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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Comments
  1. I have (known) I’ve have diabetes since I was 22y/o & except for being underweight as an infant (or so my Mom says), I have always been overweight. I have dieted many times starting when I was about 8 years old. It has always came back. Most recently when my my A1c inched over the 7.0 mark for the 1st time in 15 years, I went on another serious diet. I am now 11 lbs. lighter than I was 9 years ago when I last dieted & lost 56 lbs. My most recent A1c was 6.2, my Bp is okay w/antihypertensives but I am trying to get to a BMI just below 30 to give myself some ‘wiggle room’ when (not “if”) the weight starts accumulating again;I’ve got 5-7 lbs. to go.
    Personally, I think diabetes causes overweight, not the other way around. No matter what I weigh, my body-shape stays the same, there is just less or more of it!!

    Posted by Redneck Angel |
  2. You’ve hit the nail on the head. As a psychologist who has worked with people with eating disorders, I applaud your article. Very important information! The guilt that people often feel when they lose weight only to gain it back can be crushing. It is so helpful to know that there are natural, biological mechanisms that make this happen. I think that having this knowledge can help people 1) not hate themselves when biology takes over and the weight comes back on, 2) make smarter choices about how they approach eating overall. Great summary of a complex issue!

    Posted by Emily Mohr |
  3. Seems like you can’t win for losing. Insulin makes you gain weight, you can’t eat samdwiches because the BREAD will cause a rise in your blood sugar, etc. If you have any chance at all of beating this disease at it’s own game, you need to adopt a Paleo, hunter gatherer diet and keep moving! Anything processed or starchy is not good for you. Even some fruits are too sweet AND THEY GROW ON TRESS AND VINES!!! I know some doctors who will freak out if your A1c is 7.0! And they absolutely live to keep you on drugs! If you mention to them that you might need a vitamin or mineral supplement of some sort, they will be quick to tell you that “the FDA hasn’t approved it”. But they don’t have any problem giving you that poison that the FDA HAS approved, that big pharma pays them handsomely to push down your throat and you should read some of the side effects they offer—in some cases, even the possibility of death!!!

    Posted by Terri |
  4. Great article for educating us on why the body wants to stay overweight. That knowledge can be powerful to lead us to change negative habits. However, the conclusion to not worry about weight seems flawed. If we want to improve BG, BP, and overall how we feel, it will be pretty important to deal with the weight. I agree that guilt of poundage added to the scale shouldn’t weigh us down so much that we feel so defeated we reach for the Oreos, but if we’eve developed habits that have put on the weight, it’s also possible (although harder) to develop habits to take off the weight. Typical dieters do that for a while with success and then after a while the old habits start to surface again and that is a major reason for the weight to come back on. From a recent book I read by Charles Duhigg entitled “The Power of Habit: Habits are not destiny and can be ignored, changed, or replaced, but when a habit emerges the brain stops fully participating in decision making.”

    Posted by Erik |
  5. Personnally I hate testing my blood, its bad enough I am using insulin now, I hate using a journal and hate the fact I got diabetes by my fill in doctor because he overdosed my asthma medication. Yes, that’s how I ended up with this disease.

    He didn’t admit it until after one year passed, and in return, I told my primary I would never go to that PA again and would tell everyone I could about his so called manners, I would have put up with thousands of Asthma attacks not to be thrown into having this disease.

    So to help me out I’ve read material on the subject from every source, and the big kicker is most of the medications prescribed for this disease makes you gain weight. I inform my doctors what I will and will not take, I know I have to exercise more, eat better, and get sleep. I finally made it down to 199 but have only seen that for a week, it goes up to 205 most times.

    I use to be 98 pounds soaking wet, after my daughter was born I gained over 200 pounds, no one had a answer for me. I did manage to lose 48 pounds in 2012, but between my sluggish energy, now my BP is high, I’m always stressed, and I need to calm myself down, my sugar for the most part is good. Not great but good.

