In recognition of eating disorder awareness week, I am finally hitting send on a letter I’ve been stewing on for 1.5 years: feedback to the providers who treated me for gestational diabetes.
Here’s what I’ve come to realize: if I had not done so much work on accepting my body and eating intuitively, my gestational diabetes treatment would have activated old feelings of disordered eating.
I am grateful I was able to receive care, but I wish there hadn’t been such intense focus on my weight and on food counting. Diabetes treatment does not have to be that way.
Plus, if this is the treatment I received as a small, white woman, I can only imagine what patients who are fat or POC or trans are experiencing.
I can only imagine what it must be like for the pregnant mama who was already struggling with disordered eating to be told some of the things I was told.
That’s why I know it’s important for me to send this letter. You can read the letter below, but here’s your diet culture content warning.
I am very lucky that my friend Ariana Thompson-Lastad also supported me during my time with gestational diabetes. Ariana is a health researcher, a former health educator with gestational diabetes experience, and a body positive friend of mine. Ariana helped bring me back to my values. She showed me that it was still possible to listen to my body, even with gestational diabetes. She helped me take the focus off my weight and back to interoception.
So I’m doing it. I’m hitting send on the feedback (see below).
What you can do to help:
If you know anyone diagnosed with gestational diabetes, please share the letter with them so we can remind them that they deserve better
Please also share the letter with any medical providers, especially ones who work in prenatal care
Eating disorders do not exist in a vacuum. They are part of our culture that constantly tells us that we should all look the same, that we should all be small, that our bodies should never change– we just have to try hard enough. It’s not true. We are meant to look different. We are meant to change. We all deserve better: a culture (and a medical system) that values and cares for our bodies just as they are.
Thanks for building that world with me.
Image of me feeling pregnant and free (summer 2022)
Dear Sweet Success,
My name is Talia, I worked with a Sweet Success dietitian in summer 2022 after receiving a gestational diabetes diagnosis during my pregnancy. In recognition of Eating Disorder Awareness Week, I’d like to share my experience in hopes that it will improve the program and prevent future eating disorders.
Some background on me: I’m a first-time mama with a storied past when it comes to eating and body image. I used to try to limit my food in order to control my weight. For a while I teetered on the edge of an eating disorder, but eventually realized that I would soon fall off that edge if I didn’t change something. So I made a choice.
I learned about intuitive eating, weight stigma, and Health At Every Size®. I spent a decade reteaching myself how to enjoy food and my body. Eventually I got certified as an intuitive eating coach and now work professionally with other people on the journey towards a peaceful relationship with food.
The gestational diabetes diagnosis was hard to receive, but I was especially upset when my Sweet Success dietitian handed me a list of “Yes” foods and “No” foods– food rules, the very thing I’d worked so hard to unlearn in my recovery. I tried to maintain hope that Sweet Success would be sensitive to people with disordered eating and other food issues.
After all, at least 8% of women in the U.S have diagnosed eating disorders and more than 50% of women have kids, so surely many pregnant women have experienced eating disorders past or present. A program designed to support pregnant women around eating would have to be aware of that….right?
Alas, no.
Here are some of the ways Sweet Success failed to be sensitive around disordered eating:
Extreme emphasis on weight: in every session the first question was “how much do you weigh?” Every time I would remind my dietitian that I don’t weigh myself because doing so leads to obsessive weight thoughts. She never stopped asking.
Focus on low-fat eating: A low-fat diet, once popular in the 90s, is no longer the focus of current nutrition recommendations. I was advised to eat low-fat or non-fat foods, with no discussion of how fat can be beneficial (e.g. the benefits of Omega-3s in pregnancy). I once told my dietitian I was really hungry and wanted almonds. “Almonds can be okay,” she said, “But limit yourself to just 6.”
