Diabetes Self-Management Blog

Some people say they can’t lose weight, but almost anyone can lose. The problem is keeping the weight off. Very few people (5% in studies) maintain weight loss over the long term. Why do our bodies regain weight, and what can we learn from that?

Understanding weight loss is important for people with Type 2, because they are frequently told, “Lose weight.” Often they do, but it’s frustrating to watch the weight come back up over time, especially if blood glucose levels go up with it. You can feel like a failure. Other people, including your doctor, may blame you and accuse you of not trying hard enough.

But that guilt-throwing is unjustified and scientifically wrong. It ignores our bodies’ natural response to weight loss, which is, “Oh my gosh. There must be a famine going on. We have to pack on more fat or we’ll starve.”

This is a natural, life-saving response developed over 100 million years of evolution. The big danger has always been starvation, not diabetes. So our bodies have learned a number of tricks to get back lost weight, and often a little more just to be safe.

As Jacquie Craig, MS, RD, CDE, wrote here in 2008, these tricks include slowing down our metabolism. The body starts to do everything slower, so as to burn less energy. That way more can be saved as fat.

Bodies will even turn down their temperature to burn less fuel for heat. As a result of slowed metabolism, you may find yourself feeling more sluggish at your lower weight (although not everybody does). This slowed metabolism effect may wear off over time, but nobody knows if or when that will happen for a particular person.

Weight loss also changes our body hormones to make us eat more. Our level of the “hunger hormone” ghrelin goes up, and levels of the “I’m full hormone” leptin go down. As a result, we feel hungrier and food even starts to taste better when we have lost some weight.

Other causes of weight regain are psychological and environmental. Some people may have dreamed that their lives would be magically transformed when they weighed less. When things go on much the same as before, they may miss the comforts of food and start to eat more.

That dynamic hopefully doesn’t apply to most people with diabetes. We’re doing it for health, not to be more popular. But other environmental factors definitely promote weight gain for everyone.

One is the availability of high-calorie, attractively packaged comfort food. Another is the increased sizes of servings. The amount served makes a big difference in how much you eat.

According to Craig,

Many studies suggest that the larger the portion served or purchased, the more a person consumes. In one study, people who were served soup in invisibly self-refilling bowls ate 73% more soup than those eating from normal soup bowls. Interestingly, the people who ate more soup did not believe they had consumed more, nor did they feel more sated than those eating from normal bowls.

“Invisibly self-refilling bowls?” Wow. You have to hand it to those researchers. But the point is that the more you’re served, the more you’ll eat. Large servings make people gain weight.

So what does this information tell us about weight and diabetes? Some experts, like Craig, say we need to learn strategies to maintain weight loss. She suggests getting more sleep and more exercise, and eating more fruits, vegetables, fiber, and protein. She also recommends managing portion size when you go out or take out food, by putting half or more of it away in a box before you start to eat.

Finally, and this may be most important, Craig says “Seek ongoing support.” This could be a group, or just one person who is going through similar issues.

All of those suggestions are good. But to me, the takeaway lesson is different. I suggest not worrying about your weight numbers at all. Don’t fight your body; work with it.

Focus instead on blood glucose numbers, blood pressure, and how well you feel. If those are going in the right direction, I’d put the scale away somewhere. Use it to weigh suitcases next time you pack for a flight.

I would like to know your experiences with weight, though. Has focusing on weight helped you manage diabetes or gotten in the way? And when you have lost weight, were you able to keep it off? If you have, how did you do that?

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