The Most Effective Diabetes Care is Weight-Inclusive. Here’s Why.

No weight loss required: What actually helps people with diabetes
Diabetes Digital Podcast by Food Heaven
0:00
Welcome back to another episode of the Diabetes Digital Podcast.
You guys.
This, I think is one of my favorite episodes of this year.
I am going to suggest that all of our dietitians listen because I learned so much and we had an icon on the podcast.
0:18
So today we interviewed Migrett Fletcher, who is a dietitian, diabetes care and education specialist and author dedicated to reducing stigma through weight inclusive diabetes care.
She co-authored Eat what you love, love what you eat with diabetes and writes the newsletter No weight loss required.
0:38
Megrette also sees clients through Nourish and you can learn more at Megrette.
That’s MEGRET te.com.
Definitely bookmark that link because you’re going to want to revisit it at the end of the episode.
In today’s episode, we talk about language and why that matters for somebody with diabetes.
0:58
So if you have to diabetes or pre diabetes and you have just been told the same old rhetoric of lose weight or if you were in a thinner body this would be easier, or your numbers are bad or you need to control your blood glucose, this episode is for you.
1:16
We talked about redefining success for diabetes care without weight or perfect numbers and how we can focus on an additive approach to nutrition and not a subtractive approach to nutrition.
As well as how can we as not only patients but also providers work to lift people up or lift ourselves up and not be oppressive to other people as providers and also as patients being oppressive to ourselves.
1:45
It was honestly like there’s so many aha moments for me.
And also the way that she illustrates a lot of her points with examples.
And there was one instance where like I kind of played patient and she she was provider and she walked me through an exercise.
It was so good, you guys.
So definitely listen until the end because you’re going to enjoy this episode.
2:05
Welcome to the diabetes digital podcast.
I’m Wendy and I’m Jess and we’re best friends, registered dietitians and diabetes educators.
Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.
2:22
Visit diabetesdigital.co.
That’s Co to book.
Book your first appointment.
We accept insurance and offer affordable self pay options.
Now let’s get into today’s episode.
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2:38
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Now on to the episode.
Welcome to the podcast Me Grit.
Thank you.
How are you?
I’m doing good.
How are you today?
After lunch.
So everything’s good, right?
4:44
Yes, everything’s the only problem for me after lunch is I’m tired.
I like take it depends.
It depends.
But yeah, I often times just need like a little power nap, maybe 15 minutes or a walk, and then I’m like, good to go.
Yeah, I love that.
5:01
Yeah.
OK.
So you are one of The Pioneers working kind of at the intersections of mindfulness, diabetes and weight inclusive care.
I feel like you’re probably one of the first person that I know of at least.
And you were the first person because I had mentioned before that I had been to one of your talks just talking about weight inclusive care within diabetes.
5:24
At that time, I was a certified diabetes educator.
And I feel like it was years ago, but I feel like that was like the first time I was hearing somebody talk about these intersections.
Have you, have you also spoken at Fancy before?
OK, Yeah, I think I also saw you at Fancy Speaking.
So tell our listeners, like for people who are not even sure what is weight inclusive care for diabetes, what does that mean and how is it different from what many people have experienced within the healthcare system when it comes to diabetes?
5:56
OK, sure.
So when we think about inclusion and weight inclusion, there’s a spectrum.
And so it’s really important to understand that on one end of the spectrum is weight centered care, kind of in the middle would be weight neutral.
And then on the other end of the spectrum is weight inclusive care.
6:14
And so when we think about those words, we really can start kind of getting some hints as to what the difference is.
So weight centric care and again, this is definitions that Maudlin and May and Clifford and that’s a a research article talking about the consequences of weight centric care.
6:32
It was published in 2022, but they spend a lot of time kind of defining these terms.
If you are a professional and are curious and you want to look it up, what we’re looking at is we’re turning around.
We’re saying weight is the thing that causes improvements in health and that would be weight centric.
6:48
Weight neutral is maybe maybe not.
We’re just really not going to talk about weight.
We’re going to kind of not really look at it.
We’re not going to, you know, discourage weight loss.
We’re not going to encourage weight loss.
So it’s kind of that neutral space and weight inclusive is we’re looking at the principles of inclusion.
7:10
And when we think about the principles of inclusion, we’re talking about, you know, everybody, we’re including everybody.
And So what does that mean to include everybody in diabetes care?
And so the little asterisk I always like to put on diabetes is there’s not a place, there’s not a country, there’s not a group, there’s and there’s no one in this planet that has escaped diabetes.
7:33
It’s everywhere.
So we can’t turn around and say, well, country X doesn’t have diabetes.
Everybody has diabetes.
So when we think about we inclusive care, when we think about inclusive diabetes care, we’re actually talking about diabetes care where everyone gets care.
7:51
And I think that that to me is that’s a really essential distinction.
Yes, well, let’s talk about language because, yeah, I feel like so many people with diabetes and I used to be this person and I have since publicly apologized because we we were taught initially this idea that like with diabetes, you have to lose weight or if you were thinner, this wouldn’t be an issue, or lose 5 to 10% of your body weight and that’s going to, you know, prevent you from getting diabetes.
