The Dilemma of Weight Loss in Diabetes

Abstract

People with diabetes receive mixed messages about weight loss from magazines, newspapers, friends, family, and, yes, even health professionals. Few subjects have accumulated as much misleading and potentially dangerous folklore as the subject of obesity. A common message is that losing weight is just a matter of willpower, and if you have been losing weight and reach a plateau, it's because you've lost your willpower and are no longer following your diet. Furthermore, for people with type 2 diabetes, the message often is that weight loss is the answer to improving glucose control: “If you just lose 20 lb, you won't need insulin.” What does research tell us about these issues, and what should our messages as health professionals be to people with diabetes? Obesity is a serious worldwide problem and is associated with the risk of developing diabetes. Today, more than 1.1 billion adults worldwide are overweight, and 312 million of them are obese.1 In the past 20 years, the rates of obesity have tripled in developing countries that have adopted a Western lifestyle, with the Middle East, Pacific Islands, Southeast Asia, India, and China facing the greatest increase. Consequently, the number of people with diabetes in these countries is expected to increase from 84 million in 2000 to 228 million by 2030. Thus, preventing obesity is a high priority for the prevention of diabetes and other chronic diseases. According to some obesity researchers, it may not be possible to decrease the current numbers of overweight and obese people in the United States, but we need to try to slow or prevent the increase that has been occurring at an alarming rate.2 The hope is that slowing the rising prevalence of obesity will also slow the diabetes epidemic. Can this be accomplished? Thus far, nothing seems to …