The Weight Inclusive Approach to Gestational Diabetes
Gestational diabetes is elevated blood sugar that happens only in pregnancy - but even for those short few months, it can cause a lot of distress. I’ve busted a few myths about gestational diabetes before, but in this post, I wanted to give you a more in-depth look at a my approach to nutrition therapy for gestational diabetes.
During graduate school, I had the opportunity to work with pregnant women of all walks of life in the public health setting and in my clinical hours. What I saw during this time was a whole lot of stress around weight gain. Expecting mothers receive fear-inducing messages from healthcare providers about gaining too much weight in pregnancy, and also feel pressure from society to not gain “too much” weight for aesthetic reasons. I noticed that this focus on preventing “excessive” weight gain increased disordered eating symptoms in a lot of the patients I saw. Tack on a diagnosis of gestational diabetes that comes with a lot of pressure to further control eating, and you’ve got the perfect storm for the development of disordered eating.
Being a feminist and coming from a Health at Every Size® standpoint, this concerned me a lot. It seemed we’d lost sight of the mother in our quest to create perfectly healthy babies. I knew I wanted to provide effective nutrition care for pregnant women, but I didn’t want to put my patients on a restrictive diet or micromanage their weight. I thought:
There must be a better way to approach nutrition for gestational diabetes.
I decided to write my master’s paper on the ethics of balancing maternal and fetal metabolic health with maternal mental health. That’s kind of a mouthful, but essentially, my research questions was,
How do we actually promote holistic health - body and mind - for mothers and newborns in an evidence-based way when gestational diabetes is thrown into the mix?
I really wanted to dig into the research on different approaches for managing diabetes in pregnancy. Turns out, not only are there a wide variety of eating patterns that can improve blood sugar in pregnancy, which allows for very individualized care, there’s also evidence to suggest a weight inclusive approach to gestational diabetes management could be highly beneficial in achieving a balance between mental and physical health.
The term “weight inclusive” means that instead of focusing on weight as an indicator of health, providers can promote sustainable, healthy behaviors for all people in all sized bodies. It also means that in the nutrition counseling process, there’s a whole lot of work done to help people in larger bodies feel more at home in their bodies - it might even mean advocacy with other providers to demand equitable care. This aligns with the principles of HAES® - by removing the stigma and shame that comes along with a focus on weight, people can focus on true self-care that feels right for them.
What are the benefits of the weight inclusive approach to managing gestational diabetes?
After doing this research, I immediately began implementing it in my private practice and have been blown away by the results. Women diagnosed with gestational diabetes experience a lot of shame and stress - taking the burden of weight control off their shoulders allows them so much more room to breathe. They are able to zoom out and look at the bigger picture, preparing themselves mentally and physically for all the challenges that come along with motherhood. My clients are able to get to a place where nutrition is a small piece of the puzzle that supports their overall life goals in the long term.
However, the importance of this approach goes beyond “just stress.” The risk for postpartum depression is high among women with gestational diabetes. Disordered eating is also a very real concern - approximately 22% of women with a past eating disorder have a relapse during pregnancy, and women with active bulimia nervosa during pregnancy are more likely to have gestational diabetes and postpartum depression. Those are some serious mental health risks. Using the weight inclusive approach means that I can provide nutrition care that prevents eating disorders, promotes healing from disordered eating, and removes stressors instead of adding them.
This is not easy work.
No one is pretending that promoting a weight inclusive approach in a world with rampant fatphobia is simple, ESPECIALLY in gestational diabetes management. That’s why I really wanted to share resources I use in my private practice with other dietitians.
One of the most basic needs that I had when starting out was handouts for clients. There was nothing out there that I felt worked with the weight inclusive approach, was up-to-date, evidence-based, and actually looked good when printed. I took the time to create a Gestational Diabetes Client Handout that takes weight out of the equation and provides clear, simple information to jump-start your work in blood sugar management during pregnancy.
Another resource that I felt my clients really needed was a grocery guide - I didn’t see one out there that highlighted foods to purchase during pregnancy and also promoted intuitive eating. The Intuitive Pregnancy Grocery Guide helps clients navigate the grocery store and stock up their kitchen with the foods they need to have a healthy relationship with food and manage their blood sugar in pregnancy.
If you’re a dietitian reading this and thinking, “YES love it. But how do I actually get started?”, check out my free guide The Weight Inclusive Approach to Gestational Diabetes Management. It’s got 12 steps to structure a successful initial session, including how and when to use the handout linked above.
Maybe you’re reading this and thinking, “handouts are great but…”
“I’m so overwhelmed and have so much unlearning to do…”
“I feel really stuck with my client who just got a GD diagnosis help!”
Not only is there SO much we didn’t learn about in school when it comes to diabetes in pregnancy, but there’s even more that didn’t get covered when we’re considering supporting someone’s relationship with food, especially if they are in recovery from an eating disorder. Even though you might feel lost, it might also be the best choice for you to keep this client instead of referring out, as your therapeutic relationship with them is valuable. I’d love to help you grow as a clinician! I offer supervision and case consultation for dietitians - click the link below to read more and apply to work with me.
“I have gestational diabetes… this sounds great!”
If you are looking for support in managing your gestational diabetes, click below to learn more about two ways to work with me:
Eating intuitively, caring for your body no matter it’s size and managing your blood sugar in pregnancy all at the same time IS possible!