Reaching and maintaining a healthy weight

If you have diabetes, one of your major goals should be to lose extra pounds and achieve and maintain a healthy body weight. Lowering your caloric intake (along with getting regular exercise) will help you do this and there are a variety of approaches you can take to achieve this.

Work with your healthcare provider or registered dietitian to come up with a weight loss plan that works for you, depending on your age and health status. Your dietitian will help you come up with a weight loss plan as part of an overall healthy eating plan with realistic weight loss goals and a realistic strategy for achieving those goals. Keep in mind the old saying “slow and steady wins the race.” This is certainly true when it comes to dieting and weight loss. If you lose weight at a controlled and steady pace (about 1 to 2 lbs per week), you’re more likely to keep it off. Moreover, this kind of slow, controlled loss of weight will be safer for you given your overall diabetes care plan.

Weight loss has been shown to have a BIG payoff for people with type 2 diabetes. It can improve (at least partially) the ability of body to use the insulin that you produce.1

Modest weight loss can make a BIG difference!

To gain the benefits of weight loss, you don’t have to reach an ideal body weight, especially if you get regular exercise. Even if you lose 5% to 10% of your body weight (if you are overweight) from the time of diagnosis, this will have significant health benefits in terms of blood glucose, blood pressure, and blood cholesterol. Results from the the 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, found that an intensive program of lifestyle modification, including weight loss and physical activity, found that participants that lost a modest 8.6% of body weight from the start of the study had significant improvements one year later in blood glucose control, blood pressure, triglyceride levels, and high-density lipoprotein (HDL) cholesterol levels. By the end of the study, participants who had achieved this reduction in weight needed to use less medication to control diabetes, hypertension, and lipids.1

How do I know if I’m overweight or obese?

If you have type 2 diabetes, chances are you are overweight or obese. In fact, about two-thirds of people with type 2 diabetes are currently or were at some point in the past either overweight or obese. The definition of obesity, in medical terms, is having a body mass index (BMI), the ratio between how tall you are and how much weigh, of 30 or more (a BMI between 18.5 and 24.9 is considered normal).1

The table below shows a range of heights and body weights and can be used to figure out your BMI if you are an adult 20 years of age or older. (To figure out the BMI of a child or adolescent, you must take into consideration age and sex in addition to height and weight.) First, find your height in the column on the left hand. Then, move along the row until you find your weight (or the one closest to yours). Finally, look up to the top of the column to see your BMI and whether it falls in the normal, overweight, or obese categories. The chart has some limitations, such as overestimating body weight in athletes and those who are very muscular. It may also underestimate body fat in elderly adults and those with low muscle mass. Your BMI is2,3:

  • Underweight: under 18.5
  • Normal: 18.5 to 24.9
  • Overweight: 25 to 29.9
  • Obese: 30 to 39.9
  • Extremely obese: 40 and above

In addition to BMI, increased waist circumference (the measurement of around your waist at the abdomen just above the hip bone) is also used to determine your risk for type 2 diabetes, as well as high blood pressure and cardiovascular disease (heart disease, stroke).2,3

Weight class

BMI

Risk of diabetes and cardiovascular disease

Men Woman
waist ≤40 in waist >40 in waist ≤35 in waist >35 in
Underweight <18.5
Normal 18.5 to 24.9
Overweight 25 to 29.9 Increased High Increased High
Obese 30 to 34.9 High Very high High Very High
Obese 35 to 39.9 Very high Very high Very High Very High
Extremely obese ≥40 Extremely high Extremely high Extremely high Extremely high

