Diabetes, gatherings, food and uninvited opinions on what to eat 20 December 2021 Catching-up with friends and families over food (and drink) for many people, makes for a great Christmas and New Year. However, for others, including people living with diabetes, celebrating and socialising around food can mean uninvited comments and stress. Comments about food “you shouldn’t be eating that..”, or about diabetes and weight, can be upsetting and spoil these times and memories year after year. So what can we do as health workers, practitioners, other professionals, and as friends or family ourselves, to support and help people living with diabetes navigate these difficult interactions and conversations with family, friends, strangers which are often fuelled by diabetes and or weight stigma? Stigma is real (not imagined) and complex, and can be either externally and or internally driven. External stigmas may come from ‘well meaning’ family, friends and or health workers/ professionals or the society and culture at large. Where internal stigmas, are the beliefs people hold about themselves through sociocultural and familial factors. Much uninvited opinion and comment on food choices, eating and activity habits and body shape, to people living with diabetes is driven by stigma. So what is disease (diabetes) or weight stigma? It’s a moral judgement that a person has brought either the disease or a ‘particular body weight or shape’ upon themselves. Stigma is a negative belief, and it is dangerous. Evidence suggests diabetes and weight stigma make disease and body shape concerns respectively worse. Puhl et al (2020) report high percentages of American adults with type 2 diabetes are experiencing both diabetes (40-60%) and weight (53%) stigma, and many are blaming themselves. Such stigmas are resulting in higher rates of diabetes distress, poor diabetes self-management, less healthcare interactions, more disordered eating behaviours, and less physical activity. Supporting people living with diabetes question, understand and work through internal and external sources of diabetes and weight stigma can go a long way in helping people to self-manage confidently and enjoy social gatherings around food again. Here are three key areas we can help support people living with diabetes in, to reduce the burden and effects of internal and external diabetes and weight stigma: Create a non-judgemental stigma-free space where people living with diabetes can talk about their diabetes, and social and cultural concerns around connecting with other people including family and friends. Empower clients, their supportive family and friends to understand diabetes clearly and simply, in respectful layman terms rather than in medical jargon. Ensure the basics of diabetes, management including complication screening, perhaps using helpful visual tools such as Feltman® Feltmum ® visual tools, are tailored to the person’s and their family’s needs. And work together with other health professionals and trusted family and friends to dispel concerns and or incorrect knowledge and or beliefs around diabetes. Remember language matters, the words family, friends, and or health workers, practitioners and other professionals use, can repel or attract a person to engage with you and or their self-management. With a clear knowledge of diabetes, confidence in the ability to self-manage based in self-compassion, supportive and positive non-stigmatising friends, family and health team, a person living with diabetes is in a much better place to deal with uninvited comments at social gatherings around diabetes, food and or body shape; they can be politely respond or ignored with confidence. Supporting people living with diabetes to come up with helpful ‘one liners’ for uninvited comments at social gathering, can also be helpful and give confidence e.g. “Could you please not comment of my food choices, or .. my body shape or ..my diabetes management, I’m comfortable with myself and my diabetes management at the moment”. Support diabetes self-management knowledge and confidence through promoting meaningful blood glucose monitoring. This can also give people living with diabetes great confidence when socialising around food and a greater ability to ignore or respond to uninvited comments. As you know so many things can affect blood glucose levels. Increases can be caused by the carbohydrate-rich food (e.g. rice, potato, milk, fruit, lollies and soft-drink) quantity, exercise intensity, stress, heat, medications, age, and the progression of the diabetes itself. Helping people living with diabetes to be aware of all the possible causes of blood glucose level ups and down can help in reducing the ‘blame and shame’ when it comes to self-management. Diatribe highlights 42 factors that can affect blood glucose levels, highlighting just how complex managing blood glucose levels to within a ‘ideal’ range to prevent diabetes complications is, and that there’s really no room for blame and shame, only curiosity and trouble-shooting as best as anyone can with their positive support team (friends, family, peers living with diabetes and healthcare team). Positive non-judgemental family, social and heath care supports, and peers with diabetes ‘lived experience’, are critical in helping to build diabetes self-management knowledge and confidence. When people living with diabetes feel that their family, friends and healthcare team have their back this naturally fosters more self-compassion and confidence. From a position of self-compassion and confidence, any ignorant and or ill-informed comments at social gatherings around diabetes, food or body shape etc are much easier to ignore or politely educate the ‘person in question’ on. Peer support is a really important tool in any diabetes self-management tool-kit. However, finding other supportive people isn’t always easy due to location, time constraints, shame and stigma. This is particularly true for people living in smaller towns and or close-knit communities. If you have a client, family members or friend interested in connecting with others living with type 2 diabetes in a safe online space, Diabetes NSW & ACT have started a closed Facebook group called ‘T2 Yarning Group’, so please feel free to share this link with them. As you may already know here at Diabetes NSW & ACT our NDSS helpline 1800 637 700 is manned by diabetes health professionals (Monday – Friday (9am-5pm) and Saturday until 12pm) including a psychologist – please reach out if your client, their friend or family members or yourself need our help or support.