‘The diet and weight loss advice for type 2 diabetes is nothing but anti-fat bias’
Writing instructor Sarah Graves talks about going from fasting to finding a non-diet approach to support her body while navigating type 2 diabetes.
One of the toughest parts of rejecting diet culture is challenging the widespread belief that being fat means being unhealthy. This idea has been reinforced by clever marketing from the medical and pharmaceutical industries. It's no longer just about appearance; now, we're encouraged to diet for health rather than vanity. (Those of us who are dieting but don’t “need” to lose weight are pursuing “vanity weight loss.”)
However, if you have a medical condition and happen to be overweight, you often face blame for your health issues and increased pressure to shed weight. This is despite mounting evidence, including work by, , and others, showing that weight loss isn't necessary, sustainable for most of us, or a guaranteed cure for many of the illnesses its prescribed for.
So, I was very excited when writing instructorreached out after reading ’s story here, where she discussed her complicated relationship with dieting, food choices, and chronic illness. Now 46, Sarah was born into a larger body and a family with a history of type 2 diabetes. A lifelong dieter, she was put on Weight Watchers in first grade. At age 30, she was diagnosed with type 2 diabetes, and for 15 years, she bought into the lie that weight loss would fix her diabetes, or at least make it manageable.
“Type 2 diabetes often gets conflated with overweight and obesity, even though people of all body sizes get it,” Sarah wrote to me in our initial correspondence. “Thus, it becomes really hard to separate diet culture from eating in a way that supports my body. But thanks to writers like Regan Chastain and Virginia Sole-Smith, I was awakened to the lies of diet culture. And I've been on a journey ever since to figure out how to support my body as I deal with a chronic illness without falling into the traps of diet culture. (No easy feat!)”
Sarah E. Graves, Ph.D. is an English instructor and the coordinator of the Writing Center at Ohio Wesleyan University. She’s also a writer covering parenting, education, creativity and the arts, and health and wellness. Her words have appeared all over the web in publications like USA Today, Tiny Beans, and Healthline. She’s a frequent contributor to Healthline’s community-focused offshoot, BezzyT2D, where she shares lessons learned from her many years with type 2 diabetes. She also writes the Substack Sketch Pad, where she shares her insights for creatives of all ages, especially young creators, from her perspective as a writer, educator, and mom to a super creative kid.
Here is Sarah’s story of quitting diets. You can read more first-person accounts in my series Dared to Ditch. I would love to share your story, too. Please reach out in comments or email me at firstname.lastname@example.org.
Kristi: Why did you initially decide to stop dieting?
Sarah: I was born “fat.” So, I’ve been dieting and exercising most of my life. You name the diet; I’ve probably tried it — low calorie, low fat, low carb, whole foods, or no foods. I’ve done it all. And none of it helped change my body type, despite the decades of semistarvation.
Then, I was diagnosed with type 2 diabetes. Ironically, I was diagnosed while doing the things you’re supposed to do to prevent it — dieting and exercising.
Of course, the first “prescription” for anyone diagnosed with type 2 diabetes is weight loss, even for those at “normal” body weights. So, I believed more dieting was exactly what I needed to do, despite a lifetime of evidence proving that probably wouldn’t work out for me. And, naturally, it didn’t. My diabetes progressed anyway.
Then, my mom died of congestive heart failure, a complication of her type 2 diabetes, at the relatively young age of 66. I was scared about my own mortality, especially since I’m an “old” mom. I was 38 with a newborn son.
At this point, I was still thoroughly buying into the gaslighting — the idea that I was failing diets, not that diets were failing me.
So I tried keto, which promised to be a “cure” for type 2 diabetes. I did that for two years. And when that didn’t work, I added intermittent, alternate-day, and 4- to 5-day fasts. Again, my diabetes progressed anyway, even though I’ve managed, to this day, to maintain a 50-pound weight loss, which, for me, is way over the “magical” 10% weight loss recommended for type 2 diabetics.
