Holistic health care is more than pounds and milligrams
by IDS Diabetologist & Weight Management Specialist, Dr Paula Diab
It’s time to move beyond the metrics and focus on what really matters—you.
The American Diabetes Association’s recently released 2025 Obesity Standards of Care mark a significant shift in the way we approach diabetes and weight management. This year’s guidelines are bolder and more progressive, explicitly calling for stigma-aware, holistic, and team-based care that centers not just the disease – but the person living with it.
This is a welcome evolution.
For decades, weight management in diabetes has been approached primarily through the lenses of restriction, discipline, and numerical outcomes—HbA1c, BMI, fasting glucose, and total pounds lost. While these metrics can be useful markers of change, they have never fully captured the complexity of human health. In fact, they’ve often reinforced shame, self-blame, and burnout.
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I often find myself paging through a patient’s notes trying to locate their last recorded weight! Not such a great place to be when you’re the clinician responsible for their weight management journey! But I think the reason is that there is so much more to weight management than the numbers and I don’t like to be beholden to the numbers. I love food too much to spend the rest of my life eating boiled chicken and broccoli (who does that anyway?) and my favourite place in the world is not the inside of a sweaty gym at 5am!
I met my match at Integrated Diabetes Services (IDS), when I found other clinicians who live real lives with diabetes. They experience highs and lows just like every other person. The only difference is they choose to learn from these experiences, develop new strategies and share real-life experiences with their clients.
Weight is not a simple math problem of energy in and energy out. Diabetes care isn’t just about lowering numbers—it’s about lifting people up. The new ADA guidelines align beautifully with IDS’ long-standing commitment to compassionate, individualized, and interdisciplinary care. We know that people succeed when they are seen, heard, supported, and treated as whole humans with real lives, layered histories, and evolving goals.
Let’s start with what the 2025 ADA Obesity guidelines actually say.
The new standards emphasize the importance of:
- Addressing weight bias and stigma in healthcare settings
- Using people-first language and avoiding judgmental terminology
- Recognizing the biological drivers of obesity
- Integrating mental health support into diabetes and weight management
- Forming multidisciplinary teams to offer more comprehensive care
This is more than a philosophical shift. It’s a practical one. Research shows that weight stigma leads to worse health outcomes, not better ones. When people feel judged or misunderstood by their providers, they’re less likely to follow through with care. They’re more likely to experience disordered eating, social isolation, depression, and even higher blood sugar levels due to chronic stress.
In contrast, people who receive empathic, team-based, and stigma-free support are more likely to engage in sustainable lifestyle changes, follow up on medication plans, and report feeling motivated rather than defeated. In other words: compassion isn’t just kind—it’s clinically effective.
What does all this have to do with diabetes?
Let’s start with the estimated 110 million American adults who are impacted by obesity. It is further estimated that up to 53% of new cases of type 2 diabetes are attributed to obesity every year, which indicates the need for comprehensive and evidence-based guidelines to address the problem.
Historically, those with type 1 diabetes were often excluded from the obesity problem, but the latest research has also highlighted a phenomenon referred to as “Double diabetes,” where someone with auto-immune modulated type 1 diabetes also shows features of insulin resistance, obesity and type 2 diabetes.
Bottom line is: weight management is something that EVERYONE needs to be aware of and pay attention to.
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Self-Care Isn’t Selfish—It’s Survival
One of the most underappreciated aspects of weight management in diabetes is the role of self-image and mental health.
Too often, people are told to “just lose weight” without any attention paid to the psychological toll of trying—and often, failing—to meet an ideal that may not even be realistic. For many, weight struggles have been lifelong and intertwined with trauma, cultural expectations, family dynamics, or self-worth. Others may be dealing with medication-induced weight gain, metabolic changes after menopause, or the deep emotional fatigue that can come with managing a chronic condition.
In these cases, focusing only on external appearance or physical metrics can backfire. What’s needed is an approach that also addresses:
- Body image distress and the shame cycle
- Emotional eating and disordered patterns
- Grief over changes in physical health or independence
- Anxiety or depression, which can derail motivation
- The desire to feel attractive, vibrant, and socially engaged
In truth, caring for one’s appearance and external self is not superficial. For many people, regaining confidence in their body—whether through improved mobility, clearer skin, a new outfit, or feeling strong and energized—can reignite a sense of agency. This, in turn, fuels motivation to take care of one’s internal health. It’s a positive feedback loop, not vanity.
Just recently, I was treated to a facial and a few hours with a new hairstylist. These are indulgences that I usually don’t have time for or choose to pay much attention to. But it is amazing how these minor and admittedly, very superficial changes, can make your smile broader, your head held higher and even make that new dress fit much better!
What Holistic Care Looks Like in Practice
Our team at IDS includes Certified Diabetes Care and Education Specialists (CDCESs), Registered Dietitians, Exercise Physiologists, Nurse Practitioners, Mental Health Professionals and even a Family Physician, all of whom have a lived experience of what it means to live with a chronic disease.
They bring a unique skill set that intersects with others to form a coordinated, person-centered care plan. This is not something that we need to be taught or read in the guidelines – it’s just how we live our own lives.
Rather than prescribing generic calorie targets, we can assist clients in identifying how food fits into their life—culturally, emotionally, socially, and logistically.
We discuss grocery access, family roles, financial constraints, and relationships with food. For someone who’s battled shame around eating, this level of support can be transformative.
Exercise doesn’t have to mean punishing gym sessions or unrealistic goals. It may be an early morning walk with the dog or a good stretch to start the day, dancing with grandkids, or strength training to preserve lean mass during weight loss.
GLP-1 receptor agonists (like semaglutide and tirzepatide) are increasingly used for weight loss and blood sugar control—but they come with side effects, financial implications, and emotional complexity. These effects should be discussed openly and the benefits and risks should be clearly understood.
This is a vital and often forgotten aspect of chronic disease management. Mental and metabolic health are deeply connected and paying attention to emotional self-regulation, mindfulness and stress management are key aspects of care.
Some clients lose weight quickly; others don’t. Some need time to focus on sleep and stress before touching food or exercise.
When clinicians understand the journey, they are able to adapt, collaborate, and cheer people on without demanding perfection. Our goal is to help people make peace with their bodies—even if they’re still a work in progress.
Looking Ahead
The ADA 2025 guidelines reflect a broader trend in medicine: one that centers equity, dignity, and whole-person care. It’s a model that we at IDS have long practiced and will continue to champion.
If you’ve struggled with weight management in the past—or felt dismissed, blamed, or overwhelmed—we want you to know: there’s a different way. One that sees you. One that supports you. One that works with you, not against you.
Because in the end, managing diabetes and weight isn’t just about losing pounds or lowering HbA1c. It’s about gaining confidence, restoring health, and reclaiming your life.
And you don’t have to do it alone.
If you’re living with diabetes and struggling with weight, know this: you’re not alone—and you’re not to blame.
With the right support, it’s entirely possible to improve your health without sacrificing your dignity, joy, or self-worth.
To learn more about personalized strategies for managing weight and diabetes—whether you’re using insulin, GLP-1 therapy, or just starting your journey—reach out to Dr Paula Diab (paula@integrateddiabetes.com) at IDS. Together, we’ll create a plan that supports not just your numbers, but your whole self. You may also want to have a look at some of our T1U videos that give some more background on weight management and some of the thinking behind how we manage it. Look forward to connecting with you soon.
Dr Paula Diab
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