Rowan's Story

Beyond Numbers and Scales: The Type 2 Diabetes Journey

Meet Rowan

Rowan always stood out in their indie bookstore, carefully arranging window displays that made passersby stop and smile. At 38, they had built a life around sharing stories that mattered – though their own story was becoming increasingly difficult to tell. Between organizing local author events and running the store’s popular book club, Rowan was juggling something else: a diagnosis that had shaped the last eight years of their life.

The latest chapter wasn’t going well. Despite being on three different medications – Metformin, Januvia, and Forxiga – Rowan’s type 2 diabetes was becoming harder to manage. The newest medication, Ozempic, had left them so nauseated they could barely make it through their beloved morning poetry readings. Now their specialist nurse was suggesting insulin, and those words felt like the final sentence in a story of failure.

Rowan Is Fed Up Of Doctors

Behind the counter of their bookstore, Rowan had mastered the art of recommending the perfect book for every customer’s mood. But in sterile medical offices, they found themselves shrinking under fluorescent lights and judgment-heavy stares. Each appointment followed the same script: a disappointed look at the numbers, pointed questions about their diet, and thinly veiled suggestions about their weight.

No one seemed interested in hearing about how COVID had left them struggling to climb the stairs to their apartment, or how running the store single-handedly after their colleague’s departure had meant meals squeezed in between inventory counts and emergency staff coverage. Rowan was doing everything they could to stay on top of their blood sugar, but the harder they tried, the worse their numbers got.

Rowan Loses Faith In The Medical System

The story of Rowan’s relationship with their body had begun long before their diabetes diagnosis. Growing up, they watched their parents wage constant battles against their own bodies through fad diets and punishing exercise routines. Family dinners were served with a side of calorie counts and warnings about diabetes – a specter that loomed over every birthday cake and holiday meal. When the diagnosis finally came at 30, it felt less like a medical condition and more like a self-fulfilled prophecy, a punishment for every “bad” food choice and skipped gym session.

In their darkest moments, usually after another clinical appointment where they felt more like a collection of disappointing numbers than a person, Rowan would retreat to the philosophy section of their store. They’d run their fingers along the spines of books about healing and self-acceptance, wondering if there was a different way to write this chapter of their life.

Rowan Can't Sleep

Now, on the eve of their appointment with yet another new doctor, Rowan lay awake in bed, their mind racing faster than than they could keep up with. Their favourite book lay on the nightstand, offering no escape tonight. Instead of drifting off, they kept replaying their nurse’s words: “Insulin is the next step.”

The thought of explaining to their part-time staff why they’d need regular breaks for injections made their stomach clench. Their parents’ voices echoed in their head – “If only you’d taken better care of yourself” – mixing with memories of every doctor who’d shaken their head at the scale.

Reaching for their phone, Rowan found themselves scrolling through diabetes forums, reading story after story of weight gain on insulin. The blue light illuminated their bedroom as they imagined having to buy new clothes, again, wondering if their favorite chair behind the register would still feel comfortable.

They thought about their regular customers – would they notice? Would they whisper about how Rowan had “let themselves go”? Around 3 AM, they finally drifted into restless sleep, dreams filled with endless medical corridors and disapproving faces.

A different kind of care

What weight inclusive treatment looks like

A Better Way

The waiting room of Dr. Moon’s practice felt different from the moment Rowan stepped inside. Instead of the usual warnings about diabetes featuring headless Fat bodies with a measuring tape around their abdomen plastered on the walls, there were simple posters about community health initiatives and patient rights. The chair they chose – sturdy, wide, and comfortable – didn’t creak ominously under their weight.

Dr. Moon began not with their chart, but with a simple question: “Tell me about yourself, Rowan.” When Rowan instinctively launched into their HbA1c history, Dr. Moon gently redirected: “No, tell me about you – the person who runs the bookstore I’ve heard mention more than once by the staff here. We’ll get to the numbers later.”

For the first time in eight years of medical appointments, Rowan found themselves talking about the poetry readings they hosted, their recent bout with COVID, and the stress of being the only sernio manager at the moment. Dr. Moon listened intently, occasionally noting things down, but maintaining eye contact that felt caring rather than scrutinizing.

