For people with type 2 diabetes who are overweigh or obese, the American Diabetes Association (ADA) recommends reducing energy (calorie) intake, while maintaining a healthy eating pattern that satisfies nutritional needs. There are a variety of commercial and other weight-loss diets designed to meet these objectives.1
The first step in selecting a weight-loss diet is to consult with your healthcare provider (doctor, nurse practitioner [NP], or physician assistant [PA]) and certified diabetes educator/registered dietitian. Your diabetes educator and registered dietitian can help you adopt a pattern of eating that is appropriate for your weight-loss and blood glucose control goals. Importantly, your registered dietitian can give you the counseling and support you need to reach and maintain a healthy weight and control your diabetes.
Take advantage of Diabetes Self-Management Education and Support (DSMES)!
Ask your healthcare provider to refer you to work with a certified diabetes educator who can help you with a healthy eating plan. Medicare and most private health insurance plans will cover DSMES services if you have type 2 diabetes. These service cover diabetes education and support provided by a American Association of Diabetes Educators (AADE)-certified diabetes educator. A diabetes educator is a healthcare professional who specializes in helping people with and at risk for diabetes and related complications to make behavioral changes designed to help them better manage their condition and lead a healthier life. DSMES services focus on seven important self-care behaviors that are keys to living a healthy life with type 2 diabetes:
- Healthy eating
- Being active
- Monitoring blood glucose
- Taking medication
- Problem solving
- Healthy coping
- Reducing risks for health complications
If your provider is not familiar with DSMES services or the referral process, you can direct them to the AADE website or download and print DSMES information and a referral form and give it to your provider yourself.
Low-calorie / portion-controlled eating plans
If you have type 2 diabetes and are overweight or obese, you should work with your registered dietitian and certified diabetes educator to develop a comprehensive weight loss plan that includes counseling on healthy eating and changing eating behaviors, regular physical activity, and ongoing support to maintain weight loss. Your eating plan will set a target for daily calorie intake and plan meals to meet this target, with the goal of putting together menu that provides a balance of adequate nutrients, including protein, carbohydrates, and fats.
Eating plans for weight loss
There are several different eating plans that can be used to achieve and maintain weight-loss goals. These include1:
- Low fat
- Low carbohydrate
- Mediterranean style
- Vegetarian and vegan
A low-fat pattern of eating emphasizes eating vegetables, fruits, starches (eg, whole grains, breads, crackers, pasta, starchy vegetables), lean protein sources (lean meats and meat substitutes), and low-fat dairy products. This pattern of eating reduces fat consumption to 30% or less of calorie intake and saturated fat intake to less than 10% of calorie intake. A low-fat pattern of eating is a frequently encouraged as a strategy for losing excess weight. In the NIH-sponsored Look AHEAD Study, a 4-year randomized, controlled trial conducted in 4,503 adults with type 2 diabetes who had a body mass index (BMI) of 25 or higher, a reduced-calorie, low-fat pattern of eating was evaluated as part of an intensive program of lifestyle modification and was shown to be moderately successful in helping participates lose weight. A low-fat pattern of eating appears to be an effective approach to weight loss when it is coupled with reduced calorie intake.1
Your registered dietitian may suggest menu plans to help you reduce your fat intake. These menus will typically include reduced-fat foods, such as low-fat dairy products and lean meats. In addition, you may find it helpful to count grams of fat, as listed on nutrition labels, instead of keeping track of overall calorie intake. The ADA has concluded that there is no ideal amount of fat intake for a person with type 2 diabetes and that fat-intake goals should be individualized. If you use a low-fat diet, one rule of thumb is to keep fat consumption to 33 grams for each 1,000 calories in your diet. This means that if your target intake is 1,500 calories, your daily fat consumption will be 45 grams or less.1,2
There are a number of popular diet programs that are based on low-fat diets, including the
LEARN Diet (low-fat), the Ornish Diet (very low-fat).2
There is no consistent definition of a low-carbohydrate eating plan. However, such as plan typically focuses on eating protein-rich foods, such as meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds), fats (eg, oil, butter, olives, avocado), and vegetables that are low in carbohydrates, such as salad greens, broccoli, summer squash. Carbohydrate amounts will vary according to the specific eating plan, but most allow fruits and vegetables. However, foods that contain sugar and grain, such as pasta, rice, and bread are discouraged. Moderately-low carbohydrate eating plans generally restrict carbohydrate consumption to 30% to less than 40% of daily calorie intake, while very low-carbohydrate eating plans may restrict carbohydrate intake to 21-70 grams per day.1
Limiting carbohydrate intake has been shown to be very useful in short-term weight loss (weight loss within the first 2 weeks), more so than a low-fat diet. However, studies raise questions about whether results can be sustained over the long term (1 or more years). Low-carbohydrate diets may have particular benefits for reducing the risk of type 2 diabetes, cardiovascular disease, and some cancers.2
There are two main approaches for following a low-carbohydrate eating plan. The first involves reducing the total amount of carbohydrate intake, which can be done by carbohydrate counting and restricting all types of carbohydrates. The second focuses on eating foods with a lower glycemic index. Carbohydrates with a lower glycemic index will result in a smaller rise in blood glucose.
