Type 2 Diabetes and Pre-Diabetes: Why We Need an Anti-Diet, Weight-Neutral Approach

I saw something on social media recently that said, “diabetes is the punishment for being fat”.

What a horrible, cruel statement.

The comments were disgusting too, with so many people agreeing with the sentiment and making harmful assumptions about body size, diet and exercise.

Of course, this isn't the first time I've seen type 2 diabetes thrown around as an insult or an assumption. There are always commenters waiting to pounce on any remotely plus-size person and say they're “giving themselves” diabetes.
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I write and talk about weight stigma a lot generally, but type 2 diabetes warrants its own blog because it's one of the areas where I see some of the worst weight bias, judgement and outright cruelty.

What is type 2 diabetes?

This blog is focusing on type 2 diabetes (and pre-diabetes), rather than type 1 diabetes, which is a different condition where the body doesn't produce insulin.

Type 2 diabetes develops when the body doesn't make enough insulin or doesn't use insulin effectively, which makes it more difficult to regulate blood glucose. There are different factors involved in someone's risk of developing type 2 diabetes, including genetics, family history, age, activity levels, plus social and environmental factors.

No matter what the keyboard warriors say, you can't “eat your way into diabetes”. Eating certain foods doesn't automatically cause type 2 diabetes, and people of all body sizes can develop it. Weight stigma, yo-yo dieting and weight cycling (losing and regaining weight in a cycle, which commonly happens) contribute to an increased risk of T2 diabetes (HAES, 2026). 
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​Type 2 diabetes, blame and shame

Sadly, our societal narratives around type 2 diabetes are shrouded in shame and blame. There's often an assumption that being in a larger body automatically means you eat too much, don't exercise, and so it’s “your fault” you develop type 2 diabetes. This leads to people feeling entitled to offer their opinions about how people should just “do a calorie deficit” or “eat less and move more”.

​These are not helpful suggestions and are based on assumptions and privilege. Medical weight stigma can reinforce blame too. If weight loss is presented as the solution to type 2 diabetes (or pre-diabetes, which is the “warning” range before it), this can reinforce the idea that it’s the individual’s fault.

Many people have grown up with the narrative that eating too much or eating too many sweets equals diabetes. This means the blame and shame can become internalised and normalised, as if it is fact. We need to challenge these ideas about health and body size because they can have a huge impact on people's relationships with themselves, with food and movement, and on their general mental health.
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​Type 2 diabetes isn't just about individual choice

Type 2 diabetes is associated with what are often called “lifestyle factors”, but there can be huge assumptions about how easy those factors are to change. For instance, people with access to gyms, green spaces, affordable nutritious food and plenty of time to prepare meals can easily forget that these things are privileges.

​Not everyone has the same access to health; social and economic inequalities impact hugely. We certainly don’t “all have the same 24 hours in a day.”

Genetics plays an important role in body size and in the risk of developing type 2 diabetes. We don't have complete control over our bodies; our weight will do what it’s going to do because it’s a side effect. But weight stigma means weight loss is all too often a recommendation given by medical professionals to people in larger bodies with health conditions. This risks yo-yo dieting, weight cycling and disordered eating, and often leaves people feeling like a failure and ashamed.

​“Burden on the NHS”

There's a particularly harmful narrative that people in larger bodies, especially those with type 2 diabetes, are somehow a burden on the NHS. This fuels so much weight stigma, blame and shame. The NHS is under huge pressure for many reasons (largely political and systemic) but blaming fat people for this is neither fair nor useful.

“Obesity” strategies often only end up fuelling weight stigma too and promoting disordered eating. The term “obesity” is from the BMI chart (which was made in the 1830’s and is not fit for purpose now) and is seen by many as a medically stigmatised and pathologised term. Many people have started to reclaim the word “fat” instead, or say “larger bodies,” etc. I always use whatever term is comfortable for someone, but when writing I avoid “obesity” for this reason. It’s important to note that “obesity” is not a disease, nor a behaviour, and it is certainly not an eating disorder.

Talking about fatness in derogatory and harmful ways doesn’t help anyone. It just exacerbates our societal fears of fatness, encourages disordered eating and fuels anti-fat bias.
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​Using type 2 diabetes as a fear tactic

I've noticed a commonly used strategy in the media and in health messaging is to try to make people lose weight by using type 2 diabetes as a fear tactic. This is incredibly disrespectful and hurtful to people who actually have type 2 diabetes, or pre-diabetes (which in itself could be seen as a fear-tactic label). Fear and shame can also have a detrimental impact on mental health, and are rarely helpful in encouraging people to look after themselves.

