When Is a Change in Weight Appropriate for the Prevention of Diabetes?
For individuals with obesity, dropping 10 pounds or more may make a world of difference in reducing the risk of type 2 diabetes, at least according to a recent study of nearly 200,000 people. The weight loss method does not seem to matter, though the impact of weight change over time is unknown.
The study, conducted by Qi Sun and colleagues from the TH Chan Harvard School of Public Health, included healthy subjects from three prospective cohort studies spanning 1988 to 2017. Participants were between the ages of 24 and 78 and were mostly female.
Strategies that led to a weight loss of 4.5 kg or more were grouped into seven categories: low-calorie diet, exercise, low-calorie plus exercise, fasting, commercial weight loss program, diet pills, and a combination of fasting, commercial diet, and diet pills.
The most effective weight loss method for long-term weight control in those with obesity was exercise. Exercise was also linked with the least weight gain after four years -- 4.2% overall average weight than baseline in those with obesity, 2.5% weight loss in overweight subjects, and .4% in lean subjects.
For commercial diet + diet pills, the results were the opposite -- those with obesity sustained a .3% weight loss, overweight subjects had 2% more weight gain, and lean participants had 3.7% more weight gain.
The risk for diabetes 24 years later for those with obesity, regardless of the weight loss method used, ranged from 21% less in those using exercise to 13% in those using diet pills. In overweight subjects, a 9% reduction was noted in those doing exercise, and a 42% increase was noted in those who took diet pills and lean individuals. In lean individuals, weight loss was linked with an increased risk for type 2 diabetes -- with a range of 9% with exercise and 54% in diet pill use or commercial weight loss methods.
The authors note that weight loss is beneficial in overweight and obese individuals but does offer the same benefits in lean individuals. Weight loss should not be advised unless medically necessary.
"We were a bit surprised when we first saw the positive associations of weight loss attempts with faster weight gain and higher type 2 diabetes risk among lean individuals," Sun adds. "However, we now know that such observations are supported by biology, unfortunately, entail adverse health outcomes when lean individuals try to lose weight intentionally. [The good] news is that individuals with obesity will benefit from losing a few pounds, and the health benefits last even when the weight loss is temporary."
What should a health educator advise clients at risk for diabetes?
In overweight or obese clients -- encourage regular physical activity as a strategy for weight loss for preventing diabetes.
Discuss realistic weight loss goals for prevention. It’s likely less weight than clients expect.
Encourage other healthy habits for diabetes prevention, including less red meat and processed food and more plant-based meals.
Have clients discuss weight loss medication options with their MD. Medication is not right for everyone.
Adjust diet accordingly in lean individuals without encouraging weight loss.
Continue to encourage exercise (aerobic and strength training) as both improve insulin sensitivity.
Discuss the importance of regular sleep and medication adherence (when prescribed) in prediabetes patients.
By Lisa Andrews, MEd, RD, LD
Reference:
Keyi Si, Yang Hu, Molin Wang, Caroline M. Apovian, Jorge E. Chavarro, Qi Sun. Weight loss strategies, weight change, and type 2 diabetes in US health professionals: A cohort study. PLOS Medicine, 2022; 19 (9): e1004094 DOI: 10.1371/journal.pmed.1004094