8:22
And most, I think providers who I meet with still, even when we get referrals, the referrals, even if the person has diabetes, they are for weight loss.
So I’m very curious from a weight inclusive perspective, what kind of harm can this language cause, especially like emotionally and even physically, and also like how that might impact how somebody manages their diabetes care?
8:48
So pretty complicated question you asked and there’s a lot of unpacking when we do this.
So first and foremost, I think it’s really important to have some empathy.
We all live in a place of weight centric care.
So that’s the model that we live in.
It’s the water that we swim in.
9:05
And so when we turn around and say like, well, you know, I apologize to, you know, people because I was taught from a weight centric model and you know, blessings that you can give yourself forgiveness, that’s wonderful.
It’s familiar though.
A weight centric model is familiar.
9:22
And so when we try to do something that’s unfamiliar, it’s hard, right?
Yeah.
Yeah, it’s hard.
It’s hard to do something that’s unfamiliar.
And there are voices that have said, you know, I don’t think this is really what it’s supposed to do.
9:38
But again, if all the research is saying yes, it’s weight, then there’s kind of momentum that’s building around, you know, focusing on a weight centric model.
And so again, we just kind of see this force bias kind of conditionality, all of those things are saying, Yep, this is the right direction to move in.
9:59
We should keep moving in this direction.
And there’s lots of kind of history around those kinds of things.
So first and foremost, when we talk about weight inclusion, we talk about language.
It’s really important to understand that we’re untangling our approach to diabetes.
10:18
So when we think about stigma, all stigma is complicated.
It’s like a knot.
You don’t fix stigma, you untangle it.
So we’re all wrapped up in this.
So if you can just start imagining it like a knot and you have said, hey, I’ve worked really hard to try to untangle myself from this thing that’s present in society.
10:42
Amen.
Not everyone can.
Their other forces, other pressures on them.
And so again, when we think about trying to get untangled, you know, some, sometimes it’s just like I don’t have the bandwidth, I don’t have the capacity to do that.
Again, blessings, Amen.
10:58
We can do what we can do.
That’s where we are.
So when we think about language, when we think about trying to notice language, there’s a lot of language that’s stigmatizing and you know, as a body of culture, you understand these can land like microaggressions.
11:16
So when we think about things like blood sugar spike, that’s a really good example of it’s a microaggression.
Your blood sugars didn’t spike.
They they rose, blood sugars go up, they go down, they change.
That’s what blood sugars do.
When people say things like, you know, my blood sugar is above X or it’s a, it’s above my target, it’s a range.
11:39
Your target has a range, and everybody’s range is individualized.
So this idea, this belief that we’re homogeneous, we fit in a bucket, we’re one-size-fits-all, and that what works for Bob has to work for everybody else.
These are where we want to kind of push back.
11:56
That’s oversimplification of diabetes, and the language that follows that oversimplification is an example of diet culture.
That’s an example of somebody turning around saying, oh, I’ll just make it so easy for you.
12:13
Oh, don’t worry, we’ll just make it easy.
Just think about it this way.
Just do this one thing that’s appealing in some ways at least, particularly when I’m feeling like I’m drowning.
I just got diagnosed with diabetes.
I don’t know what I’m doing.
I just need somebody to tell me the answer.
12:32
Yes, I get it.
But we’re not in that space for very long.
Once we kind of acclimate, we go, OK, I got to do this.
What do I got to do?
Having somebody tell us what to do.
You have to do this.
12:47
You should do that.
You’ve you’ve got to do this.
You can only eat that can only eat at this time.
You know, you should do this.
It’s oppressive.
This is an oppressive system.
The diet is telling you, a bright and able person, what to do, when to eat, what to eat, how to eat, how much to eat.
13:08
And it’s also telling you if you don’t do this, you’re wrong, you’re bad, you’re lazy, It’s an oppressive system.
The thing that happens is your inner teenager wakes up.
I don’t know about you, but my inner teenager was not my shining that you know, chapter in my life.
13:31
It wasn’t like, oh, make it your teenager.
You made so many great decisions.
I I didn’t, and no one’s teenager does because a teenager pushes against depression.
That’s what teenagers do.
They go, oh, mom, dad, I need to separate from you.
I’m going to push away from that and I’m going to do my own thing.
13:50
So when we talk about language, a lot of times the language around diabetes, the language around diet culture, the language in general, when we talk about motivation, it’s oppressive language.
Yeah, it.
Hurts us.
14:05
It lands as you’re not enough and it lands as you’re being othered.
And whenever someone’s being othered, and we do it all the time, we other people all the time, you’re not motivating them, right?
14:23
So my clients who come in and they say, yeah, I’m really lazy.
I’m, I should be trying harder.
I just, you know, if I just, if I tried more, if I just did it this time, if I could just, you know, my heart’s breaking right now because this is a bright and able person who’s putting themselves down.
14:43
So I always think about it like there’s a, there’s a finish line.
