Does stigma impact how adults with type 2 diabetes manage their weight?

US research finds people with the double burden of diabetes and weight stigmas perform fewer weight-related health behaviours

By Sarah Manallack

Many people with type 2 diabetes live in larger bodies. There is stigma related to both type 2 diabetes and to obesity, as shown here. Despite this, we have seen little combined research on both stigmas among people with type 2 diabetes.

Researchers from the US, Dr Puhl and Dr Himmelstein, together with the ACBRD’s Professor Speight, have explored the impacts of both diabetes and weight stigmas on how people with type 2 diabetes manage their weight. You can read the full paper here.

They did an online survey of 1,227 adults living with type 2 diabetes in the US. On average, those who took part were aged 52 years, were living with obesity, and had lived with type 2 diabetes for around 9 years.

Stigma was assessed in several ways:

      • experiences of weight stigma, in any setting
      • experiences of weight stigma in a healthcare setting
      • being blamed and judged by others because of their diabetes
      • being treated differently by others because of their diabetes
      • diabetes and weight self-stigma*

*Self-stigma is when a person takes on (or internalize) other people’s negative judgments, blames or judges themselves or expects to be rejected by others.

Over half (53%) reported general experiences of weight stigma, 44% had experienced weight stigma in a healthcare setting, and 73% had attempted weight reduction in the past year.

When people experienced weight stigma in healthcare, were treated differently because of their diabetes, and/or self-stigma of diabetes and weight, they were also more likely to:

      • use eating as a strategy to cope with negative emotions
      • have frequent binge eating episodes; they experienced loss of personal control over their eating patterns

That is, as scores on each stigma measure went up, so did the frequency of the eating behaviours. The remaining stigma measures were not associated with the eating behaviours.

People who scored higher for weight self-stigma:

      • reported less frequent exercise. The opposite was found for higher scores on being treated differently due to diabetes.
      • gave a lower self-rating of their own health

None of the remaining stigma measures were related to exercise or to ratings of health status.

Binge eating with loss of control was more likely only for those with higher scores on:

      • diabetes or weight self-stigma
      • experienced weight stigma in healthcare

Attempted weight reduction was more likely only for participants with higher scores on:

      • weight self-stigma
      • being blamed and judged by others for their diabetes

While the findings of this study were mixed, they show how diabetes and weight stigma can affect the health and health behaviours of adults with type 2 diabetes. They also highlight the need for more research in this field and more efforts to end both diabetes and weight stigmas.

This year’s World Diabetes Day (14 November 2023) sees the global launch of the International Consensus and Pledge to Bring an End to Diabetes Stigma and Discrimination. You can find out more and take the pledge to #EndDiabetesStigma here.


Reference: Puhl RM, Himmelstein MS and Speight J. Weight stigma and diabetes stigma: Implications for weight-related health behaviours in adults with type 2 diabetes. Clinical Diabetes, 2022, 40(1), p.51–61.

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