What I Wish I Knew About How Weight Stigma Would Affect My Type 2 Diabetes Care

Alysse Dalessandro poses for a picture with the words Type 2 diabetes What I Wish I Knew next to her

Photo Courtesy of Alysse Dalessandro 

As someone who has been an online content creator before “influencer” was ever a word, I know all too well the link that society places between people living in larger bodies and having type 2 diabetes. For years, my size has been the topic of scrutiny in comment sections. While strangers crafted memes poking fun and wishing me the worst, I learned how to see their hate of my body as the manifestation of their own biggest fears and became a fierce advocate for body liberation and size activism. 

The word trolls used most often to invoke fear? Diabetes. I learned how to snap back at these comments with what became a canned response: “You can’t tell someone’s health by looking at them.” This was my way of asserting that my body size was not an indication of my health or my worth. But what I was really saying was that I didn’t have diabetes. On March 19, 2016, my statement became no longer true.

I knew everything about how to respond to people thinking I had diabetes and absolutely nothing about actually living with diabetes. I left my doctor’s office with a type 2 diabetes diagnosis, a body positive mindset, and no resources on how to reconcile the two. 

I sought resources on how to treat type 2 diabetes and was mostly met with weight loss advice, stigma, and shame. This experience is not uncommon.

A 2020 study reported the link between weight judgment from a doctor and its negative impact on diabetes care. When healthcare providers showed weight stigma, people with type 2 diabetes tended to have poorer self-care of their disease, such as less frequent blood glucose monitoring. The study also found that those who felt the stigma might be more distressed about their disease and have a more negative look on their perceived quality of healthcare.  

I remember being recommended to dietitians who made it clear my weight loss was their primary goal. I left those appointments still unclear on how to lower my A1C—my ultimate goal for managing diabetes. A1C, which is a three-month average of blood sugar levels, is one of the tools used to measure diabetes wellness. With so many factors, including stress, genetics, sleep, movement, and hydration impacting blood sugar levels, I wondered why my weight seemed to prevail as healthcare providers’ sole focus. The more I learned about diabetes management on my own, I realized that I needed to tackle way more than what food I put in my mouth. I had to take a more holistic approach to everything in my life and how that ultimately impacted my body.

And so as weight seemed to prevail as healthcare providers’ focus, it became clear to me that society’s stigma against people with larger bodies wasn’t a bias healthcare professionals left at home. Research even shows that many healthcare providers have negative attitudes and stereotypes about people with obesity, and those negative beliefs can impact care. 

While I wasn’t experiencing the same vitriol at the words of the doctor as I was internet trolls, misinformation and weight stigma prevented me from accessing the care I needed. This pervasive idea that people are to blame for their body size is a harmful and dangerous misconception. 

Unable to connect with the resources I needed locally, I started to do my own independent research. I delved into writings on Health at Every Size (HAES), a concept based around the idea that there is diversity in human body size and shape. HAES takes a holistic approach to wellness, encouraging you to eat when you’re hungry, stop when you’re full, and find the joy in movement. HAES promotes focusing on how food makes you feel rather than how society tells you food will make you look. 

While my years working in body liberation familiarized me with these concepts in theory, being diagnosed with a chronic illness brought a whole new meaning to this mindset. I learned how to articulate the link between diabetes and genetics and how diabetes impacts people differently. Most importantly, I gained the confidence to stand in my truth: My body was not the enemy. 

Knowing that my primary care doctor meant well but probably wasn’t familiar with HAES, I returned to her office determined to get us on the same team when it came to my diabetes management. Her compassionate demeanor told me that she had the capacity and willingness to learn. Given my history with disordered eating, I asked if we could take a weight-neutral approach to my diabetes care program. 

Seven years later, she’s continued to respect that ask. Looking back, I know how easily I could’ve jumped from doctor to doctor hoping to find one versed in an approach to weight that is still rare to find in mainstream society let alone medical curriculum. I learned an important lesson that day: Don’t sit in the anger and resentment of societal fatphobia. Advocate for your needs, but give individuals some grace to learn.

Over the course of my next few appointments, we focused on my A1C and the patterns in my daily blood glucose readings. She didn’t mention my weight, and I started to notice that she would ask about other things going on in my life. Through this more patient-centered approach, I learned that stress and many factors beyond what I was eating impacted my A1C levels. 

With encouragement from my primary care doctor and therapist, I found a nutritionist who treated folks with a history of disordered eating. For the first time, I felt armed with the knowledge I needed to understand and really connect with my body in a more holistic way. I learned how the dissociation that made my eating disorder thrive was the true enemy of my diabetes.

Taking the focus off my weight wasn’t the easiest approach to type 2 diabetes management, but it was the right one for me. It forced my doctor and me to sit in the discomfort of the unknown. We challenged what can be an adversarial relationship between larger-bodied patients and the healthcare providers who treat them and learned to work together.

I set out to be seen as more than my diagnosis, more than a number on the scale, and more than the manifestation of someone else’s fear. Along the way, I stopped looking outward so much to fight injustice and started looking inward to connect with myself. Somewhere in the middle, I found my peace and my purpose.

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3 Sources
Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Puhl RM, Himmelstein MS, Hateley-Browne JL, Speight J. Weight stigma and diabetes stigma in U.S. adults with type 2 diabetes: associations with diabetes self-care behaviors and perceptions of health careDiabetes Res Clin Pract. 2020;168:108387. doi:10.1016/j.diabres.2020.108387

  2. Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–326. doi:10.1111/obr.12266

  3. Association for Size Diversity and Health. Health at Every Size principles.

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