Low- and very low-carbohydrate (under 60 grams of daily carbohydrate intake) eating plans, such as the Paleo (Caveman) and Atkins diets, that have become very popular.
Glycemic index of various foods
|Baked russet potato||135|
|Whole meal bread||99|
|Spaghetti (whole wheat)||61|
|Baked beans (tinned)||60|
|Ice cream, yogurt, whole milk, apple (raw)||49-53|
|Soy beans (tinned)||20|
The Mediterranean diet is a dietary pattern common in the area of Mediterranean where olives are grown (this includes islands in the Mediterranean and parts of Greece, Italy, and Spain). The diet originated when scientists observed very low rates of heart disease and certain cancers among people who lived on the Greek Island of Crete. This lower risk was linked to consumption of olive oil which is a source of high-density lipoprotein (HDL) cholesterol as well as micronutrients with antioxidant properties. The HDL (also known as the “good” cholesterol) in olive oil actually helps lower low-density lipoprotein (LDL) cholesterol (also known as the “bad” cholesterol) which is found in other oils, butters, and margarine.1,2
The Mediterranean diet largely replaces these other oils with olive oil. In addition to olive oil, the Mediterranean diet emphasizes consumption of plant-based foods, including vegetables, fruits, whole grains, pasta, cereals, legumes, nuts and seeds. These food sources are typically eaten fresh, with limited preparation. Yogurt and cheese are eaten on a daily basis and fish, poultry, and eggs less frequently (a few times per week). Consumption of red meat is limited to a few times per month. Additionally, a small amount of red wine (a good source of antioxidants) is included every day.
Vegetarian and vegan
A vegetarian pattern of eating is defined as a diet that excludes all flesh but includes eggs and dairy products. A vegan pattern of eating is defined as a diet that excludes all flesh and other animal-derived products (dairy, eggs). Both patterns of eating involve increased consumption of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals (biologically active chemical compounds derived from plants). Higher consumption of fruits, vegetables, and whole grains, combined with restriction of saturated fats and cholesterol may reduce risk for chronic disease. Studies of vegetarian and vegan eating plans in people with type 2 diabetes have shown that these eating patterns often do result in weight loss.1
The DASH (Dietary Approaches to Stop Hypertension) diet is an eating plan that emphasizes consumption of fruits, vegetables, and low-fat dairy products, including whole grains, poultry, fish, and nuts. This eating plan restricts consumption of saturated fat, red meat, sweets, beverages that contain sugar, and sodium. In individuals without diabetes, the DASH diet has been shown to reduce risk for cardiovascular disease and lower blood pressure. There is limited evidence of the effects of the DASH eating plan in people with type 2 diabetes.1
How effective and safe are different diets?
Various commercial weight loss programs and general types of eating plans have been evaluated for their effectiveness in helping people lose weight. If you have type 2 diabetes, not all weight-loss plans are safe. So, you should consult with your healthcare provider or dietitian before you start any weight-loss plan.