So if we turn around, we say, oh, here’s the space I need to travel.
If I turn around and I say I’m inadequate, I don’t know, I’m not motivated.
I can’t get it right.
I’m starting way over here.
15:00
Yeah.
But if I say I’m a brain able person and I figured out lots of stuff and with a little bit of support and some help and some guidance, I can get this.
I’m starting here.
I’m at this place.
If this is my finish line, it’s this much shorter distance.
15:16
So we always want to start when we talk about diabetes care, we really want to start from that place of, you know, agency.
What’s agency?
I’m Bright and Abel.
You’re Bright and Abel.
Every client that walks in my door is Bright and Abel.
They have dealt with lots of stuff.
15:34
We want to start with agency.
I believe in you.
We also want to provide autonomy.
Autonomy is choice.
Nobody likes to be told you can only have this and you have to eat that, and you got to eat it this time.
15:50
Are, you know, teenagers.
It’s like, hello, You can hear it knocking at the door going, yeah, I’m not doing that.
And you’ll do it for a while and then you won’t do it, you know, so you can feel that tension.
And So what are we really talking about?
Secret inner teenager Brighton Abel Agency on autonomy.
16:08
Oh my gosh, I’m so confused.
How does this relate to diabetes?
You got to get your motivation in the right place.
If you’re doing it to please Bob or your provider or your neighbor next door, it’s not enough.
It’s got to be for us.
16:23
And when we start talking about motivation and we start talking about diabetes care, we really have to turn around and say, I gotta think sustainable.
I gotta think long term.
I gotta shift my mindset from this.
I’ll do it for a week or a month or a year.
16:40
I’ll do it until my A1C gets lower.
I’ll do it until I lose 5 lbs.
That mindset is very familiar.
It’s very much tied to the familiar diet culture that we’ve grown up with.
16:56
And shifting that mindset is turning around saying, Oh yeah, I’m, I’m actually looking for sustainable systems.
I’m really looking for something that I can do for the rest of my life.
17:12
And it isn’t you’re going to do one thing for the rest of your life.
You’re looking for insights and strategies.
We’re learning how, how can I come alongside these struggles?
How can I come alongside these things are happening to me and support myself?
17:29
How can I support myself?
And that’s so different than this oppression, It’s support.
Oh my gosh, preach so many good.
There’s so many follow up questions I have.
17:45
I think the first one is what for someone who’s coming to work with you, what are the 1st 123 questions that you ask them to kind of open the conversation and see where they’re at and maybe where they want to go with in their diabetes care to get to the root of kind of what you’re talking about supporting themselves?
18:09
Sure.
It’s a complex question that you asked, so I’m going to just kind of offer what I start with.
I’m very interested in what you’re doing that’s working.
So tell me what’s working and tell me what you want to keep doing.
That’s the very, very first thing People come in, I’m like, So what are you doing this work?
18:26
And they’re like, I’m not doing anything.
I’m like, that can’t be a true statement.
You’re here, so everybody’s doing something that’s working.
So let’s start there.
What are you doing that’s working?
What do you want to do that you want to keep doing?
And people are like, well, you know, I’m not doing this, I’m not doing that, and I’m not doing this and this isn’t working.
18:45
And I’m like, whoa, whoa, whoa.
It’s really not helpful to focus in on what doesn’t work.
It’s really helpful to focus in on what does work.
So can I, Jessica, lead you in a thought exercise?
Yes.
OK, you and I are going to walk this beach.
19:03
Now, this is a very magical beach.
This beach is said to have gold doubloons on it because a Spanish galleon was shipwrecked off the coast.
And you’re like, I’m in.
And I said, hey, Jessica, let’s go walk this beach and we will look for gold doubloons.
19:21
And you say perfect idea, Megrette.
I love it.
I I’m so excited.
I’m when I see gold doubloon, I’m going to pick it up and I’m going to put it in my basket.
And I’m like, Jessica, I am not going to take that approach.
You know what I’m going to do?
I’m going to pick up everything else but the gold doubloon.
19:36
That way I won’t miss any.
And you go, oh, OK, so we walk.
So at the end of the walk, what do you have in your basket?
Well I have a question, what are gold doubloons?
They’re the little like gold coins that Spanish.
19:55
Before you.
Oh, OK, OK.
Yeah, it’s like.
Good stuff.
So I would say at the end I would have all the gold doubloon in my basket.
And what do I have in mind?
Everything else.
I know.
I just have the trash.
Garbage sticks, rock, sand.
20:13
Yes, Yeah.
What do you want?
I want the gold doubloon.
Yay.
So right here, when we think about what works, when we focus in on what we’re doing that’s working, we’re picking up the gold doubloon.
20:30
When we train our mind to see all the things that aren’t working, that’s what we’re left with.
We’re left with things that don’t work.
Wow, yes, that is so.
I love that point, and it’s something that I actually brought up in therapy yesterday is just in general, like when it comes to all my relationships, my life, since I started focusing more on the things that are good, the things that are working because I have a tendency to focus on the negative, I feel like my whole world view has changed.
