Dan Howarth with tips for helping patients with type 2 diabetes lose weight
A significant part of all good diabetes management and, in turn, reducing the risk of complications, involves getting blood glucose, blood pressure and cholesterol to target levels. Weight management can and does play an important role in this. For people with type 2 diabetes who are overweight, weight management is the primary goal, particularly because significant weight loss can actually put type 2 diabetes into remission.1
We know weight loss has significant impact on glycaemic control in type 2 diabetes and, while the evidence is not as clear in type 1,1 we do know it can result in a reduced insulin requirement. Nevertheless, weight loss can improve other risk factors associated with diabetes complications, including cardiovascular disease (CVD). Excess weight is also linked to certain types of cancer2, which people with diabetes are not immune from. That’s why losing extra weight is important for overall health.
Most weight loss research has involved people without diabetes, and those with type 2 diabetes. Studies in people with type 2 diabetes have tended to involve either manipulating proportions of the different macronutrients (carbohydrates, fats, and proteins) to achieve weight loss, such as low carb or low fat diets; eating patterns (e.g. Mediterranean diets); or replacements or very low calorie diets. In the short-term, very low calorie diets and low carb diets seem to outperform low fat diets for weight loss, but most systematic reviews and meta-analyses have shown that in the long term, there is very little difference between the different diets for weight loss or glycaemic control in people with diabetes.1 So in effect, the diet that the individual is more likely to stick to is the one likely to be successful in the long-term.2
Whatever diet that the person chooses to follow must be evidence-based and must be seen in the context of the overall health in the long term. For weight loss in people with type 2 diabetes, the strongest evidence supports approaches such as healthy, balanced (low fat) diets, low carb diets, Mediterranean diets, meal replacements and very low calorie diets. Others, such as intermittent fasting and the use of commercial weight loss services have not been extensively studied in people with diabetes.
Tips for you to help diabetes patients lose weight
Any successful long-term weight loss for health has to be deliberate. Patients should be supported in thinking through how they are going to approach their weight loss, what challenges they’ll face, and how to overcome them. Part of this could include starting to cook more often, planning shopping so that they buy healthier foods, packing lunch for work or getting family or friends involved in their weight loss plans.
- Watching portion sizes
This may include using smaller plates, covering the plate with vegetables, therefore leaving less room for other, more calorific foods, and waiting a while before yielding to the temptation of a second helping. It may also involve specifically asking for smaller portions when eating out, sharing larger meals and avoiding the temptation of meal deals.
- Being snack wise
It is a myth that everyone with diabetes has to eat snacks. Snacking brings with it excess calories that can impede weight loss. It’s better for people to plan their meals so that they don’t go too hungry between meals. When a snack is needed, choosing fruits, vegetables, nuts and yoghurts over calorie-rich, nutrition-poor snacks like cakes and biscuits also helps.
- Avoiding drinking calories
One key step for some patients for weight loss is to refrain from drinking calories. This doesn’t mean those who are following a meal replacement or a very low calorie diet, which involves the use of specialist formulae, or when patients have to treat a hypo with sugary drink. But on the whole, patients should be supported to obtain their nutrients from solid foods instead of sugary drinks, juices and smoothies. Calories from drinks do not impact on satiety – or fullness – the same way as solid foods, so you’re more likely to overconsume quickly with drinks. Alcohol also contributes calories so it is a good idea to limit intake when aiming for weight loss.
- Incorporating more physical activity
Although the evidence is limited for the role of physical activity alone as an effective strategy for weight loss in diabetes,1 it is very important in weight management. Exercise is also effective in improving glycaemic control in people with type 2 diabetes, as well as reducing risk factors of CVD such as blood pressure and cholesterol. Patients should be supported to choose activities they enjoy so that they can stick to these for the long haul. They should also be encouraged to spend less time sitting, watching TV or behind a computer and interrupt any such sedentary time with regular standing or walking.
Whatever the principle or approach to weight loss, for long-term health, there is value in choosing foods that support good health. Therefore, people with diabetes should be supported to eat more fruits, vegetables, wholegrains, pulses, nuts, fish and reduce the intake of red and processed meat, refined carbohydrates such as white bread, sugary drinks, energy drinks and juices.
Diet and diabetes can be complex, which is why a specially trained dietitian should be involved in tailoring advice for people with diabetes and explaining the nuances that are often missed in general discussions. Patients’ preferences and other comorbidities should be considered. Some patients may also require medication review or support to check blood glucose levels more often.
Dan Howarth is a diabetes specialist nurse and head of care at Diabetes UK
- Dyson PA, Twenefour D, Breen C, Duncan A, Elvin E, Goff L, Hill A, Kalsi P, Marsland N, McArdle P, Mellor D, Oliver L, Watson K. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2018 May;35(5):541-547.
- Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet. 2014 Aug 30;384(9945):755-65.
Diabetes UK (2018). Evidence-based nutrition guidelines for the prevention and management of diabetes. Full guidelines available at www.diabetes.org.uk/nutrition-guidelines
Diabetes UK practical advice on eating healthily www.diabetes.org.uk/enjoyfood