weight-inclusive diabetes care
Breaking Barriers Across Borders with Dra Monica Peralta
In Episode 8, Season 5 of the Fat Doctor Podcast, I had the privilege of speaking with Dra. Mónica Peralta, a physician from Nicaragua specializing in weight inclusive diabetes care, intuitive eating, and Body Trust. Our conversation traversed cultural boundaries to explore how weight stigma manifests differently yet similarly across the globe, with a particular focus on the Latin American experience. What emerged was a powerful examination of how healthcare systems worldwide continue to harm fat patients, particularly those with diabetes, and the collective effort needed to create change.
Weight-Inclusive Perspectives Beyond Western Healthcare
While discussions about weight-inclusive care often center on the US, UK, and Canada, Dra. Peralta offered a necessary perspective from Latin America, highlighting how weight stigma intertwines with colonialism and economic disparities in diabetes treatment.
“When you live in Latin America, besides racism that we know is one of the roots of weight stigma, then you have colonialism, and then you have economic disparities,” Dra. Peralta explained. She described the public healthcare setting where doctors conduct rounds with 15-20 patients simultaneously, often publicly blaming patients’ bodies for their diabetes, all within earshot of other patients and their families.
“Not only are you getting a diagnosis that can affect your life forever, then you have all this shame, not only surrounding that diagnosis, but surrounding the way that diagnosis is given,” she noted, highlighting how cultural factors like volume and directness in communication can amplify the shame experienced by diabetes patients.
Cultural Food Politics and Diabetes Management
Our conversation revealed how globalization has led to the devaluation of traditional foods in Latin America, especially when discussing diabetes management. “Rice and beans are out of the question, and that’s one of the main dishes for Latin American culture,” Dra. Peralta explained. The push for “Mediterranean diets” and expensive imported foods like quinoa and salmon creates both economic barriers and unnecessary guilt for those with diabetes consuming culturally significant foods.
“That’s a perfect example of whitewashing in nutrition,” she pointed out, “because when vegans have rice and beans, ‘Oh, my God, they’re vegan! They’re doing the Lord’s work.’ But when we do it, that’s not good.”
This nutritional colonialism particularly impacts diabetes care, where cultural foods are often the first target of restrictive medical advice, despite their nutritional value and cultural significance.
The Double Burden: Diabetes and Weight Stigma in Healthcare
As a diabetic myself, I was particularly moved by our discussion of how diabetic patients face heightened levels of weight stigma in healthcare settings. When I asked Dra. Peralta if diabetics experience weight stigma, her response was unequivocal: “125%. That’s why I went into diabetes care. There’s no other diagnosis that experiences the amount of shame that comes with diabetes.”
She shared a powerful personal experience of accompanying a thin friend to a doctor’s appointment, only to have the doctor mistakenly address her as the patient with diabetes. The doctor’s comments were laden with assumptions and judgment: “See, you have diabetes, high cholesterol. Well, this is no surprise, Mónica… look how you obviously had yourself let go.”
When she clarified that she wasn’t the patient, the doctor’s response was telling: “Well, I just gave you a free consultation, because eventually you will be where she is.” This experience exemplifies how medical professionals continue to perpetuate harmful stereotypes and make dangerous assumptions based solely on body size, particularly in diabetes care contexts.
GLP-1 Medications: The Shifting Focus in Diabetes Treatment
Our discussion of GLP-1 medications like Ozempic revealed how treatments originally designed for diabetes care have been co-opted by the weight loss industry, often at the expense of diabetic patients who struggle to access these medications due to shortages.
“GLP-1s now switched, and they are working with the weight loss industry. They are no longer working with the diabetes industry,” Dra. Peralta explained. She highlighted the ethical issues of prescribing these medications—with significant side effects—to otherwise healthy individuals solely for weight loss, while diabetic patients endure these same side effects out of necessity.
“We are willing to put healthy patients with healthy pancreases through these side effects,” she noted, questioning the research that links GLP-1s to improved mental health. “They are being treated better because they are losing weight. Their surroundings, their families, their friends, are treating them better.”