21:05
Like everything is amazing.
My friends are great, my husband’s great.
Because yeah, you could spend so much energy focusing on what doesn’t work.
And I think this also, I haven’t heard somebody connect this to Wellness or nutrition in that way.
So this is like, yeah, having an aha moment here too with myself.
21:24
And I’m sure a lot of the people listening where we tend to focus on, Oh my gosh, I could be doing more.
I should be doing this or I didn’t.
Like even today, I’m like, it didn’t work out.
But instead I could focus on all the other things that I’ve done or the fact that I’ve pretty much consistently been working out for the past like couple of years versus missing a day.
21:42
So that is very helpful.
I love that you shared that.
So once you identify what’s working, the next logical question is how can I make it easier to do that?
So what would make it easier for you to work with?
What would make it easier for you to have lunch?
21:59
What would make it easier for you?
Like how can we make it easier?
And I really want to talk about and we’ll kind of try to get into this idea of ease and easier.
So a lot of my clients want to say, well, how can we make this easier for you to do this?
22:19
How can we think about future you and make this easier?
And people are like, well, why would I do that?
I’m, I’m already doing it.
Why?
Why would I make it easier?
Yeah.
Why would you make it easier?
22:35
Well, I mean, I’m guessing that you might get burned out at some point.
You may have less motivation, especially if that, you know, motivation can wear off.
Life is going to happen and you’re going to travel.
22:51
Things are going to get in the way.
Those are the first ones that come to mind.
You’re tired.
You just don’t feel like it.
Financial struggles too sometimes, like a lot of stuff that’s recommended for people, even with even, Yeah, folks with diabetes, you know, they can be recommended a bunch of supplements or all these things or, you know, the specific food and it can add up.
23:14
So I’m just thinking, yeah, there could be a lot of things that come up.
Right.
And you are really pointing to the distinction between easier and ease.
When you think about future you, when you turn around, you go, hey, future me, how can I make it easier for you?
23:34
You are actually creating a life of ease.
Ease.
I’m relaxed, I’m good.
I’ve thought about future me.
I’m good.
Like I, I don’t have to stress because like I, I thought about future me and I’m and I’ve taken steps to make this behavior sustainable.
23:55
And I get a lot of the people who turn around and think that ease and easy are the same thing and they’re not.
Ease is I get to let go.
I’m on solid ground.
24:11
I don’t have to worry.
I’m going to save place.
My armor is down.
We need ease.
Ease is a basic human need.
I’m going to say that again.
I like to say it three times.
Ease is a basic human need.
24:28
It’s a basic human need.
We all need to reach for ease.
We all get to reach for ease.
Ease and easy are not the same thing.
But if you turn around, you go, oh, I’m doing something, it’s a good thing.
I want to make it easier.
You’re creating a life that has ease.
24:45
You’re moving towards ease.
You deserve that.
It’s a basic human need.
Diet culture does not support that.
Diet culture is like try harder ineta no pain, no gain.
Diet culture is saying if you have a life of ease, you’re lazy.
25:03
If you try to make things easy, you’re lazy because you got to hack it.
You got to you got to do all this stuff.
You got to create complex systems.
You got to, and, and it has to be expensive and it’s got to be particular and, and you know, we need to put in a spreadsheet or a pie chart or we got to measure it.
25:22
We got to quantify it in some way because it doesn’t count.
If you’re just like, no, this is easy.
I got it.
Like how do I know that it’s easy?
Like I the healthcare professional, I need to know that you’re doing it right.
Yeah.
25:38
Can you see the oppression?
Yeah.
Can you see how when we look at diabetes, we are fundamentally missing key aspects of inclusion?
We belong, and ease is a basic human need.
25:55
Fundamental.
I belong.
It’s hardwired in my DNA.
It doesn’t matter who I am, where I am, I belong, and I’m going to seek belonging.
Yeah.
And I deserve ease.
26:10
You deserve ease.
Every single person in this world deserves a place to take a deep breath and go to basic human need.
Wow, yeah, it’s reminding me.
I don’t remember who said this quote, but it’s moving slowly.
26:31
Is a form of resistance something a lot?
I may be betraying it.
No.
And I need to print that out because I think so much of us in our culture, it’s like hustle, hustle, hustle.
Like you’re saying the spreadsheets of this, no pain, no gain.
26:48
And people, they come in and that’s because our culture is very diet culture heavy.
And they come in and they, they want the meal plan.
They’re like, wait, you’re asking if I don’t want to talk about my relationship with food, just give me the answer.
And I think there is comfort initially in that too, right?
27:05
Where it’s like, OK, I’m stressed, I have this diagnosis, give me the answer.
All my problems are going to go away and we’re going to fix this and it’s going to be an overnight success.
And and then they just go on their way.
But it’s, yeah, it’s so much more complex than that.
27:22
And I love how, yeah, you just kind of break it all down to ease lifting people up, focusing on what is working.
And that big mindset shift, too, I think is a lot of it.
Yeah.
