Recommendations for reducing diabetes and weight stigma in healthcare
By Dr Elizabeth Holmes-Truscott
Stigma is when people are judged or treated unfairly because of something about them that others see and label as different. Those judgments can also be internalised as negative beliefs about oneself. Our review found that around four in five people with diabetes experience stigma due to diabetes.
Diabetes stigma can occur anywhere. It is a concern that this includes healthcare settings. Some people with diabetes report being blamed and judged by their health professionals. Stigmatising comments from health professionals may be unintentional. They may even be well-intended. Yet experiences of stigma in healthcare are harmful to health. They can stop people with diabetes from getting the support they need. They can lead to worse health over time.
Health professionals have a key role in reducing diabetes stigma. This is the focus of two recent articles that I have led. These articles give an overview of the evidence on diabetes stigma in health care. Practical strategies to reduce diabetes stigma are also offered.
What can health professionals do to reduce stigma in healthcare settings?
- First, commit to stigma-free healthcare practice.
Health professionals are invited to take the Pledge to bring an end to diabetes stigma and discrimination.
- Practice self-reflection
Many biases are hidden, even to ourselves. But self-awareness exercises can help us recognise and address them. Ask yourself: what comes to mind when you think about diabetes? Or the causes of diabetes? Or how it is managed? How might these beliefs affect the way you to talk about people with diabetes? How might they affect how you talk to someone with diabetes? Or how you respond to what they tell you about living with diabetes? How might your beliefs affect the support or treatment options you discuss with people with diabetes?
- Offer support, not blame.
Empathic healthcare involves asking open questions, and actively listening, before responding. By putting aside assumptions and judgements, health professionals can create space and time to better understand the needs and priorities of the person with diabetes. Empathic care is associated with higher quality healthcare and better health outcomes. Importantly, empathic care is a learnt skill which anyone can develop, with some training.
- Adopt stigma-free communications.
Words matter. Diabetes Australia’s Language Position Statement provides helpful tips on talking with and about people with diabetes: communicating that we CARE, and avoiding BIAS. This guidance can also be for written work, such as referral letters.
We need to also think about imagery. As they say, a picture paints a thousand words. Showing positive images of people with diabetes can be a powerful tool in countering harmful stereotypes. Take the time to consider the words and images that appear in your communications, materials, and in your healthcare setting.
- Acknowledge and discuss stigma.
People with diabetes may talk about their condition in ways that express shame and self-blame. These are common responses to diagnosis, changes in treatment, and out or target glucose outcomes. But they are not always aware of their own bias – or how harmful it can be to their own well-being. So, this is a real opportunity for health professionals to show support, to dispel common myths and misconceptions, provide reassurance, and counsel those impacted by stigma.
- Challenge diabetes stigma.
Health professionals will likely witness colleagues make stigmatising comments about diabetes. This is also an opportunity. You can challenge these comments respectfully. You can champion stigma-free diabetes care. Consider how you might respond in these instances.
A call for training
Reducing stigma in healthcare is essential to achieving better health outcomes for all people with diabetes. Yet, there is limited guidance and training for health professionals on how to do this. Recently, The Obesity Collective developed a brief e-module on reducing weight stigma in care. The e-module, now available, was developed with input from healthcare workers, policymakers, researchers, and people with lived experience of obesity. A co-design workshop was held to inform the e-module, with key insights described in another article I worked on with Dr Briony Hill and colleagues. Recommendations include the need to develop training and guidelines to support implementation of strategies like those above. This approach may serve as a useful model for creating stigma-free diabetes care. We call for further research and investment to support training for diabetes health professionals in stigma-free practice. Importantly, we acknowledge that health professionals need and want support from professional bodies, policies, and systems-level change.
To read more about stigma in diabetes, check out our related blogs.
To read more, check out the full papers here:
- Holmes-Truscott E, Read M, Speight J. The vital role of health professionals in bringing an end to diabetes stigma. The Australian Diabetes Educator. 2024 Jun; 27(2)
- Holmes-Truscott E, Levett-Jones T. Empathy over Judgement: a call to address diabetes in diabetes care. Diabetes Management Journal. 2024 August
- Hill B, De la Piedad Garcia X, Rathbone JA, Malik Z, Holmes-Truscott E, Lawrence BJ, Kite J, Cooper K, Broady TR, Dixon JB. Supporting healthcare professionals to reduce weight stigma. Australian Journal of General Practice. 2024 Sep;53(9):682-5.