    Posted by Bonnie Lu Brehm |
  6. I think this is a very tricky problem. When I got diagnosed with type 2 diabetes, I was 50 but apparently, I’d been diabetic for 20 years. Well, oral meds didn’t work and I got put on insulin. I very very quickly gained 90 lbs and of course my blood pressure zoomed to say nothing of the problems weight created generallly. My eating habits hadn’t changed except to limit carbs but the weight grew. I asked a doctor, “Do you think I’d prefer to die from the ravages of diabetes or obesity?” His somewhat snide reply was “That’s up to you” and he absolutely refused to admit that insulin was a factor in my sudden weight gain. Well, just to test, I stopped the insulin and lost all the weight in 4 months, again on very low carb, almost paleollithic diet. I don’t have any answers to anythhing as the diabetes seems to advance and with it the spokes on the wheel where the hub is diabetes. It affects everything and my health is a disaster of pain, soreness, clumsiness, torpor and more. And I don’t suffer from guilt about weight but I do suffer from the artifacts of weight problems in themselves. It just can’t be good to be more than moderately overweight and I think any strategy for dealing with diabetes has to include some element of weight management. Thanks for the article

    Posted by Gary Ferrini |
  7. It’s unfortunate that many otherwise intelligent people (including some in the health care profession) will read this article and wave it off because they “know” the only thing that makes you fat is eating too much. They will ignore the evidence presented showing that the body physically changes during weight loss in order to cling to and regain pounds, and throw out the tired accusation that the dieters must have reverted to their “bad habits.”

    I agree with David’s comment about the futility of “guilt throwing” and will even take that concept a step farther to outright prejudice. Overweight people are the last group in America that it still seems OK to discriminate against. No one cringes when they hear a fat joke, and when an overweight person is terminated from a job they excel at because their new boss doesn’t want to be around fat people, we’re told, “Oh well. They’re not a protected class, and you know, they brought it on themselves because the ‘chose’ to be overweight.” As always, science and logic pale in comparison to people’s dearly held prejudices.

    Posted by Joe |
  8. My weight has fluctuated up and down for years. My BEST weight was about 15 years ago. I worked out 4 or 5 days a week, did my martial arts training 5 days a week….my weight then was 235 and my body fat content was approx. 6.8%.. After I was diagnosed, my weight crept up to over 328lbs, and my body fat content went to 32%. Seems I couldn’t stop eating!! Now, I’m back down to 280 and headed for 240 again. I think the “diet” issue is as much mental as physical. You have to WANT to be thin and STAY thinner!! One of the best things I ever learned was, “If you want to be thin, eat like a thin person”!! Sounds simplistic, but it does work. My last A1c was 7.2, up from 6.6 (my fault entirely), but my BP is now averaging 118/62, my total cholesterol is 162, and I’ll get there…I’m SURE of it!

    Posted by Karl |
  9. I have been pre-diabetic for 15-20 year, and my numbers weren’t great, but A1C of 5.8 was common and I was finally taking Janumet after years of metformin. Then my toes began to tingle and get numb and fear of losing my toes/feet was enough to motivate me to stop carbs and exercise daily. I lost 20 pounds and feel great. Toes are getting better. If a person knows what the effects of diabetes will be and what life will be like, diet and exercise is a small price to pay.

    Folks need to realize it is all about quality of life, do you want to end it in a wheel chair because you can’t walk?

    Posted by Steve |
  10. Does Metformin make you gain weight?? I am pre diabetic and my dr. put me on metformin to prevent from getting diabetes, however I have gotten really thick around my waist. I have never had a midrift bulge before. Whats going on??

    Posted by Laverne |
  11. My weight is like a yo yo. I lose five pounds then gain it back. I weigh myself daily and it is frustrating to see weight loss then gain pounds back. I am trying to lose fifty pounds.

    Posted by Toni |
  12. Steve why did you go off metformin??

    Posted by Laverne |
  13. When I was diagnosed with diabetes seven years ago my doctor told me to lose weight. I lost 35-lbs (more than 15% of my body weight). That, with an exercise regimen helps me maintain my A1c right around 7.0.

    I now weigh the same as when I got out of the army 50-years ago (after a seven year enlistment - I was extended an extra year because of the Berlin crisis), and the same as when I got married 40-years ago. I love playing soccer with my 6-year old grand-daughter - she has lots of energy and I have no problem keeping up with her.

    I feel losing weight helped in my case.

    Posted by Stan |
  14. When I was diagnosed with Diabetes in 2003 I was at my highest weight. I lost 20 lbs. over the next 3 months and another 10 the following 3 months. Of the total 30 I lost, I have managed to keep more than 20 off; however, I struggle with 5 - 7 lbs. that I just can’t seem to lose for good, and I could stand to lose another 20. I’ve struggled with weight all my life. I’m trying the Almased approach right now. I have lost 7 lbs. and am hoping it will work for me on a long term basis.