When they finally did discuss diabetes management, Dr. Moon’s approach was refreshingly different. “Diabetes is primarily genetic,” they explained, spreading out a family tree diagram. “Notice how it runs in families? Your body’s insulin resistance can change over time for many reasons – stress, illness, medications, life changes. The fact that your blood sugars have increased recently isn’t a personal failure; it’s your body telling us it needs something different.”

For the first time, Rowan heard insulin described not as a last resort for the undisciplined, but as a useful tool. Dr. Moon walked them through how it worked, using clear diagrams and everyday language. They discussed potential side effects – including weight changes – openly and without judgment.

“Some of my patients gain weight on insulin,” Dr. Moon said matter-of-factly, “because it’s a normal side effect of the medication working as it should. Our focus will be on helping you feel better, sleep better, and have more energy for your bookstore and the things you love.”

The appointment concluded not with a stern lecture, but with collaborative planning. Dr. Moon asked about Rowan’s daily routine at the bookstore, their meal breaks, and what kind of support they had. Together, they worked out practical strategies for incorporating insulin into Rowan’s life, including discreet ways to manage injections during busy store hours.

“You’re the expert on your life and your body,” Dr. Moon said as the appointment drew to a close. “My job is to provide information and support, but decisions about your health care belong to you.” Walking out of Dr. Moon’s office, Rowan felt something they hadn’t experienced in a medical setting for years: hope. The weight of shame they’d carried since childhood felt a little lighter. Maybe, just maybe, this chapter of their story could have a different ending.

How the Medical System Failed Rowan

The current medical approach to type 2 diabetes places an overwhelming focus on weight loss, creating a cycle of shame, avoidance, and deteriorating health outcomes. Doctors prescribe weight loss as if it were a simple, achievable solution, ignoring decades of research showing that intentional weight loss efforts are rarely sustainable and often lead to weight cycling. When patients inevitably regain weight, they’re blamed for “non-compliance” or “lack of willpower,” driving many to avoid future medical appointments out of shame.

This weight-centric approach has particularly devastating consequences for diabetes care. Healthcare providers often withhold insulin or delay other crucial medication changes while pushing weight loss, leading to prolonged periods of poor glucose control. The emphasis on weight means other critical factors affecting diabetes management – stress, sleep, concurrent illnesses, medications, and social determinants of health – are frequently overlooked. Moreover, when patients do start insulin, they’re often berated for the resulting weight gain, despite this being a normal and expected side effect of the medication.

The medical establishment’s fixation on weight creates a paradox where fat patients are simultaneously told their weight is killing them and denied evidence-based treatments that might cause weight gain. This leads to a healthcare environment where fat patients receive substandard care while being blamed for their poor health outcomes. The result is a medical system that not only fails to serve fat patients with diabetes, but actively contributes to their health challenges through delayed treatment, medical trauma, and systemic discrimination.

Weight Inclusive Care Looks Like...

  • Treating diabetes as a complex metabolic condition influenced by genetics, stress, medications, and various life factors – not just diet and weight
  • Understanding that health improvements can occur independent of weight changes:
    • Better blood sugar control
    • Improved liver function
    • Normalized blood pressure
    • Enhanced overall wellbeing
  • Acknowledging that some diabetes medications, including insulin, may cause weight changes, and that’s okay
  • Supporting patients in:
    • Making informed healthcare decisions
    • Setting boundaries with other healthcare providers
    • Focusing on behaviors that enhance wellbeing rather than pursuing weight loss
    • Building self-advocacy skills
    • Developing body trust

 

The goal isn’t perfect numbers or a specific body size, but rather helping patients like Rowan feel empowered in their healthcare journey and capable of managing their condition without shame or fear.

Where To Next

Over the past few years, I’ve been advocating for weight-inclusive medical care, sharing evidence and experiences that demonstrate that there’s a better way to practice medicine. This passion has grown into a book I’m currently writing, where I dive deeper into these transformative approaches to patient care. Check out No Weigh for more information.

If you’re looking for medical care that treats you as a whole person, not just a number on the scale, I’d love to work with you. Book a consultation and experience the difference that weight-inclusive healthcare can make. I have a lot of experience working with people with diabetes, and as a type 2 diabetic myself, I benefit from my own lived experience.

Want to learn more about type diabetes and how to manage it without diet or exercise? Then check out my online course that provides all the information you need to make your own informed choices.  

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