T2 and overweight? Lose weight, it will help!

Type 2 New to Type 2 diabetes
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I just finished reading through an excellent discussion started by @Brian_BSC about words, his (and others) frustration over fat-shaming and T2 diabetes; the misconception by so many that T2s cause the disease with poor eating habits; that the disease can be cured by losing weight.

The guilt heaped upon T2s unjustifiably by these misconceptions is a big problem.

However, seeing this topic again – it comes up regularly here – got me concerned about how we, the D community, seem to have gone too far in the other direction, in my opinion.

The fact is, you did not cause your diabetes by anything you did. There are plenty of people with a similar lifestyle, and many hugely obese sloths with far worse lifestyles, that are not and never will be diabetic. It is something genetic that you’ve been cursed with that makes YOU unable to process carbohydrates properly.

That said, some other facts are also important to shout out too, especially on a diabetes support forum. These are:

  • Obesity generally increases insulin resistance.
  • Lean diabetics have a greater total carb handling capacity in any given digestion cycle than obese diabetics
  • T2 diabetics are more prone to other metabolic disorders, like high cholesterol, when obese than non-diabetics

Because of these, and other aspects of the disease, most T2 diabetics who are overweight, especially those clinically obese, will benefit from losing weight. Getting to a lean BMI may even improve insulin sensitivity and carb processing by their “system” enough to get off exogenous insulin, oral beta cell stimulants, and other somewhat “nasty”, drugs like GLP agonists, etc.

As a community we do nothing good by shaming people for being fat, and causing their diabetes. Thankfully, we don’t, and indeed provide a place to get some loving comfort from this harsh, erroneous judgement by society at large.

Yet, we do our fellow diabetics no favors if we downplay, deny, sugar-coat, or otherwise diminish the very real, and substantial benefit gaining a lean, fit body mass has on the day to day treatment of, living with, and future progression of T2 diabetes.

I say all this as I, at this very moment, struggle to take off excess weight. I’ve dropped 20, and still have another 30 to go. It ain’t easy, took me 6 months just to drop 20.

If you have T2 diabetes and are overweight and sedentary, the hard truth is the single most effective thing you can do for your disease is to lose weight and establish a daily exercise program.

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@Dave26, I don’t disagree with these statements but we could rightly say that anyone with diabetes who is overweight would benefit by losing weight.

I do think as a community we need to be empathetic. Someone with T2 diabetes, who is insulin resistant will gain weight because their body preferentially stores fat. And anyone (T1 or T2) who uses insulin will also tend to store fat. As you say, we need to sympathize with those who struggle with weight not shame them.

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Brian, the only point I’m trying to make is this: We (society) advise obese people with heart disease to lose weight. Because obesity aggravates the condition.

This is true for diabetes, T2 especially. While obese T1s will benefit from losing weight too, the vast majority of T2 diabetics are overweight, many obese, and it is simply a fact that in most cases this obesity contributes significantly to the disease process.

I’m afraid we, in this community, have become oversensitive in “telling it like it is” w.r.t. obesity and T2 diabetes in the noble cause of not blaming people for their condition.

I say, instead, we do both, firmly. Ensure people understand they didn’t cause this, and also make sure they understand that getting to a lean BMI is, for most T2 diabetics, the most effective thing they can do to manage their condition (emphasize again, most, not all).

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From what I understand, lean type 2 diabetics do much worse, prognosis wise, than those who are obese. That doesn’t mean losing weight won’t help those who are obese (and apparently even those who are normal weight can sometimes reduce severity of t2d by getting to what would normally be considered too skinny), just pointing out that there are aspects of the disease pathophysiology we don’t quite understand.

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Agree entirely, Dave. Being empathetic doesn’t have to mean painting a picture that diverges from reality. Thank you for this post.

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There is another point to consider – There are those who believe that the same conditions that cause Type 2 diabetes also cause obesity. If that’s the case, it can be as difficult for a person with T2 to lose weight as it is to manage any other aspect of Type 2 diabetes. My limited experience is that this can definitely be the case. Take my mother, for an example - She has gone through extended periods of eating truly very little, but unless she eats absolutely nothing for an extended time, she cannot lose weight – and that was true even when she was able to exercise regularly. She has never been on injected insulin. Currently, due to an as-yet unknown cause, she has taken to eating virtually nothing – and, yes, she has lost quite a lot of weight – yet, unless she takes metformin, her blood sugar continues to rise to unhealthy levels.

MY original diagnosis – which may still be correct – was Type 2, and that happened only AFTER I’d lost extra weight and maintained a healthy weight for several years. Has my earlier weight loss made my diabetes easier to manage? Maybe - though, when I’d gained much of it back after going on insulin, I did not see any change in my control, nor have I seen any since again losing (half) the weight.

I still agree – anyone who is obese should be encourages to try and lose weight. Even those studies that @Tia_G mentioned, that indicate that overweight people with T2 often have a better long-term prognosis than skinny ones, don’t preclude that severe obesity can cause a multitude of harm to many people. In the end, though, I don’t think there is a simple conclusion either way – though, personally, I am more comfortable and feel healthier when I carry less (or no) extra weight.

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@Tia_G, there are no absolutes when it comes to treating any adverse health conditions. Because of this, exceptions are always to be found. However, exceptions are just that – exceptions.