So let’s talk about weight and weight loss because I feel like there’s a lot of people listening where they have been told that losing weight is like their ultimate goal in managing diabetes, especially folks with type 2 diabetes.
27:55
It’s just like, oh, lose, lose this weight.
Why?
Well, in your opinion, and I’ve heard you speak here on here, like what is your opinion on this like message of weight loss?
How can it be problematic for folks?
28:12
And I know I’m asking so many questions, but like what is left out when we center weight loss as the main measure of success?
Yeah, it’s a good question.
First and foremost, weight loss is an outcome.
It’s not a behavior.
If it’s a behavior, you can do it in your seat.
28:29
So go do weight loss in your seat.
Go ahead.
Yeah, I’m sitting here.
Yeah, right.
It’s a behavior.
It’s not a behavior.
It’s an it’s an outcome.
You have to do something to lose weight.
You know, in theory there’s like behaviors you can do and then the outcome would be losing weight.
28:49
And this is, again, really talking about how our thought process works.
That’s a contractual relationship.
So I have my body and I’m telling my body I’ve done these things.
And because I’ve done these things, you are supposed to lose weight.
29:05
You’re supposed to be smaller.
It’s A1 sided contract.
I’m telling my body I did this.
You have to do that.
When we think about diabetes, we assume that weight loss is the thing that causes these beneficial outcomes.
29:25
And I’ve been involved for the last six years and some research looking at what actually causes the outcomes for people with pre diabetes.
And the research hopefully will be published in 2025.
But, you know, we looked at over 7000 studies and of the 7000 studies, about 100 of them ask what caused the benefit that actually physically, yeah, people lost weight.
29:54
But did that cause anything?
And there was no slam dunk.
There was no nothing in that research that said, oh, yes, it was weight loss.
In fact, weight loss caused harm for many populations.
So it doesn’t work for everybody.
30:09
And this is really important to understand who does weight loss help and was the help because of the weight or was the benefit because you changed your eating, you reduced your stress, you exercised, you went to the doctor, you whatever, whatever it is you did that allowed this outcome.
30:31
And one of the studies, so the Diabetes Prevention Project, it’s kind of this landmark study you talked about how you quoted it all.
You know, this landmark study, it had 74 contact points in a five year period of time.
Now I love my family.
30:46
I don’t even think I call my family 74 times in five years.
Like, like, Oh my gosh, they’re talking to these people every two weeks.
And I’m.
Thinking to myself that is something that is impacting your health if you feel connected.
31:04
Yeah.
So was it the weight loss?
Was it the medical care?
Was it really trying to eat better, exercise, reduce your stress?
You know, what was it that caused this benefit?
And when we look at the DPP, there was a population that did not lose any weight but saw A1 CS go down.
31:24
So it doesn’t work for everybody.
And if it doesn’t work for everybody, why?
What is it about these behaviors?
What’s causing the benefit?
Was it the diet?
Was it the exercise?
31:40
What was it that caused that outcome?
And we don’t know.
We don’t know what caused it because we’re not looking.
And why aren’t we looking?
Well, it’s because we it has to be weight loss, has to be weight loss that caused it.
So again, when we take a step back and we turn around and say, can I lose weight indefinitely, it’s one of my favorite questions.
32:03
Oh, I lost 5 lbs.
Can I lose 5 lbs for the rest of my life?
Can you can you lose weight indefinitely?
No, it’s a negative.
You can’t lose weight indefinitely.
I lose 5 lbs, my A1C goes down.
32:20
I go to the doctor again, doctor says lose 5 more pounds.
I lose 5 more pounds, my A1C goes down, lose 5 more pounds.
And so there’s this belief that I can, for the rest of my life, lose 5 lbs as a way to control my A1C.
Well, I got to be honest with you.
Yeah, that’s not going to work.
32:37
It’s not going to work.
And so this idea that weight loss cures diabetes, it we need to start pushing back on that.
And it’s not the goal of diabetes care.
So if I have pre diabetes, the goal of diabetes care is I want to stabilize my blood sugars.
32:55
I want to figure out what are the things that make my blood sugars go up?
What are the things that aren’t making my blood sugars go up that I want to keep doing?
And I really want to start kind of looking that and saying like, hey, is this the stuff that I don’t, I don’t mind changing?
Is this the stuff I do?
33:10
My, you know, I’m trying to figure it all out.
There’s a lot of back and forth on that.
And I’d like to call this the play.
We need to play around with changing our lifestyle.
We need to play around with things.
If we turn around and say, this is the way you do it, you can only do it this way.
33:29
You know, you have to do it at this time.
You’ve got to do it this intensity.
I have no autonomy here and it becomes a grind because I’m not doing what I want, I’m doing what I’ve been told to do.
33:47
Yeah, and also it doesn’t like you are the expert in your own life.
And yeah, it’s just so interesting too, because as a dietitian, now when I meet with doctors, I just have a totally different perspective because for me it’s all about centering the patient.
34:06
They’re the expert asking them what do they think?
What are, you know, what would work for you?
What are your ideas?