Encouraged to lose weight immediately postpartum: In my final call I was advised to return to my pre-pregnancy weight within 3 months in order to help prevent diabetes in the future. This is shocking and appalling advice to give a new mother. New mothers should focus on eating enough food, getting sleep, and caring for their newborns. They should not focus on their weight. I accidentally did lose all the weight (and then some) after giving birth due to breastfeeding combined with new levels of stress (which caused me to eat less). This was not good for my mental health, and I shudder to think of other new moms taking this advice too far.
Thankfully I reached out to Ariana Thompson-Lastad, a health researcher, former health educator with gestational diabetes experience, and body positive friend of mine. Ariana reminded me of a few important things:
I needed to eat fat: eating fat helps keep blood sugar stable, would help my baby grow, and would eventually give me what I needed to nurse my baby.
There were other options besides obsessively counting carbs: I could also pay attention to how my body felt after eating different foods, and use the glucose meter to check how specific kinds of carbohydrates affected my blood sugar.
High blood sugar is not just about food: sleep, stress and movement play a huge role.
After talking with Ariana I stopped counting my almonds, ate more fat, and started trusting my body and the glucose meter. As a result, the following occurred:
I started to feel sated again.
I felt more comfort and less stress in my pregnancy.
My blood sugar lowered.
If I had not spoken with Ariana and if I did not have an extensive background in intuitive eating and weight-neutral coaching, I am sure I would have spiraled into disordered eating.
I am sharing this information 17 months postpartum in the hopes that Sweet Success can become a more supportive program to the 10% of people diagnosed with gestational diabetes each year. New moms get enough negative attention on their bodies as it is.
Suggestions for sweet improvement:
Get updated on eating disorders:
This program seems to believe it exists in a vacuum in which eating disorders are not real. They are and they have the second highest psychiatric mortality rate.
Please provide training to all Sweet Success dietitians on the prevalence and seriousness of eating disorders. Require practitioners to screen for disordered eating.
Remind dietitians that eating disorders are often triggered by the psychological need for control, something that can be elevated during pregnancy.
Learn about Health At Every Size® and weight-neutral nutrition guidance
Provide training on weight-stigma. Remind practitioners that people of all sizes get diabetes and people of all sizes can have a healthy delivery.
Do not require weight checks– instead learn about Health At Every Size®.
Immediately end the practice of encouraging clients to lose their pregnancy weight within 3 months– this is an extremely harmful practice that has a high chance of causing eating disorders. Instead share other research on diabetes, such as the role breastfeeding can play in prevention.
End the practice of encouraging clients to “gain weight slowly” in their pregnancy. Pregnancy weight gain is highly variable and not something in our control. Instead encourage clients to pay attention to what actually is in their control; eating and moving in ways that feel good and keep blood sugar levels stable.
Update the printed materials to include:
How to be flexible with food and how to safely experiment with what you can eat.
The importance of not restricting calories during pregnancy.
The benefits of eating fat.
Specific things I wish I’d been told by Sweet Success to decrease my stress levels:
It’s not your fault that you got gestational diabetes, it’s a common symptom of pregnancy just like morning sickness.
It’s safe to experiment with food– the glucose meter is a great tool to let you know how it’s going, and we’re not worried about a few high blood sugar numbers.
Continue to pay attention to how different foods make you feel. It is possible to learn what high and low blood sugar feels like for you, and this is a great life skill.
We are tracking your weight because we’re trying to get a sense of how big the baby is (for the sake of a smooth delivery), but we know your weight isn’t a real measure of your baby’s weight. You can decline to share your weight.
Please feel free to reach out to me with questions or for further reflection. I look forward to future mamas with gestational diabetes receiving the weight-neutral care they deserve.
Thank you,
Talia
Resources:
Academic review article on perinatal weight stigma: Weight Stigma across the Preconception, Pregnancy, and Postpartum Periods: A Narrative Review and Conceptual Model by Briony Hill and Angela C. Incollingo Rodriguez
Christy Harrison podcast episode on diabetes and intuitive eating
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