here has long been confusion regarding weight loss in diabetes. This confusion is not just a result of misinformation from newspapers, friends and family but is also the fault of doctors.
The general understanding is that if you lose weight then you can control your diabetes. However, if you do not lose weight, then you are either not following your diet or you no longer have any will to exercise.
But what exactly is the truth regarding weight loss in diabetes? Let’s start from the basics.
Obesity Is A Problem
It is well-known that obesity affects millions of individuals across the globe and is associated with the development of Type II diabetes. Clinical trials have shown that over 1 billion adults across the world are overweight with over 300 million being classed as obese.
What previously used to be a problem in the developed nations, obesity has now increased significantly in the developing countries due to their adaptation of a westernised lifestyle.
Given the link between obesity and diabetes, it is very important that every step is taken to prevent obesity in order to prevent diabetes. While reducing the current number of obese individuals may be difficult, steps must be taken to prevent the current generation and our children from getting obese in the future. This way, we can, over a period of time, get rid of obesity is a problem.
Obesity And Diabetes
There is sufficient clinical evidence to support the fact that weight loss in diabetes can help control blood sugars.
The Finnish prevention study conducted in individuals with prediabetes demonstrated that adopting the appropriate lifestyle changes and reducing body weight could reduce the overall risk of diabetes by over 58%. These studies targeted a weight loss of 5% of more than a reduction in the total fat intake to consist of less than 30% of the total calories. The recommended physical activity in this study was more than four hours a week.
When the body weight was maintained in the study for a period of seven years, the risk reduction was also maintained at around 40%.
The above study discusses individuals with prediabetes. But what about those individuals who are currently living with diabetes? Does reducing body weight really help improve blood sugar levels?
There is a slight confusion regarding this particular aspect. This is because you may find many non-obese individuals who are physically fit developing diabetes as well. In addition to this, not every obese individual develops diabetes either.
Ideal Weight Loss Goals
While there are no set guidelines when it comes to how much weight an individual should lose, most the clinical studies have suggested a weight loss of more than 5% as ideal.
Some researchers suggest that your body weight should come down to a level where your body mass index falls in the normal range. But how achievable is this really?
For example, if a 45-year-old gentleman with type 2 diabetes weighs over 130 kg and is 5’8” tall, he will have to lose over 60 kg in weight in order to fall in the ideal BMI category. While achieving this is not impossible, there are only a handful of individuals that may be able to do this through diet and exercise alone.
In a large clinical study that looked at over 24,500 individuals, different weight loss strategies were looked at to see how much weight people would lose. In the first six months, the average weight loss was around 5% to 8.7% of the total body weight. This was achieved through low energy diets and through the use of weight loss medication.
As the study continued, the subjects only lost around 3% to 6% of their weight over a 48 month period.
This means that despite every effort of theirs, the individuals who are obese will not reach an ideal body weight even if they try their very best over two years.
But why do we see such a change? Why is it the weight loss is not steady and seems to plateau after six months? Is it because individuals stop dieting or have lost their willpower?
The reason for this plateau can be explained by certain changes that occur in hormone regulation and body temperature regulation. Without going too much detail, the understanding is that the body begins to adapt to the lower energy intake. It attempts to store energy just in case the body needs it during a period of starvation.
So what does this translate into?
In a simple sense, it means that the body is not willing to give up the body fat if diets are observed for a long time. It should therefore come as no surprise that people following the same diet that led to a significant weight loss in the initial six months are now no longer losing that amount of weight.
The same sort of plateau is seen in people with diabetes who are attempting to lose weight. However, a certain degree of increasing loss of weight can be seen up to 12 months of diet and exercise.
But there is bad news.
It appears that people with diabetes may find it a lot harder to lose weight compared to those who do not have diabetes.
So What Should Be Our Target? Should It Be Weight Loss Or Better Blood Sugar Control?
This is a slightly difficult question to answer.
In the early stages of prediabetes and diabetes, insulin resistance i.e. the resistance of the body to the actions of insulin seems to be the prominent underlying physiology. In other words, the glucose levels are high because the body does not respond to insulin that is being produced by the pancreas.
In this early stage, it appears that changing one’s diet and reducing weight can improve blood sugars.
As the phenomenon of diabetes progresses, what was initially resistance to insulin now becomes insulin ‘deficiency’. This means that the quantity of insulin that is being secreted by the pancreas starts to decrease.
In this stage where insulin is deficient, weight loss may not be helpful. It is usually in this stage that patients require a combination of oral medications with insulin as well.
That being said, it is still essential that patients make every attempt to follow a healthy, balanced diet and perform regular exercise and prevent weight gain.
“Weight loss is no longer important. Preventing weight gain becomes priority.”
So what exactly would work in patients with diabetes? Is the blood sugar control a result of diet or is it a result of weight loss?
It appears that the positive effects on blood glucose control are seen a lot before weight loss occurs.
Take for example individuals who have undergone gastric bypass surgery. Once the surgery has concluded, the weight loss process begins and can take a year to 2 years for a great deal of weight to be lost. However, the blood sugar levels will start to reduce early on after the surgery even before any weight loss is seen.
Advice To Patients Regarding Weight Loss
If you are looking to lose weight, there are certain things that you need to expect.
Firstly, only expect to lose about 5 to 10% of your starting body weight. Beyond this, it becomes quite difficult to bring the weight down further. It is important therefore to set realistic goals.
If your weight starts to plateau, it is important that you continue to follow the same lifestyle changes and weight loss strategies that brought down your weight in the first place. As previously mentioned, preventing weight gain is important during this stage. And this is completely possible to achieve.
Keep a strict exercise plan. Exercise not only helps maintain your body weight, it can also improve your cardiovascular fitness and reduce your risk of heart attacks and stroke.
Weight loss and dieting form an important part of the management of diabetes. While it can be achieved to a certain degree, it may not be possible to reach the target weight your doctor recommends.
Stick with your diet and exercise plan and take your medications and your blood glucose levels will be controlled well.
Franz, Marion J., et al. “Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up.” Journal of the American Dietetic Association 107.10 (2007): 1755-1767.
Franz, Marion J. “The dilemma of weight loss in diabetes.” Diabetes spectrum 20.3 (2007): 133-136.
Tuomilehto, Henri, Lavigne Dmd, and Sirkka Aunola. “Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.” (2001).
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