Setting a weight goal

The first step in losing weight is to determine your target or goal. Your dietitian or nutritionist will work with you to determine your target weight and the daily calorie intake you will need to get to this weight.1Getting to your goalStrategies for losing weight typically involve reducing calorie intake balanced with physical activity (usually at least 30 minutes of moderate exercise on most days). This combination will allow you to achieve gradual, lasting weight loss. You can reduce the number of calories that you get by decreasing portion sizes and/or eliminating certain foods from your diet. Choosing weekly or monthly goals for weigh loss will help you take the small, gradual steps you need to get you to your healthy destination. Remember, you can’t do this all at once. (Setting frequent small goals will also give you the opportunity to celebrate your accomplishments more often!).Another important factor to consider in putting together a weight loss plan is that whatever diet you use should ensure that you get the proper nutrition. Your dietitian or nutritionist will work with you to make sure that while you restrict your intake of calories, you still manage to get all the nutrient that you need to stay healthy.Learn more about the basics of nutrition and how to eat a healthy diet. As you lose weight, remember to monitor of your blood glucose. This is important because if you take diabetes medications to control your blood glucose, as you lose weight you may need to adjust your medication. Often times weight loss will translate to the need for less medication.Also be cautious about restricting your calorie consumption if you take certain diabetes medications that increase risk for hypoglycemia. Risk for low blood sugar (hypoglycemia) is increased in people with type 2 diabetes who are being treated with insulin or oral diabetes medications that cause insulin secretion (called secretagogues), including sulfonylureas and glinides (repaglinide and nateglinide).4,5 Learn more about hypoglycemia, including its symptoms and how to manage it. Practice portion control. One key to reducing the amount of calories you take in is to control the portions of food you eat. Here are a few suggestions to help you achieve this:

  • Purchase some basic tools for food measuring (if you don’t already have them), including measuring cups and spoons and a food scale (one that allows measurement in ounces or grams).
  • Give yourself what you consider a normal, usual portion, then measure it. This is a good way to get a reality check to see if it is more or less than you expected. If it is more, you will need to adjust your expectations to restrict your calories.
  • Get in the habit of weighing common food items, such as a piece of bread or a bagel. Typically, a serving of bread is 1 ounce. How does your measurement compare?
  • Also experiment with meats and seafood. Divide and weigh portions before you cook them and then measure them after cooking. A single serving of raw meat is 4 ounces raw, but 3 ounces cooked.
  • You will find that if you develop expertise in portion control at home, you’ll be better able to estimate portions when you eat out. (Get used to asking for a doggy bag when you visit your favorite restaurant!)

Learn to read Nutrition Facts labelsThe US Department of Agriculture (USDA) and the US Food and drug administration (FDA) require food manufacturers to provide labels that spell out the nutritional content of different food products (this does not include fresh fruit and vegetables or seafood). You’ve probably seen the “Nutrition Facts” label on foods. If you have diabetes, you should become an expert at reading labels like this. Knowing your Nutrition Facts not only allows you to figure out the amount of carbohydrates in foods. It also allows you to figure out the calories per serving of food items, a piece of information that is important for successfully reducing your calorie intake.

[nutrition chart]

Learn how to read “Nutrition Facts” when food shopping.

Combine your diet with regular physical activityTo be truly successful at taking weight off and keeping it off, you will need to combine a healthy diet with regular physical activity. Talk to your doctor and other care team members about your options for regular exercise. There are many wonderful, enjoyable ways to get fit. Remember, you don’t have to run a marathon. One of the best forms of regular exercise is a brisk walk. Find an exercise partner and make it a part of your daily routine.Learn more about how to can get regular exercise. Types of diets for individuals with type 2 diabetes who are overweight or obese, for weight loss the ADA recommends a healthy eating pattern that reduces calorie intake is recommended. There are a variety of low-fat, low-calorie and other types of diets designed to help you lose weight.

Before starting any diet, make sure you speak with your healthcare provider or your registered dietitian determine whether that diet is appropriate for you. In addition to dietary strategies for losing weight, there are also other approaches, including diet medications, behavioral modification, and surgical interventions.There are a number of commercial weight loss programs that incorporate the principles of these conventional weight loss diets, namely to reduce the number of calories consumed. For most people, it’s not the type of diet that is what determines diet success, but how successful the individual is at sticking with a particular diet (in combination with regular physical activity). This is why fad diets, which involve eating unusual combinations of food, usually don’t work. It’s difficult to stick with something that doesn’t give you some variety and pleasure. To lose weight and keep it off, most dietitians will suggest that you choose a diet that includes many different types of foods and is based on your individual food preferences.3

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Written by: Jonathan Simmons | Last reviewed: May 2014.
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