This shift in focus from diabetes management to weight loss illustrates how even diabetes care innovations can be redirected away from those who need them most.
"A Day to Eradicate a Type of Human Being": Weight Stigma at the Systemic Level
One of the most powerful moments in our conversation came when discussing World Ob*sity Day, which Dra. Peralta characterized in stark terms:
“It really surprised me that as human beings, we are okay with having a day to eradicate a type of human being, a type of person, a body type. We are okay with telling people, ‘Hey, March 4th, we want to eradicate you. We don’t want you to exist. Welcome to World Ob*sity Day!'”
This framing cuts to the heart of what makes such “awareness” days so harmful to Fat people, especially diabetes patients – they position certain body types as problems to be solved rather than human variations to be respected. As Dra. Peralta pointed out, the language of eradication is not one we would accept when discussing other forms of human diversity, yet it’s normalized in discussions about weight and diabetes.
Healthcare Providers' Role in Weight-Inclusive Diabetes Care
A recurring theme in our conversation was the responsibility of healthcare providers to examine and address their own weight bias in diabetes treatment. “In Latin America, doctors are God. Whatever the White Coat says goes,” Dra. Peralta explained, highlighting how cultural deference to medical authority can amplify harm.
She candidly shared her own journey from weight-centric to weight-inclusive diabetes practice: “It was really hard for me to admit that I’ve been doing harm. And for me to say, ‘What a shitty person! What was I doing? Did I go through all this medical training for this?'”
This self-reflection is precisely what’s needed across the medical profession—yet it remains rare. As I noted during our conversation, if weight stigma is the underlying cause of many health issues faced by fat patients with diabetes, “the solution is not to make them thinner. The solution is to treat the weight stigma, but that would include us.” This recognition that doctors need to change, not patients, remains revolutionary in most diabetes care settings.
AWSIM: Building a Community for Weight-Inclusive Diabetes Healthcare
Our conversation ended on a hopeful note as we discussed the Association for Weight and Size Inclusive Medicine (AWSIM), where both Dra. Peralta and I serve as board members. This organization provides community for healthcare professionals transitioning to weight-inclusive approaches, including those specializing in diabetes care.
“The transition between a weight-centric and a weight-inclusive approach can get really lonely, can get really confusing,” Dra. Peralta explained. “We are creating opportunities for healthcare professionals to grow within the weight-inclusive world…”
This work of building community and resources for healthcare professionals is essential for creating lasting change in diabetes care. As Dra. Peralta put it, “If AWSIM is doing that, just planting the seed of doubt, we are doing a lot.”
The Future of Weight-Inclusive Diabetes Care
My conversation with Dra. Peralta serves as a powerful reminder that weight stigma in diabetes care is a global issue requiring global solutions. By centering voices from diverse cultural backgrounds and experiences, we gain a more complete understanding of how weight stigma operates across different healthcare systems and what we can do to combat it.
For patients navigating weight-centric diabetes care, Dra. Peralta offered practical advice, from strategic questioning techniques to asking for referrals to specialists. For healthcare providers, the message was clear: the hard work of self-reflection and unlearning harmful practices is non-negotiable if we want to provide truly inclusive diabetes care.
As we work toward a more just and equitable healthcare system, organizations like AWSIM provide crucial support and community for those implementing weight-inclusive diabetes care. While the road ahead may be long, particularly in regions where weight-inclusive approaches are still in their infancy, the growing movement of healthcare professionals committed to this work gives us reason for hope.
This blog post is based on a conversation between Dr. Asher Larmie and Dra. Mónica Peralta, a Nicaraguan physician specializing in weight-inclusive diabetes care, intuitive eating, and Body Trust. Dra. Peralta works with clients online in both Spanish and English. You can find her on Instagram at @dra.monicaperalta and at her website www.monicaperalta.org. You can listen to the podcast or watch the video on YouTube.