Episode Details

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Diabetes Prevention Programs are a group of programs that are created to prevent the onset of Type 2 Diabetes, often in people who have been identified as at-risk. Most include behavior changes, social support, and include weight loss as a metric and/or the primary outcome.

The assumption is typically that any health changes and/or reductions in the development of T2D are because of any weight loss. In discussing these programs previously I’ve expressed the concern that any differences in health/T2D development were more likely due to behavior changes/support than any weight loss and that, because of their insistence on a weight-loss focus, the programs likely included much more restriction than is necessary to create any health changes, which could create harms including weight cycling (which can actually drive T2D,) weight stigma (which can actually drive T2D,) and disengagement from behaviors that might actually support health and make T2D less likely (with the clear and critical understanding that whether or not someone develops T2D involves myriad factors, many of which are completely outside of their control, including genetics.)

Enter the new systematic review “Potential mechanisms for change in diabetes prevention programs” which sought “to investigate potential mechanisms for change in diabetes prevention programs (DPPs), and assess the strength of associations.” Their hypothesis was that “ Weight loss would be less strongly associated with improved health than other mechanisms.”

Summary

A group of researchers, several of whom work in weight inclusive Type 2 Diabetes preventions and management, sought to fill a gap in research around Diabetes Prevention Programs (DPPs). These program seek to delay/prevent onset of Type 2 Diabetes and typically include multiple interventions but often target an end goal of weight loss. There is a significant lack of research that even attempts to determine which aspects of DPPs might actually be responsible for any benefits and which might be unhelpful or cause harm. These researchers undertook a systematic review to attempt to determine just that.

The Authors

We’ll begin, as we always do, with the authors. Spoiler alert, this is going to be much shorter than these typically are. The study received no funding and the authors disclosed no conflicts of interest. I’ll do my usual deeper dive into their work and, as a reminder, working in the space in which you are researching is not considered a conflict of interest that requires disclosure but is something that always makes me give extra scrutiny to methodology. As usual, if you want to skip this part you can scroll down to where it says “The Study.”

Margit I. Berman is an Associate Professor at the Graduate School of Professional Psychology at the University of St. Thomas. Dr. Berman is the author of a “A Clinician’s Guide to Acceptance-Based Approaches for Weight Concerns: The Accept Yourself! Framework” This is not a DPP program but does have a section on Health at Every Size™ approaches to Diabetes and Cardiovascular Health. [Note: that Health at Every Size is the trademarked brand of the Association for Size Diversity and Health)

Martha Burla -

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