Decoupling Weight and Health: Integrating a Weight-Neutral Framework into Diabetes Self-Management Education for Adults with Type II Diabetes in Franklin County, Virginia

In Franklin County (FC), a rural locale in Southwestern Virginia, the prevalence of Type 2 Diabetes (T2D) has increased to 18.3%, among the highest of any Virginia county. Yet, the nearest Diabetes Self-Management Education and Support (DSMES) program; a cost-effective and evidence-based treatment model for T2D, is located over 3 hours away. Historically, standard diabetes care has hinged upon weight loss as a primary outcome objective. However, recent research revealed that weight-normative messaging can inadvertently worsen diabetes outcomes through increased HbA1c, weight stigma internalization, and psychosocial complications. The BEAM Program (Blood glucose self-management, Eating for diabetes management, Activity that sparks joy, and Mindfulness for sustained lifestyle change) is a hybrid, 8-session, weight-neutral DSMES pilot intervention grounded in Health at Every Size (HAES) and Social Cognitive Theory (SCT), designed to simultaneously address iatrogenic weight stigma in DSMES while improving DSMES access in FC. Triangulating components of existing evidence based interventions, BEAM will deliver four individual and four group sessions across 8-weeks. We will aim to enroll approximately 125 participants over a three-year pilot period to test the feasibility and acceptability of the BEAM program. Primary outcomes include change in HbA1c, diabetes distress, and weight stigma internalization assessed at baseline, post-intervention, and 3-month follow-up. If successful, BEAM has the potential for systems-level integration into existing clinical settings in Franklin County, preventing weight-stigma in DSMES while simultaneously addressing DSMES under-provision in Franklin County.