In the search for answers, I dove into the research. I discovered there’s absolutely no credible evidence to support a causal factor between weight and type 2 diabetes (after all, people of all sizes get type 2 diabetes). Additionally, there’s zero evidence that weight loss helps. In fact, even though the American Diabetes Association (ADA) continues to recommend it, they’ve admitted that the research doesn’t show weight loss is helpful.
So, once I knew with absolute certainty that the diet and weight loss advice for type 2 diabetes is nothing but anti-fat bias and, worse, that the constant dieting was harming me more than it was helping me, I finally ditched diets for good.
Kristi: How did, and does, having Type 2 diabetes change your relationship with food and your body?
Sarah: It’s made me much kinder and more compassionate towards myself. I’ve had type 2 diabetes for sixteen years, and the more experience I’ve gained with the disease, the more it’s sunk in that, just like with my big body, type 2 diabetes isn’t my fault.
My experience with dieting directly showed me this. For example, when keto didn’t work for me, I went more extreme and tried different kinds of fasting, which is also touted as a cure for type 2 diabetes. But when I fasted, my blood sugars shot through the roof, even though I was eating nothing.
Most people think type 2 diabetes is just about insulin resistance, so — in a complete misunderstanding of insulin resistance — they label it a “lifestyle” disease. This leads to a lot of stigma, including the idea that we give ourselves diabetes and, therefore, we can cure it with lifestyle changes.
However, although many type 2 diabetics can manage their condition with exercise and food choices, no one gives themselves diabetes. It’s a complex disease involving many factors, including (but not limited to) insulin resistance, insufficient insulin production, and impaired glucose signaling. And all of these factors are genetic, including even insulin resistance.
My doctor and I believe impaired glucose signaling is the reason fasting doesn’t work for me. My body perceives it’s starving (because it is!), so my liver releases glucose into my bloodstream. Someone without diabetes produces sufficient insulin to move all that glucose into their cells. But I don’t make enough insulin to compensate, so my blood sugar soars even though I haven’t eaten.
Likewise, I discovered that my blood sugars are lower when I eat more carbs than are allowed on keto. This could also be because of perceived starvation, or it could be because of cortisol. Research shows that dieting, including ketogenic diets, increases cortisol, and cortisol signals the release of glucose.
Another thing I discovered about type 2 diabetes is that blood sugar can spike for reasons completely unrelated to food. For example, poor sleep, stress, and extreme exercise can all cause spikes. So can the early morning rise in cortisol, which signals the body to release glucose on waking. Other hormones can also impact blood sugar; my diabetes progressed in menopause thanks to lower estrogen.
I used to feel like I’d “failed” whenever I had high blood sugar. But things like hormone fluctuations are utterly uncontrollable. Realizing this helped me break free of buying into the stigma that diabetes was my fault.
Kristi: What has been the biggest benefit of not dieting?
Sarah: My mental sanity. In the past, I could get a little crazy trying to eat all the “right” things. And I’d blame myself, not the diet, when it didn’t work. But when I finally realized there is no magical diet cure for type 2 diabetes, I regained my sanity and a more balanced approach to food.
I still eat significantly less carbs than the average American diet. But I eat yummy food and don’t miss those carbs, so there’s no sense of restriction. I also don’t track anything, including carbs, since tracking can also mess with my head. I just generally know how my body reacts to certain foods.
And if I want to indulge occasionally, I go ahead and indulge since it’s chronic high blood sugar, not the occasional high blood sugar, that leads to complications. And I’ve found that this approach lets me eat in a way that supports my body without the deprivation of dieting.
Kristi: Do you have any advice or encouragement to share for those who haven’t yet broken free of diets?
Sarah: It’s so important to practice self-compassion. If you have type 2 diabetes and have high blood sugar, it’s not your fault. You haven’t failed; you have a disease. Moreover, type 2 diabetes is a complex disease, and we often don’t have as much control over blood sugar spikes as we’re led to believe since blood sugar can rise for all sorts of reasons unrelated to food choices. So it’s far more valuable to listen to your body than adhere to a specific diet.
Share Your Story of Ditching Diets
If you’ve found freedom from dieting, we’d love to share your story so that it may inspire someone else…or simply make them feel less alone. Comment below or reach out email@example.com.