Diabetes Self-Management Blog

It has long been something approaching gospel within the diabetes community — for people who are obese and at risk for Type 2 diabetes, losing weight is the surest way to prevent or delay the onset of the condition. This advice is backed up by serious research; in one prominent study, overweight people with elevated blood glucose levels who aimed to lose 7% of their body weight through an organized program had a 58% lower risk of developing diabetes over the course of the study.

But studies showing the diabetes-prevention benefits of weight loss also tend to show something else: that very few people manage to sustain their weight loss once the organized program responsible for it has ended. This challenge is recognized by many experts, and some research has specifically examined how weight loss can best be sustained. But one prominent expert believes that in light of the data, health policy makers should give up on the idea of weight loss as a means of diabetes prevention.

In an article published last month in the journal Health Affairs, Richard Kahn, formerly the chief medical officer of the American Diabetes Association, claims that we don’t know enough right now about the biological processes underlying the body’s regulation of weight to develop effective weight-loss programs that can be applied on a large scale. In the meantime, he writes, public health officials and medical groups should concentrate on finding ways to help people control their diabetes once it develops. This, he believes, is a better use of valuable time and research dollars, since effectively controlling blood glucose levels has shown to be sustainable and leads to a greatly reduced risk of diabetes complications.

Not all medical experts and groups, however, are on the same page. As an article published at DiabetesInControl.com notes, several doctors associated with Boston’s Joslin Diabetes Center released a statement indicating strong disagreement with Kahn. Osama Hamdy, medical director of the center’s Obesity Clinical Program, asserted that Kahn was advocating “a surrender in the face of one of the greatest threats to public health the world faces.” Hamdy goes on to say that while maintaining weight loss is “a lifelong battle,” Joslin programs have shown that weight loss can be sustained for long periods of time. One program, he notes, led to a 50% reduction in diabetes medicines taken by participants and a 27% reduction in overall health-care costs.

What do you think — is getting large numbers of people to achieve sustained weight loss an impossible dream? Is it foolish to suppose that programs administered by a leading diabetes research center can be effectively duplicated across the country? Or is Kahn’s approach too pessimistic — or even, as one writer suggests, possibly distorted by ties to diabetes drug manufacturers? Leave a comment below!

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Comments
  1. Quinn, excellent thoughts! There may be many factors affecting Kahn’s thoughts - least likely dementia, but one never knows. Kahn is from the generation of doctors that do not believe in preventive medicine because it does not pay the bills.

    I believe Joslin’s approach is possible, but most in the medical occupation are not willing to get that close to their patients and practice medicine unless there are large dividends for them. Anything that smells like preventive medicine means small dividends in their pocket and these doctors detest small dividends.

    Until we can get another generation (or two) of doctors retired, do not expect Joslin’s ideas to gain any traction.

    We don’t need government adding more restriction as they already are making it onerous for doctors to practice any form of medicine - reporting and accountability forms to complete, insurance forms to prepare - don’t dare make a mistake there as this will cause a delay in payment, and the list goes on.

    Just some of the possibilities.

    Posted by Bob Fenton |
  2. I think the constant haranguing to lose weight “or you will get diabetes” is such a turn off. I’m 68 , with Type 2, overweight and I constantly try to make better eating choices. But I’m not active enough and I’m not going to lose weight. My A1C is consistently 6.1%. A much better approach is to try to emphasize better eating choices and a more active lifestyle, and quit with the guilt-inducing of “being too fat”. People try and they can’t lose weight so the guilt makes them eat whatever they want because “its no use trying”. Please don’t continue to make people feel they give themselves diabetes. It contributes to being depressed, which is no way to work on losing weight. Give people reasons to be happier and stop the emphasis on weight.

    Posted by Linda Truesdell |
  3. I am a Type 2 diabetic, non-insulin dependent. I take medication to control my blood sugars. I have been in a nationally-recognized weight loss program for 6 weeks now with good success. I have confidence that I will keep the weight off. Why? Because I am learning new habits that I will carry with me once the program is completed. Habits such as exercise for 30 or more minutes 5 times a week, using a smaller plate for meals, limiting calorie-dense carbs like breads and sweets, eating more fruits and vegetables, etc.

    If I was only dieting and not embracing these new healthy habits, I’m sure I would go back to my old eating patterns at the end of the program. For me, a weight loss program works because it’s giving me the tools to control my blood sugars and I get to enjoy the added benefits of losing weight and keeping it off!

    Posted by Jamie M. |
  4. I have effectively given up on weight loss, I am now researching lap band surgery.

