Diabetes Without Weight Loss? Surely Not!
I can teach you how to manage diabetes without ever mentioning weight loss, let alone recommending it. I guess that makes me a bad doctor, right?
Wrong!
Allow me to explain why…
Type 2 diabetes is NOT a fat person’s disease
The medical profession and the media would have us believe otherwise, but anyone can develop diabetes. That being said, chances are it was passed on through your DNA. Studies show that the children of type 2 diabetics will often develop signs of insulin resistance early on in life, irrespective of BMI.
Type 2 diabetics can make insulin. The problem is that their cells are resistant to it. Insulin acts like a key that opens the doors of the cells and allows energy (in the form of glucose or sugar) to pass from the blood into the cell core. In insulin resistance, some of the locks are broken. That means less energy can enter the cells (which leads to weakness and fatigue), and more glucose stays in the blood where it is eventually turned into fat.
Being fat did not make you diabetic. Insulin resistance made you fat.
There is nothing you can do to prevent diabetes. Researchers already looked into that. It’s called the Diabetes Prevention Program Outcomes Study, or DPPOS for short. More than twenty years of data has shown that even in those with impaired fasting glucose (sometimes called prediabetes, although in my opinion, that’s not even a real condition), nothing much can be done.
Weight loss won’t improve type 2 diabetes
I know, I know. That’s not what everyone else says. But I want us to take a look at two very important long-term studies that back me up. (Oh, and whilst you’re at it, feel free to ask everyone else to provide one single bit of long-term evidence that proves me wrong.)
The first is the DIRECT study. They took a large group of type 2 diabetics and put them on a very low-calorie diet (an 800Kcal meal replacement for several weeks). Unsurprisingly, almost everyone lost weight initially and almost 50% of participants went into remission. By the second year, that number had dropped significantly. By the end of the 5-year study, just under a third had dropped out and only 8% of the original weight loss cohort remained in remission.
Now the authors of the study claim that it’s possible for some people to stay in remission of type 2 diabetes for at least five years. Which is true. BUT the vast majority don’t. They also claim that “no matter how long you stay in remission for, spending any time in remission can have lasting benefits to health”. Says who?
Not the look AHEAD study. This multi-centre randomised control study found that intentional weight loss in type 2 diabetes does not improve any health outcomes, including cardiovascular disease and cancer. They also found that weight loss does not reduce mortality rates in diabetics.
And here’s the thing that nobody really talks about when it comes to weight loss research. What happened to all the people who didn’t remain in remission during the DIRECT study? How is their diabetes control doing after 5 years? What if they’re worse off?
Weight cycling is harmful in type 2 diabetes
Weight loss is unsustainable for the vast majority of people. Most people regain all of the weight that they lost within the first two years, and up to two thirds end up heavier than when they started. In short, weight regain is an inevitable consequence of intentional weight loss, which is why I prefer the term weight restoration. It’s simply a normal part of the weight loss cycle.
But here’s the thing. Weight cycling is bad for your health. It alters body composition, including the intestinal barrier. It causes oxidative stress and immune cell infiltration, which is a fancy way of saying it causes low grade inflammation. All of these can worsen insulin resistance, and have a potentially negative on diabetics.
So what does the evidence say? Well oddly enough, that research doesn’t exist. It’s almost as if people don’t want to know if weight loss for harmful in type 2 diabetics.
Hmmm 🤔 I suppose that makes sense, seeing as the weight loss industrial complex is worth hundreds of billions of dollars and I guess they wouldn’t want that getting out…
Why is weight loss all diabetic clinicians want to talk about?
I know what you’re thinking. If what I say is true, why are diabetes clinicians focussed primarily on weight loss? It isn’t sustainable, it doesn’t really benefit us and it may well causes long term harm. So why even bring it up?
Good question. I suggest you ask them that. I’ve personally tried, and they never seem to have an answer. That doesn’t necessarily mean they are bad people. A few years ago, I used to be the diabetic lead in my practice, and I was pushing weight loss at the time.
It’s in the guidelines. It’s in all the literature. It’s all you’re taught since day one of medical school. Why wouldn’t you push weight loss?
And so what if it’s stigmatising? So what if you’re patients are so traumatised by your care that they’d rather avoid you and put their health at risk than face one more lecture or thinly veiled insult?
At the end of the day, the doctor gets to go home every night convinced that they’ve done a good job because no one has ever questioned the status quo or challenged them on their problematic behaviour.
I was once that doctor. I’ll be honest – I slept just fine at the time. Not anymore.
Diabetes care that focuses on weight loss
I wonder if any of this sounds familiar?
You’re diagnosed with type two diabetes and even if it is not directly implied, you are made to feel like it is your fault for being fat, eating too much sugar, and not exercising enough.
The first thing you’re advised to do is lose weight. The second thing you’re advised to do is cut down on carbs, deny your sweet tooth for the rest of your life, and pray you don’t lose a foot or a kidney in the next few years.
No one really takes the time to explain the diagnosis, what you can expect going forward, or what your life is going to look like in the future. You probably feel like you’re doomed to a life of misery. You worry that your kidneys will fail, or you’ll go blind, or you’ll have a heart attack in the next few years unless you do something drastic about your weight.
You immediately change how you eat. Even if you’re anti-diet, this is different. This is about blood sugars not weight loss. Before you know it, you’re back to the same old habits. Restricting. Punishing yourself. Binging.
You’ve got no one to talk to. You couldn’t possibly talk to your nurse or doctor about this because you know they’ll judge you and probably tell you off. You’re afraid of getting your HbA1c measured because you’re worried it will reflect poorly on you.
Your healthcare team don’t really take much time to explain things to you. You’re told to take this medication and avoid this food. You’re told off if your blood sugar is “too high”, but you don’t know what “too high” means and how it will impact you. Will you fall into a coma and die? Will your blood vessels start clogging up straight away?
It’s a living nightmare.
Diabetes care without weight loss
You need a doctor who cares, listens, validates, and doesn’t judge. Someone who takes the time to explain things to you, and answer any questions you might have (no matter how trivial they may seem).
You need a doctor who will encourage you. Someone who works with and for you.
And folks, I am that doctor.
When you work with me, you’ll get all the time you need to talk though your diagnosis and what it means for your future. I won’t recommend weight loss under any circumstance, and I won’t focus on your diet or activity levels. Together we’ll create a management plan that is tailored to your individual needs that you can take back to your own team with the evidence and confidence you need to back it up.
Interested in working with me? Then why not book a discovery call and we can figure out if we’re a good fit.