Disordered Eating

Diabetes stigma and diet culture amplifies messaging which suggests diabetes requires mental vigilance, special food, and rigorous activity to add to the challenge. This means a disproportionately large number of people with diabetes are receiving messages implying diabetes is ‘their fault’ and unless they are perfect they have failed. The blame, shame, and stigma of diabetes is also part of the challenge because it touches the population who most likely are also already managing heart disease, stroke, kidney, urinary problems, and depression. Diabetes isn’t a single issue because it impacts those struggling financially, who have an existing mental illness, depression, chronic pain, or mobility issues. 


Depression is a risk factor for diabetes and diabetes is a factor for causing depression. The symbiotic relationship is complicated and can be seen as an opportunity for the medical community to consider how messaging is targeting a more privileged population. Reflect for a moment and consider the impact having ‘just a touch” or “borderline” diabetes descriptions could have on your patients. Offered as a way to ease fears and worry, the unintended consequences minimize a person’s experiences which feels invalidating and fail to express how diabetes is tied to other conditions, including heart disease, hypertension, and risk of depression which, by the way, is increased by a factor of two in patients with diabetes. Studies have documented the interdependence of depression/diabetes as contributing to poor patient engagement, adherence to medication and dietary regimens, glycemic control, reduced quality of life, and of course, increased health expenditures. The expense of depression and diabetes was calculated in a 2016 study with the overall mean medical expenditures for patients with diabetes and no depression was $10,016, unrecognized depression was $15,155, asymptomatic depression was $16,134, and symptomatic depression was $20,105. This study looked narrowly at depression and didn’t factor in how the Social Determinants of Health (SDoH) have a similar symbiotic relationship with diabetes.  

Disordered Coping

According to the National Institute of Drug Abuse, Substance abuse costs our Nation over $600 billion annually. The average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $24,000 per person. Every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to society also stem from fewer interpersonal conflicts; greater workplace productivity; and fewer drug-related accidents, including overdoses and deaths.

The Solution to Health Inequity is Inclusion

To address health inequity and reestablish medical trust, the Inclusive Diabetes Care Certificate pilot program was created. The goal of the program is to deepen the understanding and need for diversity, inclusion, and equity among diabetes care workers. This unique program provides small groups and interactive relationship-based learning, which creates the conditions to reestablish trust, community, and justice. 

The IDC Certificate Program uses a combination of self-paced education, a private community environment, and small group coaching over an 11-month period of time. The learning process is layered into five areas to help professionals deepen their understanding of inclusive diabetes care:

  1. Inclusive Diabetes Care is the first track. It forms the vision of the organization. Exploring the concept of inclusion helps shift a person’s identity to the felt sense of belonging to a diverse group standing in solidarity supporting all bodies impacted or at risk of diabetes.  
  2. The Health Equity in Diabetes Care track creates the goal for this program while helping to uncover the hidden barriers faced by individuals with or at risk of diabetes. Humanizing the need for ease begins to unlink the many rights people with diabetes and elevated blood sugar have been denied. Helping clients experience a felt sense of ease and sustainability is the next step in this five-track program. 
  3. Understanding Trauma begins a multi-layered process of expanding understanding while creating the felt sense of being seen and heard
  4. The Counseling track shifts diabetes care from knowledge to connection, helping professionals deepen their non-judgmental, inclusive communication skills. The complex task is practiced with multiple layers of support as participants engage in coaching and small group discussion over the 11-month program. Individuals in the IDC program learn how to humanize their knowledge-driven educational meetings to offer patient-centered therapeutic care. 
  5. The final track works to strengthen the prevention, identification, reduction, and treatment of disordered eating and coping. The intention of this track is to understand the interdependent role of the individual and the community. Completing this final track fosters the client and professional in identifying and engaging in a felt sense of kind/wholesome self-care.

Shifting the focus of diabetes care to inclusion is an essential solution to the challenges present for those at risk of or who have elevated blood sugar. The IDC Certificate program provides the needed training to help healthcare workers support all bodies.