Why the Stigma? Medication Use for Diabetes and Obesity Management
By Matthew Garza
Taking your diabetes medication, especially in public, can create shame and embarrassment. Let’s rethink this dynamic that surrounds the use of drugs that actually help people with diabetes flourish and live healthy lives.
I don’t personally have diabetes or obesity but both of these conditions run in my family, as well as a number of others. One of these is hypertension or high blood pressure.
I’m 25 years old and very mindful about integrating healthful nutrition and exercise into my routine, so I always figured that I didn’t have anything to worry about – at least not right now.
That’s probably why it was so shocking when a nurse told me my blood pressure was 159/98 at last year’s checkup. For reference, blood pressure should be closer to 120/80.
For a few months, I made minor adjustments to my eating and exercise habits. I tried cutting down on salt and ramped up my cardio workouts. However, my blood pressure was still high so my physician prescribed medication.
Even though the medicine brought my numbers down, I couldn’t help but feel ashamed. What was I doing so wrong that I had to use a pill to achieve normal blood pressure? Why did this happen to me?
The self-blame mentality is common, especially with conditions that are associated with lifestyle choices like diabetes, obesity, or in my case, high blood pressure. In particular, the drugs that help people manage diabetes and obesity can carry a lot of stigma.
Whether it’s feeling like a failure when your physician recommends starting insulin or being told that you’re “cheating” by trying to manage your weight using a GLP-1 receptor agonist like Ozempic, these medications can come with a lot of judgment and shame. But why is that the case? What can we do to reframe the way we think about the medications we take?
How diabetes and weight stigma impact our perception of medication
Both diabetes and obesity are conditions that come with a lot of stigma. There is an inaccurate opinion that both are caused solely by unhealthy lifestyle behaviors and a lack of personal responsibility. Another misconception is that any resulting health complications are your fault. In fact, almost 80% of adults with diabetes report experiencing stigma.
However, the reality is that diabetes and obesity are complex conditions caused by a combination of risk factors including genetics, biology, ethnicity, family history, environment, and individual behavior.
“Diabetes and obesity are metabolic conditions that often have a constellation of causes,” said Julie Valdes, a pharmacist and certified diabetes care and education specialist (CDCES) for a community health center in Florida. Many of the people she works with have diabetes, hypertension, or obesity.
“To imply that dietary discipline or fitness alone is all that’s required [to manage them] is very ignorant,” she said. Often the best way to manage conditions like diabetes and obesity is through a combination of lifestyle changes, medications, and technology, as well as a strong support network of loved ones, peers, and healthcare professionals.
Even though medications are an essential piece of the puzzle, many people feel shame for needing them. And for some reason, many people feel comfortable judging others for taking prescription drugs. When someone experiences stigma like this, it can have harmful impacts on their mental, emotional, and physical health.
“I think the biggest one is that insulin is considered a punishment. [People] are frequently like, ‘I’ve failed because you’re now saying I have to go on insulin,’” said Melanie Duran, who has had type 2 diabetes for over 25 years and currently works as a family nurse practitioner and CDCES in New Mexico.
Insulin carries other forms of judgment as well. “For instance, there are many [people with diabetes] using insulin that have embarrassment or shame concerning their need to carry around syringes,” said Valdes. “Without any context, the presence of syringes in a person’s pocket or in their bag can be correlated with recreational drug use.”
Duran shared a similar story about the judgment she’s faced using injectable medications to manage her diabetes.
“It's interesting that in stigma research you see when [the stigmatized condition] is visible, the stigma increases,” she said. “Whether it's wearing a sensor or having to give yourself injections in public (I can remember giving myself insulin at the table and having people look at me funny) it’s like you're doing drugs in a seedy back alley or something.”
It’s not just insulin, though. There’s also stigma associated with using non-injectables. Valdes explained that many people are quick to make assumptions about others simply for carrying around prescription bottles. And it seems that regardless of how a medication is delivered there is a tendency to pass judgment when people assume a condition can or should be managed with lifestyle changes alone.
This becomes a major issue when judgment from oneself or others contributes negatively to the experience of living with a chronic health condition. Research on both diabetes stigma and obesity stigma shows that these experiences can cause people to:
- Experience increased depressive and anxiety symptoms, diabetes distress, and lower self-esteem.
- Conceal their diabetes and how they manage it. For example, some may choose not to check their glucose levels or give themselves insulin and other medications in public, which can endanger glucose levels.
- Disengage from the healthcare system. For example, people may avoid doctor’s appointments or avoid getting screened for diabetes and related complications.
These are just some of the ways that stigma can impact people’s lives and their health. And it makes sense – if you felt like you were constantly being judged for lacking self-control, “cheating,” or being lazy because of the conditions you have and the medications you use, why would you want to give people an opportunity to pass those judgments?
“To discriminate against some diseases versus others, or decide who is worthy of medication help and who isn’t, is not in alignment with the principles of healthcare,” said Valdes.
How we should reframe the way we think about diabetes and weight management medications
So how can we start to rethink drugs to remove some of the stigma around using them? The first thing that’s important to recognize is that medications are just a tool, said Valdes. They aren’t always a silver bullet, but they can dramatically help you manage complex conditions and prevent progression or further complications.
And while you may not be able to control what other people say or think, especially when it comes to your health, you should never feel blamed, stigmatized, or judged by your medical team. This is especially true when using or asking about different medicines and their effects.
“If you don’t like the [medications] you have, ask about alternatives,” said Valdes. “Find a healthcare provider who is willing to work with you and meet you where you are.”
Healthcare professionals have a responsibility to reduce misconceptions about medications and be honest and open about the realities of using drugs to manage diabetes and obesity. This includes how drugs are delivered, how often you have to take them, and their side effects.
“I think we all have to remember that not everybody's goal in life is weight loss,” said Duran. “So when [healthcare professionals] walk in the room and say, ‘Hey, I've got this medication that's gonna help your diabetes and you're gonna lose weight’ that may not be what somebody is concerned about.”
Especially when it comes to the more popular medications used to treat diabetes (like Ozempic), if all of the emphasis is placed on weight loss benefits it sets someone up for unrealistic expectations and can make them feel as though they might have failed, said Duran.
Instead, as much as possible, medical professionals should tailor conversations about treatments to each individual’s health goals. When people feel like they have a more collaborative relationship with their healthcare team it helps people “buy-in” to their treatment plan.
So don’t be afraid to ask lots of questions about what medication is best based on your health goals and lifestyle. There are many different options when it comes to diabetes and obesity treatments. Working together with your healthcare team can help you frame these medications as just one more thing that helps you manage your condition – and not something that your physician is forcing you to take because they said so.
“Medications are just tools. No one with diabetes or obesity should feel stigmatized, judged, or ashamed of needing tools to help them manage an extremely complex, and often unpredictable, condition,” said Valdes.
Being open about how we manage our health helps us not feel so alone
Stigma can make people feel isolated – like they’re the only ones who failed to achieve good health. It’s how I felt about my own high blood pressure diagnosis.
But Duran made the point that when people are open about living with diabetes or obesity and the medications and technology they use to manage these conditions, it can help to reduce stigma and push back against inaccurate narratives about these conditions.
It’s been a few months since I started taking a small pink pill to help me manage my blood pressure. And each day I’m finding ways to reframe this act. Not as evidence that I failed to take care of myself, but as just one more thing that I can do each day to help live a long, happy, and fulfilling life.
And maybe being open about how I manage my own condition with medication it can help someone with diabetes feel confident enough to give themselves that insulin shot right there at the restaurant table without fear of judgment