    Posted by Janet |
  15. I have been diabetic since 2001 and my weight has went up and down. I take met&ongluza combo and was taking glybride. I told the dr that my numbers kept bottoming out mostly 56 and 39 after exercising. I am off the glybride(I was discouraged because of the lows it gives. I asked how could I lose weight if I had to keep eating because of my BS going low?? My a1c was 6.2 enough to be taking off glybrude. I joined a free online weight loss site called spark people. I have joined a BLC Biggest loser Challenge and am down about 15 pounds. I feel great and look great and will continue to loss weight. I know it will be a battle to keep the weight off but I am so worth it! I am nearing over weight not not obese. I hate that word!

    Posted by pat |
  16. I have struggled with my weight for years and I’m sick and tired of it. If I don’t lose weight I get frustrated and if I do I get excited then I gain it back. It’s a never ending cycle.
    I try to eat right but sometimes I just don’t give a hoot and I’m off Then I worry that my Dr. will yell (kinda) so I stop.
    I’ve had diabetes for 10 years and I’m not on insulin (yet). My last A1c was 6.3 down from 7.1
    I go up and down, so I liked the article and I’m not going to worry about losing weight or gaining it (HA) like I might be lying about not worrying
    I’ll probably worry the rest of my life.
    Oh well, life goes on.
    Thank you for the article.
    Holly

    Posted by Holly Wirth |
  17. I just read the above post and my dr admitted that diabetic meds can cause weight gain. In the beginning he did not want to place my on any meds. As I started out on ameryl 4 gms 2001 got off because of weight loss. Controlled with diet and exercise until 2007. I started met and junevia. later I told the dr I did not want actos, advandia, and now junevia all may cause cancer and heart attacks. then dr stopped practicing to hlpe at a hospice house. Got anther dr and he has helped greatly. He listens to my concerns and he himself is trying to lose weight. So he understands the battle. I never take amy meds without checking them out first. My pulmonary dr does not appreciate my debating with him on certain meds. But that is too bad this is my body and I do have control over what goes in it.

    Posted by pat |
  18. I was diagnosed with type 2 diabetes about 2 years ago. I was very overweight, 266 pounds. My medical provider said if i could lose at least 10% of my body weight, I may not need to stay on metformin. I spoke with a dietician that explained about portion control. I lost weight just by changing the amount of food I ate. For breakfast, instead of eating 2 pieces of toast, I had one. I ate less of everything. I didn’t “diet”, I allowed myself to continue eating what I wanted, but less of it. I’ve learned over the past 2 years about carbs, protein, exercise and fat intake. I am happy to say i have lost 65 pounds thus far, my clothes are 3 sizes smaller! I still eat “unhealthy” sometimes, but not everyday like I used to. I’ve incorporated more fruits and veggies and fiber into my diet. I’ve made several “small” changes like using light mayo,eating Sara Lee 45 calorie bread, switching to whole wheat pasta’s and rice, and I drink more water. I am no longer on diabetes medication.

    Posted by Gypsy |
  19. I’ve had diabetes 2 for nearly 15 years. At first it was easy to manage my eating and keep the A1C below 6, but as time went by, the A1c crept up as did the weight. What once could be controlled with metformin began to require increased doses, and then the addition of glyburide, and then the addition of Januvia. At one point the A1c went as high as 9 and I really worked to lose weight and lower that to 7.2. I gave up bread, I became a vegetarian, I changed to almond milk instead of dairy milk, I changed to five small meals a day. I still need to lose 20 lbs. I am 71 and moderately active.

    During the last two months I have started drinking smoothies with protein powder twice a day and eating a reasonable meal once a day, with an afternoon and evening snack. The weight is slowly changing — about a lb or 2 per month, but the morning glucose readings have been dropping rapidly. My FBS average for two weeks is 117 and the 30 day average is 129. I’ve even had several readings below 100. I think the better balance of nutrition in the protein powder is helping to bring down my FBS. I’d like to lose the weight faster, but I’m not concentrating on it now — I’m just pleased every morning to see the glucose numbers going down.