    Posted by Donna Bennett |
  5. This is really interesting, especially Linda Truesdell’s comment. My mother has been bugging me a lot lately about losing weight. I don’t cotton to tthe guilt trips. I don’t know how to fit an exercise regimen into my life, but am also lazy. I don’t know exactly how to approach my Mom about her “nagging (I have been advised not to use such a word with her.) Please advise.

    Posted by Dan Beane |
  6. What does work… keep the carbs down which keeps the blood sugar down and also the insulin. Most medical people agree that insulin is the chief hormone for fat storage and yet they ignore that fact. Research has proven this over and over again which is probably the chief reason you lose weight when on a high protein (and fat) diet. And there is the fact that most overweight people have learned to only burn only carbohydrates (not fat).

    I’ve used this method for years (I’m on insulin) and it works — never hungry — and not overweight. I also get pretty lazy in the winter without any ill effects… and I’m over 65.

    Posted by John_C |
  7. I sure would hate to see us give up on community programs that promote weight loss just because many of us regain the weight. There may be other benefits even if that weight is regained. And for those who are able to maintain, perhaps because like Jamie, they became more active and/or changed their eating habits for life, there are certainly benefits.

    Trying to counsel people to lose weight as a way to prevent or delay diabetes is a tightrope. We don’t want to insinuate they gave themselves diabetes. As a CDE I always tried to say wt loss will help,even 5 to 7%, but it is very hard to do, but some succeed so I tried to be hopeful. But I also tried to point out to folks who felt they caused their own diabetes that there are also many lucky people with obesity who do not have diabetes. It is a combination of factors so spare the guilt. It isn’t helpful.

    Posted by BK CDE |
  8. Dan, I don’t believe that your mom is intentionally “nagging” you. I believe that she loves you very much and is terribly worried about your health. Mothers are like that! My question for you is do you have 30 minutes to spare every day? Here’s the thing - I am a 72 year old type 2 and I was overweight and have tried just about every diet plan the has come along over the past 15 years or so. Last November, my sister (the marathoner) challenged me to perform some sort of intentional exercise for thirty minutes every day for 100 days. Today I completed my 100th day of walking for at least 30 minutes each day. No gym. No goofy plan. I have lost 35 pounds, My waist has shrunk from 40 inches to a slim 36 and I am going to have to invest is some 34 inch jeans pretty soon. My A1C has gone from 7.5 to 5.6. I don’t follow any diet plan any more - I am in control of what and when I eat by following the “mindful eating” approach. Exercise - 30 minutes a day - 100 days!! You can do it! Love yourself as much as your mother loves you.

    Posted by Jon S. |
  9. People nag, nag, nag and they do not realize the damage they’re doing. If your mother would give up the nagging perhaps you would take it upon yourself to work at whatever goal you would set for yourself. Only you can make a decision to diet, exercise…nobody else can do it for you. If she will let you alone long enough for you to make the decision, then perhaps all will be well and a bonus… you won’t have to remind her what a nag she is.

    Posted by Granny Pat |
  10. I am pleased to see some progessionals finally realizing that dieting & weight-loss is not the golden egg. I have had diabetes for over 40 years. As far as I can tell, I have been overweight for 64 (I am 66 y/o). I have lost several hundred pounds during my lifetime. I am active, exercise 5-7 days every week, practice “mindful eating” & they have all eventually “found” me again. Loosing a chunk of weight does prolong “pre-diabetes” or improve insuling resistance, but in time–the condition returns.

    Posted by RedneckAngel |
  11. Dr. Kahn is partly right and partly wrong. Weight-loss programs are a waste of time, and possibly worse, as the weight is regained 95% of the time, and the regained weight is likely to be more fat and less muscle than the weight that was lost.

    However, community-based fitness programs, which would be similar in content but focus on health instead of weight, are a wonderful idea. Getting people moving and bringing them together is good for them. Focusing on weight is a recipe for failure, although a few of our readers do succeed at it, and more power to them. Check out Health at Every Size at http://www.haescommunity.org/.

    Posted by David Spero RN |
  12. Weight loss programs while of interest and some value, the real issue is energy balance in body and preventing constant overgeneration of glucose.

    In addition identifying reasons for the excess fat build up can go beyond just carbs control and exercise expecially if liver is throwing back too much glucose on regular basis.

    For type 2 diabetics the root cause of the issue is to solve the insulin resistance and get off all the misleading dead end tunnels with no lights on and goof ball theories about fat and insulin efficiency.

    Posted by jim snell |
  13. thanks for information

    Posted by damanpreetkaur |

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Flashpoints
Weight and Diabetes Risk (09/10/14)
Caving to Cravings (09/03/14)
Control Solution = Better Control? (08/27/14)
Candy-Carrying Crisis (08/20/14)

 

 

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