Can Acceptance and Commitment Therapy (ACT) make type 2 diabetes risk-reduction programs more supportive?
The risk of developing type 2 diabetes is shaped by a complex mix of factors, including genetics, age, ethnic background, environment, behaviours, and potentially other unknown factors. The good news is that some of these risks can be reduced. Healthy changes can help lower this risk and support overall health and well-being.
Research shows that up to 58% of people at higher risk of type 2 diabetes can reduce their risks and improve their overall health. This can be done by making changes to eating habits, being more physically active, managing weight, and ongoing support. Getting the right information and practical help at the right time is key for anyone wanting to lower their risk.
But, too often, messages about type 2 diabetes focus narrowly on telling people to “lose weight” and change their “lifestyle”. This kind of simplistic messaging can be misleading and harmful. For some people, a focus on weight can make them feel ashamed of their bodies or efforts, which actually makes it harder to get healthy. Weight stigma — being judged or blamed because of your body size — is a common experience for people in larger bodies and those living with type 2 diabetes. Research shows that this shame and blame can lead to weight gain over time and harm both physical and mental health.
Recent expert recommendations to improve type 2 diabetes risk reduction programs emphasise the need for research on how to find the right balance. How can we better support people to reduce their risk of type 2 diabetes, without stigma?
A study led by Megan Lipsett and Elliot Berkman from the University of Oregon tested a different approach. Their aim was to help people lower their risk of type 2 diabetes and increase self-acceptance. They tested whether diabetes education combined with strategies from Acceptance and Commitment Therapy (ACT) could help reduce body shame and improve other important outcomes.
What is Acceptance Commitment Therapy (ACT)?
ACT focuses on helping people accept difficult thoughts and feelings. It teaches mindfulness and self-acceptance, and encourages behaviour changes that align with what matters most to the individual. There is plenty of evidence that this is a useful approach.
Researchers expected that ACT could help improve emotional regulation and reduce psychological barriers, like shame and body dissatisfaction, that make it harder to make healthy changes.
What did this study involve?
Nearly 300 adults at high risk for type 2 diabetes were randomly split into two groups:
One group received usual type 2 diabetes risk-reduction education. This focused on information about diabetes, healthy eating, and physical activity. The other group received similar education, but with added ACT elements. This included mindfulness and acceptance training, exploring personal values, and setting personalised goals. For this group, the language was also changed to avoid shaming people about their weight or body size, and to focus instead on supporting healthy behaviour change.
After the education, all participants filled out a set of questionnaires. These measured body shame, diabetes distress, how threatening they thought diabetes was, and how confident they felt about managing their risk.
What did this study find?
After the education session, both groups had similar knowledge about type 2 diabetes. But, participants who received the ACT-informed education reported feeling less shame about their bodies compared to those in the standard program. Lower body shame was also linked to:
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- Feeling less anxious or worried about the risk for type 2 diabetes
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- Greater confidence in ability to make healthy choices, like eating better or being active.
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Further research is needed to examine these results before and after the program to better understand its effects over time.
Why this matters
Risk-reduction campaigns and education programs are important tools for improving population health and can have real benefits. Unfortunately though, stigmatising messages are common and can cause shame and distress. Weight stigma can be a barrier, making it harder for people to feel motivated and stick with healthy changes. Programs that support healthy behaviours and reduce shame — focusing on overall well-being, not just weight — can help people take better care of their health.
This research shows that type 2 diabetes risk reduction programs may have more positive outcomes if they:
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- Avoid shaming language
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- Encourage self-acceptance
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- Focus on healthy habits, not weight loss.
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A simple shift in approach could help people feel supported instead of judged and stigmatised. That way, more people can be given the best chance to stick with healthy changes for the long term.
If you are interested in reading more about weight stigma, particularly for those with type 2 diabetes, see our blog posts – here and here.
Reference:
Lipsett, M. & Berkman, E. A randomized controlled trial of an Acceptance and Commitment Therapy-informed diabetes prevention program reduces body shame and distress. Health Psychology. 2025:44(5), 549-559. doi.org/10.1037/hea0001434
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