Because you might be going on a tangent.
And it’s like they don’t want to do that or they have no interest.
And so I find that with a lot of my providers who are still kind of in that top down mentality, I challenge them now all the time.
34:24
And I’m just like, yeah, I don’t want to do that.
And they’re probably like, oh gosh, this difficult patient.
But at the end of the day, I, I feel like they would have much better outcome, all of us as providers, if we just center the patient, their lived experience.
They have the best ideas.
34:40
Like I’m learning from them all the time myself, just things that I want to try because they, yeah, everybody has this great idea.
So I, I love that you, yeah, you just center people and try to help them figure out what’s best for them.
34:57
Yeah.
And you would ask kind of like, what’s my approach?
And kind of circling back to that, I write a newsletter called No Weight Loss Required.
And it it really is for people trying to prevent or manage diabetes from a weight inclusive lens.
And I recently published something called the Road Map.
35:15
It has four parts to it.
And the first one is just this idea about, you know, nutrition math, this idea that subtraction, like nutrition is all about taking foods away.
We have to flip the script.
Actually, nutrition is about adding.
How could I add to my diet so it’s balanced?
35:31
So that’s the first mental shift.
So somebody comes in and they’re like, oh, hey, Jessica, I got to change my diet.
They’re thinking I can’t eat XY and Z and we have to flip the script and say, what can I add to my diet to make it more balanced?
35:47
What can I add to my diet to give me more nutrients?
What can I add to my diet to help me help my body function better?
I’m supporting my body.
I’m not restricting my body.
Step one, let’s change the math about nutrition so that we need to make it an addition, no longer a subtraction.
36:06
Addition is positive.
Subtraction is negative.
Literally the sign means negative with literally the sign means positive.
So it’s not just mentally in your head like oh it feels negative to take things away from it feels like a loss.
It’s actually negative it.
36:24
Is.
So, so there’s that.
The second step we need to do is we really need to learn about diabetes.
So Step 2 is learning about diabetes.
Now you’re CDC.
Yes, you’ve done this for a long time.
It’s information you learn when you started in diabetes care the same as today.
36:45
No.
No, diabetes changes all the time.
Right now we are in a tsunami of change around diabetes.
We have technology, we have AI, we have all kinds of closed loop.
We have new medications, we have new understandings.
Like everything is changing.
37:02
And people like you and I, we’re running as fast as we can to keep up with the research, which, by the way, is not easy to do, keep up with the technology, not easy to do.
So as a consumer, if you turn around and say, well, I know about diabetes because my grandmother had it.
37:21
Yeah, it’s different today.
It’s very different today.
And it’s really important to turn around and say, like, you get to learn.
I get to learn.
You get to learn.
You’re not stupid because you don’t know you’re normal like that, that like, and, and turning around saying like, you know, Jessica, I want to learn about diabetes.
37:42
That’s a growth mindset.
That’s a growth mindset.
That is somebody who’s saying I get to learn and I want to learn and I want to be up to date.
That’s a growth mindset.
I feel like diabetes is what you should have known.
37:59
You should have known.
Why don’t you know that?
Everybody knows that.
Yeah.
That’s stigma.
No one’s born knowing.
No one is born knowing.
That is stigma that is really turning around and using our knowledge as a weapon.
38:18
And that’s out of bounds.
It’s out of bounds.
That’s not fair.
You know I.
Mean, even as a provider, I feel it’s easy to feel like you don’t know everything because like you’re saying, there’s so much.
It’s always changing, new medications, AI, you know, it’s a lot technology.
38:39
And I think we also have to create a space for providers, dietitians to be able to say, hey, I don’t know this.
Or hey, like I never knew what the difference between this wasn’t that or so yeah.
38:54
I think starting with giving yourself compassion will help you be able to give more compassion to other people as well.
And, and even, you know, we have a lot of patients where they’ve had diabetes for a really long time and maybe they have been doing things a certain way or have a certain understanding and even they sometimes are like, wow, I had, there’s so much that I learned or was able to learn.
39:18
I thought that I knew everything or that it, you know, whatever it is.
And yeah, it’s always cool to expand someone’s understanding.
Yeah, I call those G Wiz appointments.
G Wiz, I didn’t know we did that.
G Wiz I didn’t know that was available.
39:34
G Wiz, I didn’t know that I know G Wiz like, oh, isn’t that fun?
So the third step in the road map is this fundamental shift, which a lot of weight inclusive providers already know.
But I just to remind people that people are not broken, they’re hurt and people are not fixed, they’re healed.
39:55
And we have to make that shift.
So when somebody comes in and they’re like, you know, I’m broken, I’m like, no, things are broken.
People are not broken, they’re hurt.
And it’s not, I’m not here to fix you.
I’m here to support your healing.
And that’s a fundamental shift and it’s non judgmental and it is embracive and it is just all about I’m here to support you.
40:19
Let me know how I can do that.
Yeah.
Yeah.
What is the 4th I?
Knew you were going to ask about that.
So we have to look if we come from an oppressive system.
