There is a known connection between obesity and Type 2 diabetes. It is known that the obesity epidemic is driving the Type 2 Diabetes epidemic world wide. There is strong evidence that modest weight loss can delay the progression from pre-diabetes to type 2 diabetes (1,2,3). Weight loss in diabetes is beneficial in managing type 2 diabetes. Why lose weight question, for many type 2 diabetics is an important one to get their diabetes under control.
Studies have shown that reduction in calories lead to a reduction in A1C of 0.3% to 2.0% in adults with type 2 diabetes, leads to reduction in medication doses and improvement in quality of life (1). Maintaining weight loss is challenging (4) but offers long-term benefits. For example, maintaining weight loss for 5 years is associated with sustained improvements in A1C and cholesterol levels (5). Weight loss in diabetes can be attained with lifestyle programs that offer a 500–750 calorie energy deficit or offer 1,200–1,500 calorie for women and 1,500–1,800 calorie for men. For many obese individuals with type 2 diabetes, losing >5% can produce beneficial outcomes in sugar control, cholesterol, and blood pressure, and sustained weight loss of ≥7% is optimal (4).
Definition of Obesity
Body Mass Index, or BMI, is used as a screening tool for overweight or obesity.
• If your BMI is less than 18.5, it falls within the underweight range.
• If your BMI is 18.5 to <25, it falls within the normal.
• If your BMI is 25.0 to <30, it falls within the overweight range.
• If your BMI is 30.0 or higher, it falls within the obese range.
To calculate BMI, see the Adult BMI Calculator or determine BMI by finding your height and weight in this BMI Index Chart.
How does Obesity Lead to Type 2 Diabetes?
Increase weight leads to increase fat (adiposity), increase adiposity leads to insulin resistance which eventually will lead to diabetes.
To have weight loss in diabetes, there are three modalities: bariatric surgery, weight loss medications (pharmaceuticals) and energy deficit. A combination of any of the three modalities with behavior modification can help patients achieve weight loss.
Bariatric surgery
Bariatric surgery is indicated for patients with a BMI equal or greater than 40 or a BMI equal or greater than 35 with co-morbidities such as diabetes. The two most popular types of bariatric surgery are Roux-en-Y gastric bypass and Gastric sleeve surgery also known as vertical sleeve gastrectomy. Gastric sleeve is more popular because the number of side effects are less than with the Roux-en-Y bypass but is not as effective.
Weight loss Medications (Pharmaceuticals)
Prescription weight loss drugs: Belviq, Contrave, Saxenda, phentermine, and Qsymia. Over the counter you can find orlistat. Lifestyle intervention plus pharmacotherapy intervention lead to better response to calorie restriction. For patients on weight loss medications see an increase magnitude of response, average percentage of weight loss is greater. Overall pharmaceuticals can help extend weight loss sustained response. SEQUEL study data showed amount of weight loss group on pharmaceutical treatment lead to greater weight loss more than the placebo group.
Who can benefit from the use of Pharmaceuticals for weight loss?
Patients who report early hunger shortly after eating, patients who tend to have more than one plate of food to feel full, Patients with persistent food thoughts, strong emotional response to food or eating, and less than robust response to dietary plan. For some, pharmaceuticals can be use indefinitely or in maintenance can be use when needed.
Calorie Restriction
Type 2 diabetes is potentially reversible via an 8-week, very low-calorie diet followed by careful weight management for up to 6 months, new research shows. The findings were published online March 21, 2016 in Diabetes Care by Dr Sarah Steven of Newcastle University, United Kingdom, and colleagues.
The best weight loss response was seen in Younger age patients, in those with shorter duration of diabetes and not on insulin. STAMPEDE trial followed 150 patients with a BMI of 27-43 1 for five years 1 out of 3 patients were in remission after 5 years after bariatric surgery. Look AHEAD and DIRECT trial achieve 50% remission on an average weight loss of 10 kgs.
Calorie restriction paired with exercise provides patients with type 2 diabetes with a plan to lose weight and control blood sugars. Before starting any exercise, program consult your Primary care physician.
Lifestyle is always recommended to manage diabetes, for some patients with type 2 diabetes it may not be enough. Pharmaceuticals and bariatric surgery are other tools that can help. For patients who are morbidly obese bariatric surgery maybe the best alternative. Talk to your Primary Care Physician to find out what they recommend for you.
Weight loss in type 2 diabetes can lead to remission or well control diabetes at the levels of prediabetes leading to decrease complications from diabetes. Make weight loss part of your diabetes action plan.
References
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https://jandonline.org/article/S2212-2672(17)30333-7/abstract
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http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002095
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http://annals.org/aim/fullarticle/2395729
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https://jandonline.org/article/S2212-2672(15)00259-2/fulltext
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http://drc.bmj.com/content/5/1/e000259
