Diabetes Prevention Week rolls around each year, a time when public health campaigns often focus on individual risk factors, frequently highlighting weight as a primary concern. But what if this very focus is hindering, rather than helping, meaningful engagement with health? What if a weight-inclusive approach could foster a more positive and ultimately more effective path to poor health prevention and potentially lower the incidence of type 2 diabetes?

For too long, discussions around diabetes prevention have been steeped in weight talk. The relentless emphasis on body size is leading to feelings of shame, guilt, and disengagement, particularly for those in larger bodies who are already disproportionately affected by weight bias in healthcare. This constant barrage of messaging is creating a climate where individuals avoid seeking support or making positive changes, fearing judgement rather than finding encouragement - the harmful impacts of trying to ‘solve obesity' is significant.

Let’s examine the concept of 'pre-diabetes'

This label, often assigned based on slightly elevated blood glucose levels, can create unnecessary anxiety and contribute to the pathologising of individuals who may never develop type 2 diabetes.

Dr Asher Larmie wrote in his blog about the problematic ‘pre’ - “The Diabetes Prevention Program Outcomes Study which started in 2002 and is still going, took 3000 pre-diabetics and randomly assigned them to a lifestyle intervention, metformin or control group.  6 years later 5.3%, 6.4% and 7.8% of them respectively had gone on to develop diabetes. There is still no evidence as to whether these interventions altered cardiovascular outcomes.”

The data surrounding 'pre-diabetes' vastly overestimates the likelihood of progression to T2 diabetes and can lead to unnecessary medical interventions and increased weight stigma. A weight-neutral approach focuses on supporting individuals with slightly elevated blood glucose without the fear-mongering associated with the 'pre-diabetes' label.

People Do Not Engage

And to demonstrate the ultra-low engagement rates with (weight focused) Diabetes Structured Education, we only have to look at data from the National Diabetes Audit April - September 2024:

• 281,485 people newly diagnosed as T2 or ‘other’

• 84.9% offered Structured Education within 12 months

• 10.1% attend Structured Education within 12 months 

VCSE Nutriri firmly believes such low uptake is influenced by individual histories of weight surveillance, ‘failed’ weight change attempts and having health markers largely ignored. And let’s not forget those in lower body weights who are going un-diagnosed because T2D is regarded mostly as a 'weight related health condition'.

Doing Prevention Better

So let’s imagine a Diabetes Prevention Week that shifts the focus from body weight to health-promoting behaviours accessible to everyone, regardless of size. Instead of focusing on weight change, campaigns could celebrate and encourage:

• Nourishing movement: Equitable access to physical activity for all abilities and body sizes, rather than framing exercise as a tool for ‘weight management’. Think campaigns promoting accessible activities like walking, dancing, or gardening, focusing on how these activities improve mental health, energy levels and overall well-being.

• Balanced and varied eating: Encouraging a focus on access and enjoying a wide range of foods, listening to hunger and fullness cues, and prioritising nutrient-dense options without restrictive dieting. This approach moves away from demonising food groups and promotes a sustainable and positive relationship with food.

• Stress management and sleep: Highlighting the crucial role of mental well-being and adequate rest in overall health and blood sugar regulation. Campaigns could offer practical tips for managing stress and improving sleep habits.

• Building supportive communities: Fostering environments where inclusivity is the norm and individuals feel supported in making positive changes, irrespective of their body size. This could involve community cooking classes, group exercise sessions that welcome all abilities, and peer support networks.

This weight-inclusive approach acknowledges that health is multifaceted and not determined by a number on a scale. It recognises that people in larger bodies can already be healthy and that focusing on weight change can be detrimental to both our physical and mental well-being. By shifting the narrative, we can create a more welcoming and empowering environment for everyone to engage in behaviours that support their health.

A truly effective Diabetes Prevention Week #Type2DiabetesPreventionWeek can be about equity building-health-promoting behaviours, regardless of our body size. Let's make this year's focus on health for all, in every body. And if we have to measure anything let’s #MeasureHealthNotWeight