So wait, centered care is oppressive?
You can’t, you know, go back into an oppressive system.
40:38
If you leave an oppressive system and you say, oh, I’m good.
I learned everything.
I hung out with Jess.
We did.
We, you know, we just did a great job.
I’m just going to go back into that oppressive system.
Yeah, it’s not going to last.
So the last part is really turning around, saying how can I create a system in my life that’s not oppressive?
40:58
How can I move away from this?
I can’t, you know, turn around, support myself for a while and say, Oh yeah, but I’m just going to go back and tell myself what to do.
We have to deconstruct this oppressive paradigm, this weight centric, this, you know, you’re inadequate.
41:14
You don’t know, you don’t, you don’t fit in all of these negative oppressive things.
We have to deconstruct that and reconstruct A supportive system.
And sometimes that looks like boundaries.
Sometimes that supportive system looks like getting different providers, seeing a different kind of dietitian, getting more support, you know, talking to people and saying like, you know, when you talk about that, it’s not a topic I’m interested in.
41:43
So can we just like skip to that great show we all love, you know so.
Helpful.
I want to ask you one last question about mindful eating.
This is also one of your specialties and we can’t have you on without talking about this.
41:59
What is maybe 1 tip that you have that could help someone focus on mindful eating?
The connection with their body while eating being present and evoking more of a curiosity instead of judgement around food.
42:15
Yeah, Mindful Eating is checking in.
So it’s a reflection.
So I’m reflecting on my direct experience.
I’m not spending time worried about Bob.
Oh, I wonder what Bob thinks about my eating.
I wonder if if Bob is noticing that I eat, is Bob thinking that I shouldn’t be having that?
42:36
It’s not about Bob.
Oh, my provider will be mad.
Oh, you know, that has too many calories.
It’s not about calories.
It’s not about Bob.
It’s not about what other people think Mindful Eating is saying I’m not doing that.
I am learning about what I think, what I feel, what my direct experiences.
42:55
Mindful eating is turning around saying what’s the world inside?
And that’s mindfulness.
It’s awareness of the present moment without judgement.
And when I do that before eating, I’m doing mindful eating now.
The benefits of mindful eating, practicing mindfulness when eating, you know when you’re going to practice.
43:15
I know when I’m going to practice being mindful when I have breakfast, I’m going to practice being mindful when I have lunch, when I have a snack.
Like I know when I’m going to go do it.
Am I going to do it every time?
Maybe, maybe not.
I mean, that’s OK.
But if I turn around and say I want to become more aware of me, I want to become more curious about me.
43:32
I want to be more compassionate about me.
I want to understand what’s going on in my life, in my inner world.
Beautiful.
That’s a beautiful wish.
When are you going to do that?
I think it’s interesting the number one reason why people don’t change.
43:49
Can you guess the number one reason why people don’t change?
I know.
So good.
Yeah.
I know so.
This answer comes from Doctor BJ Fogg, the director of the Persuasion Lab at Stanford University.
Number one reason he has found in his research?
44:06
Why people don’t change as they forget?
Wow.
I know it’s nothing sinister.
It’s not.
You were lazy.
It wasn’t.
You didn’t try, isn’t it?
Wow.
You just forgot.
You just.
Forgot.
I forgot and I was like, oh that Lanza is very accurate.
44:26
Yeah.
Very accurate so when we think about the change process, we really have to know like when am I going to do this when am I actually going to eat a balanced diet?
When am I actually going to buy food to cook?
When am I actually going to plan my menu?
When am I actually going to go for a walk?
44:42
When am I actually going to check my blood sugar?
When am I actually going to do these things?
Because if I know when I’m less likely to forget, unless you’re me and then I and forget.
So I write endless amounts of lists and I put things on my computer and they still get it wrong.
44:58
But I try really hard not to forget because forgetting is the is the number one reason why people don’t do what they want to do.
And you know when you start turning around saying like mind fleeting, it’s mindfulness.
45:14
When I eat, because I paired those two things together, I’m more likely to remember if I pay attention to my eating experience, and it’s terrible.
What could I do?
What could I do if my eating experience was terrible?
45:33
Definitely taking note of it.
And what was terrible about it for you?
What?
Yeah.
What makes you think it was terrible?
Right.
If I got information and I was like, oh, this is terrible.
I could stop eating or oh, this, this eating experience is terrible because my back hurts.
I could stand up or I could change chairs or I could, I could modify.
45:50
My experience was at least neutral.
Maybe I could turn around and say, oh, I need more seasoning.
I put some pepper or salt on something and then and all of a sudden now it tastes better, you know, So we just start turning around and saying when we get information in, we can use that information to make choices that support our lives.
46:09
When we don’t get information, we can’t make that choice.
So when we’re eating mindfully, it’s not always pleasant.
The present moment isn’t always pleasant.
But when I get that, oh, this eating experience isn’t so great, I can turn around and say, oh, I’m bright and I’m able and I have choice and I have options.
46:28
So I can turn around and make changes to this eating experience.
So at least it’s neutral.
