Weight stigma and diabetes stigma in U.S. adults with type 2 diabetes: Associations with diabetes self-care behaviors and perceptions of health care. (October 2020)

• Record Type: Journal Article
• Authors: Puhl, Rebecca M.; Himmelstein, Mary S.; Hateley-Browne, Jessica L.; Speight, Jane
• Is Part Of: Diabetes research and clinical practice. Volume 168(2020)
• Publication Date: 2020-10
• Subjects: Stigma -- Prejudice -- Obesity -- Diabetes care -- Quality of care; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2020.108387
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Adults who internalize weight stigma have higher diabetes-specific distress. Self-stigma for diabetes is associated with higher diabetes-specific distress. Self-stigma for diabetes relates to less diabetes self-management and lower self-efficacy. Diabetes-specific distress is higher among those judged about their weight by a doctor. Both diabetes self-stigma and weight stigma relate to poorer provider-patient interactions. Abstract: Aims: Diabetes stigma and weight stigma have been identified as important but neglected issues that warrant attention among people with type 2 diabetes. This study assessed associations of diabetes stigma and weight stigma with diabetes self-care behaviors and health care in adults with type 2 diabetes. Methods: U.S. adults with type 2 diabetes (N = 1, 227) completed self-report questionnaires to assess their experiences of weight stigma, diabetes stigma, diabetes self-management, diabetes-specific distress, healthcare utilization, perceptions of diabetes-specific health care. They also provided sociodemographic information. Linear regressions examined relationships among stigma and diabetes self-care and related health care, controlling for participants' age, education, income, gender, race/ethnicity, and body mass index. Results: Internalized weight stigma and diabetes self-stigma were both significantly associated with higher diabetes-specific distress. Adults who expressed self-stigma for their diabetes reported less diabetes self-management and lower self-efficacy, and those who reported being judged about their weight by a doctor exhibited greater diabetes-specific distress. While a history of experienced weight stigma (in general) did not reduce frequency of seeking health care, lower quality interactions with health care professionals were reported by adults who expressed diabetes self-stigma and those who experienced weight stigma from a doctor. Conclusions: Self-stigma for diabetes and body weight, as well as experiencing judgment about weight from doctors, may have negative implications for diabetes-specific self-care behaviors and perceived quality of health care. Efforts to promote wellbeing in individuals with type 2 diabetes need to consider reducing both diabetes and weight stigma and their potentially harmful consequences.