    Posted by Juanita |
  20. If you only diet to lose weight, of course, you’ll maintain the same body shape, just a smaller size. I used to follow a diabetic diet and would walk for miles trying to lose wt. and change my body shape. With the help of Dr. Becky Gillaspy online, I have been doing high intensitey interval training 4 days a week along with lowering my carb intake, and have lost 25 lbs. in 4 months and totally reshaped my body! I’m almost 70 years old, so it’s not something only the young can do. Get with the program and get serious about not just losing wt., but getting healthier too. I’m off 3 prescription meds now and hope to get off more. Don’t wait, just DO IT!!!!

    Posted by Pam |
  21. I read your article and was overjoyed to read something that didn’t degrade people who have weight problems and are diabetic.
    What many people don’t realize is that there are people with diabetes who CANNOT exercise because of other problems. I struggle everyday because some times it’s difficult for me to even walk with spine issues that surgery cannot correct. Add to that, I have porphyra, a disease which needs CARBS in order for me to function. The treatment I need when I’m having and attack is an IV glucose which I can’t have because I’m diabetic so I deal with the IV of saline for the dehydration part of it. Added to that is Celiac disease where you can’t have anything with wheat in it and life becomes a roulette wheel.

    I envy people who have success with this disease and the ability to change their diet and exercise.
    May God or whomever or whatever you might believe in, give us the strength to get from day to day.

    Posted by Carole Broskoskie |
  22. Good for you Gypsy. You are doing great. Keep up the good work.

    Posted by Laverne |
  23. Usually I would make a new Year’s resolution to lose weight, but this year my New Year’s resolution instead was to monitor my blood sugars since after almost 19 years they were getting more out of control than they had been, mostly on the high side..
    Luckily I tried to keep this New Year’s resolution because I knew intuitively that eating to control diabetes would help with weight loss. I did end up losing close to 60 pounds, but the most important thing was that it seemed to actually save my life.
    I had no symptoms, but my doctor recommended a CAT scan before he changed my medications that seemingly were not working effectively. The CAT scan revealed pancreatic cancer, and I had immediate surgery.When the surgeon talked about pancreatic cancer before doing the actual surgery, he was not too optimistic about a long life because there are no tests for pancreatic cancer, and when the symptoms come, they often come after it has spread.
    I am at the end of a regimen of 6 months of mild chemotherapy, which was recommended as a precautionary measure since it appeared the tumor was removed completely and did not spread.
    I am a person who usually enjoys food, but now I have the same commitment to keeping my carbohydrates low so my diabetes can be under decent control. I don’t know for sure that I will definitely keep the weight off now that my appetite has increased, but I do know that eating low carbohydrates to do the best I can in keeping my diabetes under control has to continue to be my goal.

    Posted by sharon epstein |
  24. Wow, this is quite a topic. I agree, we were made to survive a famine and most of us are not ever going to see one. We are surrounded by food!!! But we can’t ignore the studies that show people who lose weight when they are diagnosed with Type 2 do better in the long run, EVEN IF THEY GAIN IT BACK! So it is worthwhile, but yes we have to acknowledge that it is not easy to do and not easy to maintain. I am convinced that exercise and stress management, if that is really possible, are some of the keys to weight maintenance. I also think we need to look at trying to use meds that do not cause weight gain, but insulin is an absolute necessity for some. Some studies though have suggested that it is less likely to cause wt gain if used so blood sugars are near normal. So many factors to consider. Unfortunately, not the least of which is money. At least metformin tends not to cause wt gain and may help people with wt loss and it is generic.

    Posted by BK CDE |
  25. How true! Also individuals from certain countries, such as, Scotland, England and Scandinavian Countries, seem to be especial “prone” to the “feast or famine” problem.

    Posted by Sharon |
  26. I agree with most of this blog. I’ve been diabetic for a good 12 years, I hate metforin with a passion, I know where every toilet is in my town. How many times do I have to say to my care team, Is there anything else I could take? It’s either diarreah or I’m plugged up. I have stayed the same with my weight 210 lbs to 225 lbs for years, but in the last 5 years I broke my ankle then recently had knee surgery on the other leg. I’m tired of not being able to get out much. I used to be hiking and riding my bike for hours on end now I can barely walk. How am I to control my BS #’s and my weight? other than starving myself. I’m tired of all this. Sometimes I can’t wait til it’s all over. But I’m just tired of weighing my food or myself and seeing everyone around me just enjoying whatever… its so depressing.

