Why We Don’t Recommend Weight Loss For Type 2 Diabetes 

0:00
Welcome to the Diabetes Digital Podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

0:17
Visit diabetesdigital.co That’s Co to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

A quick Google search asking Do you need to lose weight to improve Type 2 diabetes Will have you 100% convinced that you should focus on weight loss to manage diabetes.

0:39
In this episode, we’re going to unpack if weight loss is or is not the goal for diabetes management.

And as always, our disclaimer, this podcast is for informational purposes only and should not be considered a substitute for medical advice.

So a scenario that I see all of the time in clinical settings is a patient comes in, they want to lose weight, so they go on a calorie restricted diet.

1:04
And what that means is they’re cutting out foods they’re not eating as much as what they used to eat as much as what their body needs to feel satisfied.

Basically they feel like they’re going hungry.

And for people with diabetes, something that happens often is they cut out carbohydrates because they think that that’s going to help with their blood sugar management.

1:23
This particular patient might also start exercising.

And initially for many people, they might see a drop in weight and they take that as a sign that this is working.

You have doctors, even some dietitians, they’re cheering them on.

1:39
They’re telling them to keep going.

And there’s a false narrative that if you just keep doing what you’re doing, the weight is going to keep coming off at the same rate.

And if it doesn’t happen, which the reality and what we’ve seen in our, you know, 10 plus years of practice is that it usually doesn’t, the weight doesn’t just consistently come off forever.

2:01
So if it doesn’t happen, they might even prescribe weight loss medication.

Or they might say, oh, it’s that you’re doing something wrong.

Absolutely.

And just to give a little bit of perspective, the reality is the reason the scenario is so common is that sustaining long term weight loss is very hard in a meta analysis of 29 long term weight loss studies.

2:24
And just for people who aren’t science starts, meta analysis means that they are studying the studies, essentially looking at a collection of studies.

They found that more than half of the weight loss was regained within two years, and by the five year mark, more than 80% of the weight was regained.

2:42
So that essentially says that even if people are successful in losing weight long term, it’s very hard to keep that weight off.

And many people gain more weight than they lost, as we mentioned.

And so for us as dietitians, this has always been challenging because in school, and we went to school a while ago, 10 plus years ago for nutrition, we were taught that weight loss was the Holy Grail and everybody needs to lose weight to improve their conditions.

3:09
And then we came across this research and kind of the health at every size paradigm and we realized it wasn’t that simple, that many people struggle to keep the weight off.

That’s what the research shows, and for us, we couldn’t in good faith continue recommending weight loss or helping people lose weight, knowing that for many people this intervention just doesn’t work.

3:32
Yeah.

So for today, we are going to cover the nuances of weight loss as a goal for people with diabetes management and also highlight some mindset shifts that could help someone manage their diabetes independent of weight loss.

3:48
Yeah, let’s start by talking about the fact that dieting and restrictive behaviors are meant to fail and keep you coming back.

The thing is, diet brands and companies, they know this.

This is why they spend so much money on marketing and if it works in the short term, but then you gain the weight back, they make it seem like it’s your fault, or you failed and didn’t have enough willpower and you come back because you want to lose the weight again.

4:13
But the reality is that your body is complex and it’s not as simple as doing a diet and losing weight.

Your weight is influenced by so many other factors, mostly genetics, which many people don’t realize that, like a huge chunk of our weight is determined by genetics, but it’s also influenced by medical history, environment, medications, and so much more.

4:35
Yeah, that makes me think of this meme that I saw online.

And it was something along the lines of like if keto worked, then why would you have to restart it a million times?

And I feel like that’s the case for all of these diets.

Like it’s very rare to come across a person who has been doing these diets for years and years on end.

4:55
It’s usually like, Oh yeah, I’m going to restart.

I feel like people usually with that, I’m going to restart X diet again.

And that is very telling because in in thinking about diet and just like not restrictive dieting, but just like the ways that you eat, you want to come up with something that is going to work for you long term that you don’t have to like pause and start, pause and start.

5:16
You don’t want to put so much energy and thought into the foods that you’re eating because like, there’s just so much other stuff that you could be putting your energy towards.

