November 27, 2021

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Type 2 Diabetes Management 15 Percent Weight Loss

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Experts say a 15 percent weight loss should be a goal for people with type 2 diabetes, even if they aren’t significantly overweight. Getty Images
  • Researchers say a 15 percent weight loss should be the focus of type 2 diabetes management.
  • Sustained weight loss can slow disease progression or reverse type 2 diabetes.
  • Experts say intensive lifestyle interventions are needed and clinical guidelines need to be updated.

A weight loss of 15 percent or more can reduce complications and slow the progression of type 2 diabetes.

It can even reverse type 2 diabetes in many cases.

That 15 percent weight loss goal, in fact, should be the central focus of disease management for most people with type 2 diabetes, according to a review article published in the journal The Lancet.

As noted in the review, the study DiRECT trial showed weight loss benefits in type 2 diabetes management.

The trial involved people who were overweight or obese and had type 2 diabetes for less than 6 years. In the trial, 70 percent of those who took part in intensive lifestyle intervention achieved remission at 2 years.

In addition, studies of bariatric surgery for people with obesity and type 2 diabetes have also shown a reduced need for glucose-lowering drugs.

Dr. Laurie A. Kane is an endocrinologist at Providence Saint John’s Health Center in Santa Monica, California. She told Healthline that she agrees that weight management should be a priority.

“Authorities from around the world covered a lot of topics in this extensive article. The focus has always been on lifestyle changes ahead of medicine. The emphasis here is on the degree of weight loss in order to reverse type 2 diabetes. Fifteen percent is a lot. It’s difficult, but studies show it can be done,” she said.

“The scientists discussed investigative therapies in phase 3 trials are showing huge benefits for weight loss and significant lowering of A1C in some patients. All internal medicine physicians and endocrinologists should be reading this to be aware of what’s on the horizon,” added Kane.

Losing that much body weight and keeping it off is a challenge.

As the study authors point out, people with type 2 diabetes and obesity may be reluctant to ask healthcare professionals for help. They may fear being blamed for their weight.

And for many people, bariatric surgery isn’t desirable or feasible.

The researchers say that as more noninvasive treatments become available, people will have more choices. But it will take updated treatment guidelines and obesity management training for providers and support staff.

They also state that health systems should focus on the benefits of reducing weight to prevent or control type 2 diabetes before complications arise.

Exactly how one goes about losing weight depends on the person, said Kane.

Factors to consider are how much weight someone needs to lose, what they’ve tried in the past, and what they’re doing now.

“Lifestyle involves a healthy diet and daily or near daily exercise, and behavior modification. You have to know how to have healthy diet and healthy exercise. Next up is pharmacotherapy: medicine, medical devices, or bariatric surgery,” said Kane.

“It’s an exceptional patient who, just on advice of diet and exercise, will start losing. Most need an intensive program,” she continued.

“We do have studies like the Diabetes Prevention Program that involved 16 visits over 6 months and helped promote different ways of thinking,” said Kane.

An endocrinologist may be able to point you toward resources in your area.

You can have type 2 diabetes and appear as though you can’t spare 15 percent of your body weight.

Visceral fat isn’t always visible. It’s the type of fat that accumulates in and around the abdomen.

Michelle Routhenstein, MS, RD, CDE, CDN, is a cardiology dietitian and owner of Entirely Nourished.

“In my private practice, I have seen many people who have a normal weight but an increased waist circumference,” Routhenstein told Healthline.

“We would still need to address insulin resistance and inflammation to target the abdominal region to help manage type 2 diabetes and reduce risk of other chronic diseases like heart disease,” she continued.

“Excess abdominal weight plays a role in type 2 diabetes because it is the most metabolically active type of fat. It’s directly linked to both insulin resistance and low-grade chronic inflammation,” said Routhenstein.

She helps her clients lower their abdominal weight by addressing insulin resistance and low-grade inflammation through science-based nutrition.

“This includes ensuring macronutrient balanced meals and snacks with limited complex carbohydrates to assist the body in glucose metabolism, decreasing pro-inflammatory foods, and also by adding in therapeutic foods to reduce inflammation and assist with insulin sensitivity, ” said Routhenstein.

Kane stressed the importance of catching type 2 diabetes early or preventing it from developing in the first place.

“Everyone should be screened by age 45 or earlier if they have risk factors such as a history of cardiovascular disease, hypertension, physical inactivity, or insulin resistance. Prediabetes should be treated,” she said.

“Both obesity and type 2 diabetes are serious and progressive. They increase morbidity and mortality. Patients should work with their provider to make sure diagnostic parameters like weight, BMI, and waist circumference, are tracked every year,” she said.

Kane notes there are now 11 classes of medicine for type 2 diabetes.

“We can always find a treatment program, and we can think more about diabetes going into remission,” she said.

https://www.healthline.com/health-news/type-2-diabetes-management-should-include-15-percent-weight-loss-researchers-say