    Posted by theresa |
  27. I was taking , by one Dr. ’s orders, (4) metformin, (1) actos, (1)januvia, 8units of lantus in the morning, and 14 units at night. I kept having lows during the day and at night. I was gaining an extreme amount of weight. Went to an endocrinologist, loweredthe lantus, to 8 units a day,dropped the actos, changed the metformin to (2)janumet a day. Lost 57 lbs. Improved my BP, lowered my A1C to 5.9% . Still excercise, feel great.

    Posted by KAY C PRUITT |
  28. Oh yeah—to piggyback on that vitamin comment I made in a previous post, my doctor was totally against me taking D vitamins, saying “the FDA hasn’t approved them” and would you like to guess which vitamin my bloodwork showed I was deficient? You got it—VITAMIN D! Ugh! Seems to me that you have to be a little bit of your own doctor these days. I love homeopathic and naturopathic physicians too, but sometimes it’s all about the money with them too. They are going to be more expensive to see because insurance will not cover the visits and if you do find someone who is saying all the right things about natural supplements and the like, they will charge you an arm and a leg to get them and act like you have to get theirs or no one else’s will do! Fruits and vegetables, lean meats, a little fat (good fat), and lots of fresh air, excercise and a good nights sleep. And a treat every once in awhile. And leave all that processed, diet and sugar free stuff alone! If it’s got more than three or four ingredients and you can’t pronounce what they are or if it comes packaged and can live on a shelf for months, sometimes years—leave it alone!

    Posted by Terri |
  29. My heritage is Celt and northern German and maybe some Franc. That’s all. Our ancestors are all northern European. If we so much as sniff at food we will gain weight. I have had to bicycle 100 miles 3 times a week and run 5 to 10 miles twice a week in order to maintain a normal weight. I will have eaten no more than a smaller person eats. Since I was injured and have lost some of my balance and can’t ride a bicycle or run. I have a terrible problem if I even dare to eat at all. My families DNA is such that our metabolism is slow and we maintain heft for the Northern European weather. But I don’t do what my ancestors did then and what a struggle.

    Posted by Herb |
  30. Terri,

    My endocrinologist tested me for vitamin d deficiency because she herself suffers from it. She found that a large number of her type two diabetes patients do.

    Posted by Joe |
  31. Insulin absolutely makes you gain weight- BUT not all by itself. When your Dr. starts you on an insulin regimen it is imperative that you also see a registered dietitian to change your eating habits!!! The two work together, If you take insulin and keep eating the same way, you will gain the weight. Let me repeat- you can’t do one without the other. I counsel overweight patients with and without Diabetes and at least 50% of the problem is eating habits and lack of knowledge about what to eat. They always gain the weight back when they go back to old habits. If you have several issues like immobility and can’t exercise, you may consider Bariatric surgery. It’s not easy and it’s not for everyone, but it does get you to a place of better, manageable health and off the insulin . It’s then up to you to keep it off by being able to exercise, eating correctly and meeting with your medical teanm including a dietitian.

    Posted by Cindy |
  32. I hear Theresa about metformin. It is a great drug for those who can tolerate it, but some people absolutely can not. It makes their life miserable. Hopefully we will have more affordable options in the future.
    I also hear the person talking about their metabolism. I don’t have diabetes, but I do weigh almost all my food and use My Fitness Pal to be able to maintain my weight, and like mentioned, I have to exercise about an hour a day, usually walking about 3 to 3/5 mph and stick to 1200 calories which is not very much, but it’s the way it is for me.

    Posted by BK CDE |
  33. I have experienced a battle trying to lose weight. I have tried many weight loss program. The one program that has so far been good for me is Weight Watchers. I still am losing very very slow but the weight is gradually coming off. You are right it is very frustrating.

    Posted by Stella |
  34. Does anybody know if there is a time when you should STOP eating at night. I have heard (can’t remember where) that you should stop eating at 7. My blood sugar is still too high in the morning..sometimes 125 - 140ish. I don’t eat lots during the day but wondered for blood sugar sake if there is a better time than not to stop eating. I am not on injectables..but take a 500 mg in the morning of Metformin and take 2 or 3 at nite. thanks.

    Posted by mishelle |

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