A systematic search and critical thematic, narrative review of lifestyle interventions for the prevention and management of diabetes

ABSTRACT

Moralism, myths, and presumptions regarding relationships between diet, exercise, weight, and disease incidence persist. It is unclear to what extent researchers contribute to presumptions concerning weight, lifestyle, and diabetes, and how often these relationships are thoroughly, distinctly delineated in intervention literature. Our purpose in this paper is to focus on interventions designed to prevent the onset of diabetes and to explore how weight is framed and discussed within randomized controlled trials (RCTs), to examine how diabetes prevention is constructed. We completed a search of several electronic databases for records published between 2007 and November 2016. Selection criteria included RCTs with a follow-up period of ≥12 months; adult participants with type 2 diabetes/pre-diabetes; and lifestyle interventions classified as dietary, exercise, and/or behavioral. Nineteen articles were identified for inclusion and subject to thematic content analysis. Two superordinate themes emerged from the analysis – entangled mechanisms and the meaning of weight and prevention through compliance. The relationship between obesity and adverse health outcomes was presented in some studies as taken-for-granted but underlain by unspecified mechanisms. Participants’ behaviors were also presented as central to forestalling diabetes, and behaviors were depicted as ‘compliance’, ‘resistance’, or ‘adherence’. Researchers’ biases and assumptions contribute to the discursive construction of diabetes as a product of patients’ irresponsible behaviors and subsequent fatness. This work extends previous critiques of RCTs in general to ‘diabesity’ RCTs by exploring how interventions are constructed as failures due to participants’ noncompliance despite evident etiological uncertainty.

KEYWORDS:

• Diabetes
• weight loss
• obesity
• lifestyle
• randomized controlled trials

Acknowledgements

Support during the search process by Robin Sabo is appreciated. We would also like to thank Dr. Shayne Taback for his insights regarding randomized controlled trials.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplemental Material

Supplementary material for this article can be accessed here

Additional information

Funding

This work was supported by the Central Michigan University [Start-up funds to AEB];University of Manitoba [Start-up funds to NDR].