Regardless of the peculiarities and exceptional differences some lean T2 diabetics – especially those lean at the time of diagnosis – experience, it’s irrelevant to this one iron-clad fact: The vast majority of T2 diabetics are overweight, and among those obese. Losing weight, even achieving medically “proper”, lean body weight, will improve their BG management significantly, and their future prognosis.

This thread is not about how one “got” T2 diabetes. It’s about what to do once you’ve unfortunately joined the club.

The reason doctors harp on T2s to lose weight, improve their diet, and increase physical activity in their lives is because these things are the most powerful treatment modalities for most T2s.

Being overweight and sedentary is generally not a healthy way to live, for anyone. For a T2 diabetic, its a central issue to managing the disease.

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@Thas, I agree that T2 could be a result of an underlying disease process that also leads to obesity. Some believe the fat accumulation is actually the body’s attempt to mitigate inflammation, even though it also precipitates a further spiral towards impaired glucose response. In this theory, thin people, therefore, have less capacity to buffer against that disease process before manifesting symptoms.

And I agree that carrying excess weight can feel crummy for reasons other than accelerating the disease process. I’ve never been overweight, but when I am over the healthy weight for me (which is technically underweight), I feel awful. Walking is harder, being active is harder, I feel sluggish, etc.

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@Dave26, You won’t hear me arguing that losing weight is bad for T2s! I agree that it’s one of the few things demonstrated to improve prognosis across a wide variety of metrics. All the other options, like medication or surgery, have side effects, tradeoffs and somewhat equivocal benefits in trials.
So yes, great option. I was just pointing out that obesity is clearly not the whole story, as people who are thin often get T2D as well (they comprise 12 percent of the T2D population), so it can be frustrating for a substantial fraction of people being told to lose weight because basically it doesn’t apply to them, or would require a near-starvation-level diet.

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I would say for many people telling them to lose weight because of diabetes/heart disease/arthritis isn’t terribly helpful. If I could lose weight and keep it off, not only I would have done so by now but I’d be happier person. Wasn’t like I didn’t have enough reasons to want to lose weight before the diagnosis…

¯\_(ツ)_/¯

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A large part of what is know about with an type 2 diabetes comes from the Look AHEAD trial, which was a lifestyle intervention program for people with type 2 diabetes targeted to achieve a 7% weight-loss and do over 175 minutes of moderate physical activity a week.

There were benefits, but the primary goal of reducing heart disease and stroke events was not met. More people in the lifestyle group had a partial remission of diabetes in the first 4 years of the trial. Other benefits included reductions in sleep apnea, loss of bladder control, and depression. There were also improvements in quality of life, physical functioning, and mobility.

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Medication choice also has an effect. weight gain is caused by drugs in the sulfonylurea, TZD, insulin classes. And the SGTL2 inhibitor, and GLP-1 receptor agonist classes promote weight loss. Switching to the newer SGLT2 and GLP1s could help control your blood sugar and loos weight.

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I would argue that the results of the Look-Ahead trial showed that a low fat high carb diet is useless in reducing CVD. I would also note that the results of the long term study of the DPP (DPPOS) showed the futility of the same diet in reducing the incidence of T2 diabetes. After 15 years, 62% of patients that did nothing got diabetes. 56% of patients that took metformin got diabetes. And 55% of patients that followed a calorie restricted low fat high carb diet got diabetes. The DPP didn’t work. You might as well just take metformin.

Unfortunately nobody has the guts to do the real study that should be done looking at a low carb high fat diet as a treatment.

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The Look AHEAD diet:

Participants are prescribed a diet of self-selected foods for the first 2 weeks with recommendations to consume 30% or fewer kcal from fat of which <10% kcal are from saturated fat. The calorie goal is 1200–1500 kcal/day for those who weigh <250 pounds, or 1500–1800 kcal/day for those whose weight exceeds 250 pounds. At session three, the participants are prescribed a more structured dietary program to help them achieve this calorie goal; the plan consists of two meal replacement products, one portion-controlled snack, and a self-selected meal each day. At week 20, participants are prescribed one meal replacement per day and two meals of self-selected foods are allowed. The maintenance dietary protocol for years 2–4 allows for continued use of one meal replacement per day.

Here is the summary of the diet literature compiled in 2012. http://care.diabetesjournals.org/content/35/2/434
You can look for the high-fat low carb diets in the references.

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I have thought and thought over this issue many times. How do we not shame people or marginalize their struggles with having diabetes or being obese, but at the same time educate the populous on how to live a healthy lifestyle? It’s a tough question! For one thing our culture defines what a “healthy” body looks like- model thin. Look at the ads for sports stores or
Exercise gear! This is not correct nor is it healthy.on the other hand I live in a state that has one of the highest obesity rates in the nation. Parents think nothing of buying their kids a 32oz. slushee. Candy is always a reward here- whether in school or church or anytime! Basic education and a balanced diet, combined with realistic images of what a heathy person is and does would go a long way. That is of course if people are willing to listen…

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I also know there are fans of low carb diets and it works well for individuals who can stick to the diet. It sounds like it works for you.

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When it comes to a healthy eating lifestyle, I have the willpower of a recently paroled pedophile. Despite this, a LCHF diet has been extremely doable and has resulted in a gradual but significant weight loss for me. Granted, I “cheat” and eat something containing peanut butter and chocolate about once a week on average. I’ve convinced myself this “shocks” my metabolism back into weight-loss mode whenever I hit a plateau. Seems to work so far (knock wood) without having to resort to extreme calorie restriction.