Underlying principles

Prevention and remission of type 2 diabetes (SIGN)
Healthcare Improvement Scotland
SIGN toolkit logo

Person-centred communication

A positive patient experience in healthcare communications leads to better health outcomes and enhanced clinical effectiveness. Communication of recommendations in this guideline should be underpinned by best practice delivered through person-centred conversations. Health care professionals should adopt a collaborative, tailored and trauma-informed approach, recognising the person’s individual and social context and resources. Positive interactions are likely to improve psychological wellbeing and be more effective in developing knowledge, skills and confidence to support behaviour change. These include communicating potentially difficult information about increased risk and avoiding stigma. Training resources to support person-centred conversations that respect the impact of lived experience of trauma are available:

While lifestyle changes, especially weight loss, are a core part of the recommendations made in this guideline, it is important to consider when additional caution may be required in providing advice to minimise the risk of unintended harms. It is essential to ask permission before starting any discussions linked to overweight, obesity and central adiposity.26 The stigma associated with living with obesity can be distressing for many people and can impact outcomes. It is essential that all healthcare professionals have an awareness and understanding of this, and undertake suitable training on how to practice in a non-stigmatising way. Weight stigma, bias and discrimination can cause considerable harm including compromised psychosocial wellbeing, depressed mood, increased metabolic risk factors and lower self-esteem.27 Public Health Scotland host a weight stigma learning hub that is free to access for all health professionals.

People with suspected eating disorder

Additional caution is recommended in conversations with those who have, have had, or are suspected of having, an eating disorder of any kind. Weight-loss attempts may be contraindicated and may exacerbate or maintain the condition.28 Prevalence of eating disorders in people living with overweight or obesity and in those at increased risk of, or with a diagnosis of, type 2 diabetes is unclear. Studies have shown that adults with binge eating disorder (BED) have a higher prevalence of type 2 diabetes.29 People with lived experience have reported that their diabetes was diagnosed prior to their eating disorder being formally diagnosed, despite having lived with an eating disorder for decades.30

People with both type 2 diabetes and an eating disorder are likely to need treatment for their eating disorder first, with the most appropriate service for this varying depending on local pathways in each health board. Weight-management services with specialist psychology resource can support treatment of binge eating difficulties, including BED, when this is picked up as part of the assessment process. However, there can often be a significant wait for an assessment. Consider local referral pathways, waiting times and the person’s preferences when deciding between a referral to weight-management services, eating disorder services or mental health services.

References

  1. 26       National Institute for Health and Care Excellence (NICE). Overweight and obesity management. [cited 22 Jan 2025]. Available from url: https://www.nice.org.uk/guidance/ng246

    27       Editorial. Addressing weight stigma. Lancet Public Health, 2019;4(4):e168.

    28       Scottish Intercollegiate Guidleines Network (SIGN). Eating disorders (SIGN publication no.164). Edinburgh: SIGN; 2022. [cited 11 Sep 2024]. Available from url: https://www.sign.ac.uk/our-guidelines/eating-disorders/

    29       Abbott S DN, Tahrani AA, Piya MK,. Binge eating disorder and night eating syndrome in adults with type 2 diabetes: a systematic review. J Eat Disord 2018;6:36-41.

    30       Salvia MG, Ritholz MD, Craigen KL, Quatromoni PA. Managing type 2 diabetes or prediabetes and binge eating disorder: a qualitative study of patients’ perceptions and lived experiences  J Eat Disord 2022;10(1):148.