If an eating experience is neutral, it’s not bad.
It’s kind of meh, you know, like it’s it’s OK.
You might turn around and say like, could I add something to this meal that might give it a little sparkle?
And I call that food sparkle.
46:45
Can I give anything to this meal just to kind of give it that little judges.
So it’s like, oh, I love it.
Last night for dinner I had a side salad and I was so excited because my food sparkle with salad is croutons.
47:01
Yeah, I love it.
Croutons are the best.
They are the best.
What is your favorite thing to add to a salad?
Sauerkraut.
There you go.
That’s your food, sparkle.
Anything.
Salty olive sauerkraut.
Ready.
Pickled red onions.
47:20
I added those two.
All of a sudden this salad wasn’t I’m having salad, it was I’m having salad.
I got croutons and pickled red onions on it.
If I had peas, I’d be like in heaven.
Like I love peas on my salad.
47:36
You know, everybody has things that give it that judge.
Mindful eating allows us to reach 4 and have more enjoyable meals.
And you can add sparkle and you can take something you like and you can make it.
47:55
You can take something that’s meh and you can make it and if you’re having kind of a experience and it’s not so great, you can turn and say like, well, this would make it taste better.
This would make it a better experience, or I can’t make it a better experience than it is what it is and I’m not going to beat myself up about it.
48:15
We’ve all had those moments where we’re running late or like it’s just not going to be a greedy experience.
Yes, but just noting that and and also in the moment, if you want to, if you can, if it’s available to you, making a change because I think so.
48:31
Yeah.
We often are just like, well, it is what it is.
But it’s like actually I could just move.
I could add a sparkle.
I could, you know, have some water with this.
I don’t know what it like make it tea.
It makes it more exciting.
That’s really good advice and advice.
48:47
Everything I feel like I’ve heard on this podcast is like, you have such a great perspective.
I’m learning so much.
I’m going to ask our dietitians to also listen to this pod because, yeah, you know, we, our podcast definitely focuses on like weight inclusivity, intuitive eating, but I, I really appreciate your unique perspective within the space.
49:06
And I, I thank you so much for being on our pod.
And I’m, you know, want to have you share like for people who want to learn more from you, whether it’s I know you have a lot, you have books, you have your website, there’s a lot of resources on your website.
How can they connect with your work?
49:23
Sure.
So I did mention my newsletter, which is no weight loss required and it’s no weight loss required.substack.com.
You can get there.
You can Google no weight loss required and I’m pretty sure I’m pretty high on the Google rank.
I’m very excited.
49:38
You got to review the newest book.
So no weight loss required has an e-book.
And I say it’s AE book because it’s part of that.
If you become a paid subscriber, you get it.
But it’s like, you know, 78 pages and it’s really walking through all the resources around why a weight inclusive approach is essential.
49:58
Now that e-book I haven’t abridged.
If you’re a provider, head over to inclusivediabetescare.com and again, it’s inclusive diabetescare.com.
And if you click on that, you know, look for the little article that says research around weight inclusive care.
50:18
And there’s a 16 page e-book that I list hundreds of research articles that go through.
Why await?
Inclusive approach is essential and I am just so passionate about bringing a non judgmental approach to diabetes.
50:35
I’d love diabetes to be kind of the the model by which we start centering patients on.
And it’s so hard because it’s a knot.
It’s a big thing we all have to untangle.
50:51
And when we talk about stigma around diabetes, there’s seven kinds of stigma.
So stigma around gender, finance, knowledge, race, you know, sexual orientation.
We start getting into stigma about health ISM, you know, diabetes stigma, weight stigma.
51:12
There’s so many different stigmas, and they’re all intersectional.
I don’t think people really understand what intersectionality means, but intersectionality is really just understanding that it’s going to land differently for me because of my existing experience.
51:34
So my existing experience as a white woman is different than your, you know, experience as a black woman.
I grew up in, you know, a rural area that might be very different than growing up in an urban area.
51:53
So again, we’re starting to look and say like, oh, because of this experience, this is how these this is landing on me because of my past.
This is how it’s landing.
And it’s not right or wrong, but that curiosity that you talked about in the beginning and you know, I’ve gotten to listen to some of your other podcasts and you really do feature what is other people’s experience?
52:17
We’re we’re trying to get curious about that.
And I think that that’s really at the heart of intersectionality is let’s let’s be interested.
What is your experience?
I’m here to listen.
I love it.
Well, thank you so much.
52:33
That honesty was incredible.
I feel like I just went to church listening to this.
Truly.
I’m like, Oh my gosh, there’s so many gems in here as it relates to my work as an audition and also just with myself that I’m going to take away from this.
52:48
I appreciate it so, so, so much.
And yeah, thanks again for joining us.
Thank you.
Thanks for joining us for today’s episode.
If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.
53:08
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes plus share with someone who might find this helpful.
You can also connect with us on Instagram at diabetesdigital.co and TuneIn every Wednesday for practical, inclusive, and culturally humble Diabetes BD’s insights.
53:27
We’ll catch you later.
Bye.
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