And like the reality is that these restrictive diets with extreme behaviors, they’re not very sustainable. yo-yo dieting is not good for blood sugar control and for someone with pre diabetes or diabetes, it could actually cause harm.

5:41
Now I know a lot of these diets they are recommended to for like diabetes reversal, which we have an episode about that.

Make sure you you dial it back if you want to learn more about diabetes reversal, whether or not that’s possible.

But yeah, these things are are recommended for improving your blood sugar, for reversing diabetes.

5:59
And it’s like the jury’s so out.

The science is very murky around whether or not these are ways of eating that are actually sustainable.

And if someone does manage to lower the A1C with restrictive dieting, that result is only going to last as long as the diet can, right?

6:18
So research shows that on average, maybe six months or less, depending on how strict the rules are.

And I feel like that kind of aligns with my experience.

And what I’ve seen.

Six months is a long time.

Usually I see people who do these diets and they might last maybe two to three months.

6:35
I feel like that’s more So what I see.

If they’ve had like an experience with dieting for someone who’s like just fresh or trying to start a diet that they’ve never done before, maybe a few weeks because they’re like, Oh my God, this is really hard.

The other thing too is we don’t want to shame anybody for wanting to be on a diet or doing diets because it is so normalized in our culture that is very diet focused.

6:59
So we don’t want to shame people.

And we do know that people in smaller bodies and thinner bodies do have thin privilege and they are treated differently.

And people in larger bodies, they experience weight stigma which can affect their mental and physical health.

7:14
So we want to make sure to point that out as well.

It’s not.

The reason for wanting to lose weight makes a lot of sense in our culture.

Having said that, research shows that for most people it’s going to be hard to lose that weight and keep it off.

7:30
And so then the question becomes how ethical is it to be prescribing weight loss if we know that it’s an intervention that has a really low success rate.

The other thing to point out is that weight is not a behavior which makes weight loss an unpredictable outcome at best.

7:48
So for diabetes management in particular or pre diabetes, let’s focus on outcomes that we may be able to affect with some of our behavior changes.

So for example, shouldn’t the outcome be lowering your A1C or improving your blood sugar control?

8:05
Or fewer symptoms of uncontrolled blood sugar, good blood flow, less frequent hypoglycemic episodes, preserved eyesight, better quality of life, Those are all things that we like to focus on at diabetes digital that have nothing to do with weight.

8:23
And the other thing too is just like someone can be at a higher weight or in a larger body and have well managed diabetes, someone can also be at a lower weight and have their blood sugar levels all over the place.

And we’ve seen this first hand often times as providers we focus our efforts on people in larger bodies and we overlook people at lower weights who might be struggling with diabetes and pre diabetes and they may not even get the right diagnostic testing because it’s often assumed that they can’t have blood sugar issues since their BMI is considered quote normal.

8:57
Exactly.

And as health at every size practitioners, you know, we believe healthcare IT should be accessible to everyone regardless of their body size.

Healthcare providers, they commonly have these fat phobic beliefs, whether it’s thinking that people are fat because they neglected their health, because they’re lazy, because they don’t exercise, because they don’t eat healthy.

9:22
Like just in saying that out loud, I’m like, Oh my God, that sounds horrific.

But the reality is that working in these clinical settings, this is something you hear all of the time coming from medical providers.

It’s very normal conversation.

They don’t believe people in larger sizes.

9:38
They’re like, Oh yeah, what?

What they say that they’re eating is not actually what they’re eating because it doesn’t line up with their weight.

And the reality is that if we look around us just using common sense, there are thin people who eat a lot more than fat people or who barely do any exercise at all and are still thin.

9:56
So it’s just like the rationale and just thinking about it in very basic terms, it just doesn’t add up.

But there’s still like all of the just like assumptions placed on why people are a certain weight.

Also, some healthcare providers, they’ll refuse to offer care like medication and referrals to physical therapy.

10:16
They might even deny certain surgeries unless the patient is actively pursuing weight loss.

