Dr Gillian Riley

its national diabetes week! A week when your local health professional comes into their social media to talk to you very seriously about diabetes. So here I am, like a good stereotype.

jokes aside though, diabetes is pretty common – affecting about 2 million Australians. Also it can have some pretty gnarly outcomes if we don’t manage to diagnose it and control it well. Too much sugar damages everything from your eyes, to your heart, to your circulation, to your kidneys.

there are several different types of diabetics – this is a good summary here.

it can be a challenging illness to manage for patients and I think, to my mind, what has always distressed me is the stigma.

By which I mean there’s very much a narrative of a “good” diabetes, and a “bad” diabetes.

this is not too suggest in anyway that type 1 diabetics have it easy. I’m just always interested in the idea that because type 2 diabetes has a later onset, and is initially treated with what is termed “lifestyle control”, that it is very much perceived that it’s a patients fault if they get sick. Even though we know that type 2 diabetes also has a strong genetic component. (If your parents have it for example, you probably will too). That it’s much more likely in certain population groups (Aboriginal and Torres Strait Islanders, Pasifika and South Asians have much higher rates) and it will usually get worse as you get older no matter how “good” you are.

I just don’t think illness picks us because we deserve it and if “lifestyle” changes were simple and straightforward we’d all be swimwear models. That’s all.

I’m often asked how I manage diabetes when I work from a HAES framework. (Not by patients because most are pretty relieved when I take the pressure off. Generally by other health care workers). That’s fair. Because the prevailing doctrine in diabetes management has always been weight loss.

To be fair, that’s not unreasonable either because it will work.

My problem is the science is increasingly telling us, it will probably not work long term. And it may have a great deal of psychological effects on a person, particularly on a person in a larger body who, chances are, already has a difficult relationship with food and their body.

to be very clear, if you come to me and you are diabetic (or even if you’re not) and you want to change your body size or shape, I am not going to stop you. It’s your body. You have agency. I am going to take you through the science, screen you for an eating disorder and make sure it’s an informed choice and support you while you do it. Because that’s my job.

but equally I am also not going to dictate that you have to. Just because the guidelines say we must.

I advocate for slow and steady changes. Taking into account your personal history with food, and your personal readiness. Sometimes I involve a dietitian ( and we have some great non-diet dietitians in Canberra). Sometimes I involve a psychologist! The concept of eating intuitively may be involved. I can’t promise you that your body shape won’t change, because body shapes change. I can tell you that I won’t ever expect intentional weight loss to be a part of our management plan, unless that’s your own personal choice.

will I absolutely talk to you endlessly about moving your body as much as possible in a way you find joyful. Hell yes. Will you also hear about resistance training. A lot. Yes. Will I apologise for this. Not. At. All. Will I tell you to do a body fat composition Dexa or weigh yourself? Nup. Not unless it’s something that helps you.

we’ll focus on the numbers that matter, like your diabetes markers, but again in a way that’s tailored individually around you and your health and what works personally for you.

if you think this might be the approach you’ve been seeking for your care – I’d love to work with you. Click on the link in bio to book with me and we can have a chat about how I can help.