Weight Loss and Type 2 Diabetes

Weight Loss and Type 2 Diabetes


The current guidelines by the American Diabetes Association (ADA) recommend that adults with prediabetes or type 2 diabetes (T2D) who are overweight (body mass index (BMI) >25 kg/m2) or obese (BMI >30 kg/m2) should lose weight.1,2



A modest weight loss should be aimed for in individuals who are overweight or obese with prediabetes or T2D. The ADA defines modest weight loss as losing 5% of initial body weight. Achieving and sustaining a weight loss of >7% of initial body weight, however, is optimal.



There is strong evidence suggesting that obesity is the greatest risk factor for developing prediabetes and T2D. Excess body fat, especially visceral and abdominal adiposity, is associated with various metabolic abnormalities linked with the development of T2D such as insulin resistance, pancreatic b-cell dysfunction, and dyslipidemia.3,4 On the other hand, a 5% weight loss has been shown to improve the insulin sensitivity of adipose tissue, the liver, and skeletal muscle as well as increase b-cell function.3,5

Additionally, rigorous randomized controlled trials (RCT) have consistently shown that weight loss can help manage the illness and even delay the onset of T2D.6–9

The Look AHEAD (Action for Health in Diabetes) Trial, a landmark multicenter RCT, studied the effectiveness of an intensive lifestyle intervention (ILI) in overweight/obese individuals with T2D.9 Over the period of 8 years, significantly more individuals who received ILI achieved a >5% weight loss than those who only received diabetes support and education (DSE). A later finding showed that the ILI group had 3-6 times higher rates of partial or complete remission compared to the DSE group.10 The study noted that the rates of remission were higher in those with substantial weight loss and concluded that a >5% weight loss leads to improved glycemic control and reduced need for blood-glucose lowering medications.10,11

Another key multicenter RCT, the Diabetes Prevention Program (DPP), reported similar benefits of ILI that aimed to achieve and maintain a >7% weight loss in nondiabetic individuals with elevated blood-glucose levels.6–8 At all time points of follow-up, ILI reduced the incidence of diabetes more than the administration of either placebo or metformin (an oral diabetic medication). When compared to placebo at the 2.8-year follow-up, ILI reduced diabetes incidence by 58% whereas metformin lowered the incidence by 31%; at 10-year, by 34% vs. 18%; at 15-year, by 27% vs. 18%, respectively.



Individuals with T2D should focus on making healthy lifestyle changes early on in their illness. The ADA recommends eating a healthy diet and engaging in physical activity to achieve a 500-750 kcal/day energy deficit.1,2 Additionally, blood-glucose levels should be monitored to assess the effectiveness of lifestyle changes and assess whether adjustments to diet and physical activity or addition of medications are needed.5

In select patients, weight loss medications and bariatric surgery (weight loss surgery that involves making modifications to the stomach or intestines) may be considered in conjunction with lifestyle changes.1

For more details on healthy diets and physical activity to manage T2D, read the following articles:


1. Standards of Medical Care in Diabetes—2016 Abridged for Primary Care Providers. Clin Diabetes. 2016;34(1):3-21. doi:10.2337/diaclin.34.1.3
2. American Diabetes Association. 5. Lifestyle Management: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2018;42(Supplement_1):S46-S60. doi:10.2337/dc19-S005
3. Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab. 2016;23(4):591-601. doi:10.1016/j.cmet.2016.02.005
4. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology. 2018;14(2):88-99. doi:10.1038/nrendo.2017.151
5. Franz MJ. Weight Management: Obesity to Diabetes. Diabetes Spectr. 2017;30(3):149-153. doi:10.2337/ds17-0011
6. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. doi:10.1056/NEJMoa012512
7. Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677-1686. doi:10.1016/S0140-6736(09)61457-4
8. Nathan DM, Barrett-Connor E, Crandall JP, et al. Long-term Effects of Lifestyle Intervention or Metformin on Diabetes Development and Microvascular Complications: the DPP Outcomes Study. Lancet Diabetes Endocrinol. 2015;3(11):866-875. doi:10.1016/S2213-8587(15)00291-0
9. Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22(1):5-13. doi:10.1002/oby.20662
10. Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489-2496. doi:10.1001/jama.2012.67929
11. Koenigsberg MR, Corliss J. Diabetes Self-Management: Facilitating Lifestyle Change. AFP. 2017;96(6):362-370.



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