And in a diabetes setting, people in larger bodies, they’re consistently told to lose weight or they’re like, oh, you’re not being compliant with the recommendations.

So this creates a lot of shame around weight.

10:34
It can result in someone feeling disempowered, maybe not wanting to go to their doctor, which can lead to, you know, just so many other issues.

So to answer the question of the day, Jess, do you need to lose weight to improve your type 2 diabetes?

10:51
Absolutely not.

And that’s why a core pillar of our diabetes digital nutrition practice is weight inclusivity, because we recognize that health comes in all shapes and sizes.

So we provide an inclusive approach that prioritizes well-being over the number on the scale, and we don’t want our clients obsessing over food or weight.

11:10
Everybody is valued and we prefer to help you live an enjoyable life with diabetes.

So no one needs to stress that comes with dieting or fixating on being thin, because by the way, that stress can raise your blood sugar levels anyways, so it’s kind of counterproductive.

11:27
Yeah, and you just end up feeling unhappy, and that’s not fun either.

And thinking about the behaviors that you can focus on and that have nothing to do with weight loss and have been shown to help with diabetes.

Those include exercise.

11:44
And with exercise, we don’t mean going to the gym, even though you can go to the gym.

And that’s totally fine if you like that, But it could be any kind of movement.

If you enjoy dancing, walking, boxing.

What have you been doing lately, Jess?

Feel like you’re pretty creative with movement.

12:00
I like the.

Gym.

Yeah, I like.

Well, I like weightlifting.

Okay.

Yeah.

Or I’ll do it from home.

Like yesterday.

I didn’t make it to the gym, but I did from home.

And I like walking and I like my hip hop dance classes.

And yeah, that’s those are my main things.

What about you?

12:15
Oh.

I love that.

Are you doing in person hip hop dance classes?

No, not yet.

I will.

OK, one.

One of your.

Time.

Baby stuff.

It’s.

Taken a.

Year to get back.

Oh God, OK What I’ve been doing lately has been boxing, jiu jitsu and just walking.

12:31
Yeah, trying to, you know, mix it up.

But what I basically whatever you find fun is whatever you should do, don’t force it.

Cause like food, if you’re not enjoying it, it’s probably not going to last a long time.

We spoke a little bit about nutrition and we have covered nutrition extensively on this podcast, but trying to eat balanced meals that include carbohydrates but also include, you know, your proteins, your fats, your fiber so that you have stable blood sugars throughout the day, Mental health, making sure that whatever that is, you’re talking with loved ones.

13:05
Get a therapist if you can afford one.

Or if you’re open to it, yeah, just trying to make sure that aside from taking care of your physical body, you’re also taking care of your mind.

I feel like we often want to make taking care of ourselves more complicated, but a lot of us know that sometimes it’s just doing less and getting more in touch with ourselves.

13:26
I think we’re always looking for these plans and quick fixes and formulas and at the end of the day it might just be being in stillness, right and maybe not frantically overworking yourself every day if you have the option.

And so I think focusing on baby steps and what makes you feel better in the moment and also overall is really key.

13:49
If you’re looking for a holistic and personalized approach to diabetes management, look no further than Diabetes Digital.

Our organization is committed to transforming the way you navigate your diabetes and pre diabetes journey and we are excited to share this approach with our podcast audience.

14:06
So we’re a team of dietitians, certified diabetes educators and we have extensive experience in diabetes and pre diabetes management.

We offer one-on-one nutrition counseling and as add-ons we have groups and you get meal plans and newsletters and all these different offerings and we invite you to check us out.

14:25
Our website is www.diabetesdigital.co You can go there and go to the Get Started quiz and that will walk you through our different options.

It’ll figure out which is best for you.

We accept insurance and we also have an affordable self pay membership, so check us out Diabetes digital.co.

14:45
Thanks so much for tuning into this podcast and we’ll check you out next week.

Bye, bye.

Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.

15:02
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes.

Plus share with someone who might find this helpful.

You can also connect with us on Instagram at Diabetes Digital.

Dot Co and TuneIn every Wednesday for practical, inclusive and culturally humble diabetes insights.

15:21
We’ll catch you later.

Bye.