Yo-yo dieting and disordered eating are prevalent in our society, so weight loss recommendations and pressure to “reverse” their type 2 diabetes or pre-diabetes can be particularly triggering. Research has found that disordered eating behaviours may be present in up to 40% of people with type 2 diabetes (García-Mayor, et al, 2017) 
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​An anti-diet, weight-neutral approach to type 2 diabetes

As a counsellor working with people with type 2 diabetes and pre-diabetes, there’s a sense that an anti-diet approach clashes with recommended medical advice (dieting and weight loss attempts). One of the biggest misconceptions about anti-diet approaches is that they mean “glorifying obesity” or simply “letting yourself go”. For me, it's actually the opposite. It's about choosing to prioritise your own needs over what society demands of you. It means recognising the harms of diet culture, weight stigma and the thin ideal.

If people are told they need to lose weight and need to change their lifestyle, this can sound a lot like diet culture, food rules and disordered eating thoughts. Having lived with many years of diet culture myself, and having done a hell of a lot of work on unlearning that, these types of narratives do feel like diet culture repackaged. This is exactly why we need an anti-diet, weight-neutral approach to diabetes care.

Focusing heavily on weight loss, calorie counting or restrictive eating can distract from other aspects of diabetes management, i.e. blood sugar management, joyful movement (if possible). Weight is just a side effect. It may change, it may not – it’s not a helpful focus.

I also want to be clear that I'm anti-diet culture, not anti-individuals who diet. I understand the power of weight stigma and diet culture. I've experienced it myself. Dieting, disordered eating and compensatory exercise were ways I punished myself. They weren't about looking after my body. Unlearning diet culture and appearance pressures was a crucial part of my own development. It helped me work towards accepting and respecting my body, and led me to this work where I can support others.

So instead of seeing type 2 diabetes and an anti-diet approach as conflicting or incompatible, I see them as going perfectly hand in hand.

“Weight loss as the primary strategy for diabetes management is often unsuccessful long-term. Interventions can lead to poor mental health and quality of life for individuals due to weight cycling” (Waseem et al, 2026) 

For someone with a history of disordered eating, it can also risk reinforcing behaviours that have caused them harm in the past. I personally feel that telling someone they “can't” eat something, or that they have to completely cut out particular foods or food groups, can sometimes make the allure of those foods even more powerful. For me, that once would've triggered thoughts of binge eating or a last supper mentality, i.e. “eat it all before it’s gone forever”. That feeling of deprivation isn't helpful. It can make us think about food more, increase the sense that certain foods are forbidden and potentially contribute to binge and restrict cycles. 
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​Looking at the whole person

For most people with chronic health conditions, they just want to feel a little bit better. I find that many people with type 2 diabetes are also dealing with other health conditions, fatigue, stress or mental health difficulties.

This is where taking a broader view of health, rather than weight, is helpful:

• Sleep
• Stress levels
• Movement and exercise, where possible
• Adding in nutritious foods
• Community and social connection
• Mental health
• Rest
• Enjoyment
• Quality of life

 
This is why, as a weight-neutral counsellor, I take a whole person approach. I never tell people what to eat or what not to eat as that’s not within my remit, but I do help people explore and understand their relationship with their bodies, eating and exercise, and to build on self-worth.
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​How counselling can help people who are type 2 diabetic and pre-diabetic

How can somebody with T2 diabetes or pre-diabetes be expected to look after and respect their bodies if they’re feeling the weight of judgment, blame and shame? Our societal narratives need to change. We need to reduce weight stigma.

For individuals wanting to feel better, taking the focus off weight (which is a side effect if you need another reminder!) can help reframe health as an act of self-care and self-respect. Nobody with type 2 diabetes or pre-diabetes deserves to feel blamed, shamed or punished. It’s not your fault. You deserve support from people who won’t just tell you to lose weight.

Counselling can help unpack the messages you've received about weight, food, health and your body, and to explore how these messages have affected the way you see yourself. It can also help you develop self-worth and self-compassion that aren't dependent on your weight. This can be particularly important if you've got a history of dieting, body image difficulties or disordered eating.

An anti-diet, weight-neutral approach is about finding ways to connect and care for yourself with respect, without punishment. Many of us, including myself, have experienced struggles with body image and eating, and when you develop a chronic illness this can just feel like another way that your body is working against you. But it’s a partnership, and we need to find ways to be kind to our bodies. I know that can feel alien and very challenging for some! That’s where counselling can help.

I offer a free 15-minute introductory call on Zoom. To book, contact me here.

To read more of my blogs on disordered eating, body image, weight loss injections and more, click here. 

Further Info & Resources

Regan Chastain’s blog on weight-neutral blood sugar management: https://weightandhealthcare.substack.com/p/weight-neutral-non-restrictive-blood

Regan Chastain webinars: https://danceswithfat.org/monthly-online-workshops/#Weight-Neutral-Blood-Sugar-Management

HAES T2 Diabetes Helpsheet: https://haeshealthsheets.com/type-2-diabetes/

​Pre-diabetes critics: https://www.theguardian.com/society/2019/mar/07/pre-diabetes-makes-patients-out-of-healthy-people-say-critics