or the other. Sometimes you might want to talk about think about how life could be better first, and write some things out and read it, you know, everyday for a few days, kind of let it sink in. Right, then separately or another time, look at how it could be difficult. Or you might do them kind of both in one setting and just kind of add to it a little bit more each day. But literally give yourself some time like a whole week, you know longer if you need it. But like give yourself some time to really ask yourself these questions. See what you write down as your truth. And I think that you'll see, the answer will be really, really clear. And it will give you some amount of emotional energy to deal with what kind of strength you need to resist the pressure because this program is you know, we're outlier clinicians, the program is an outlier, you know, there's just a very small element of truly helpful diabetes care that is weight neutral. And it can feel difficult to kind of be outside of the norm. But we believe that there are people out there who really need to be outside of the weight normative paradigm in order to truly be healthy. And if that's you, you know, we really want to connect with you and hope that we've helped you in some way with this conversation in this reflection prompt.

Glenys Oyston, RDN: 29:51

I love journal activities like this because I think they're so great at exposing our underlying attitudes that some We don't even know we have. And once you know that they're there, I think it shortens the half life of them considerably. So I just think there's so much value in doing those.

Rebecca Scritchfield, RDN: 30:12

Yeah,

Glenys Oyston, RDN: 30:12

yeah.

Rebecca Scritchfield, RDN: 30:13

Thank you.

Glenys Oyston, RDN: 30:14

Well, Rebecca, thanks so much for hosting me on your podcast. This is always fun to hang out and chat with you. And yeah, I just really appreciate getting the chance to talk about this and helping people to not feel like failures around weight loss and to feel like they can actually take care of themselves well, without focusing on weight loss. So I appreciate appreciate the space you've made on your podcast for this.

Rebecca Scritchfield, RDN: 30:46

Thank you. I appreciate you everyday.

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