Open Access
Feature Article

Is weight loss the best treatment for type 2 diabetes?

JOSEPH PROIETTO
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© ktaylorg/istockphoto.com. model used for illustrative purposes only.
© ktaylorg/istockphoto.com. model used for illustrative purposes only.

Abstract

Obesity is the main driver of type 2 diabetes and weight loss has been shown to improve blood glucose levels. This article describes the author’s own approach to weight loss in people with diabetes – the use of a very low energy diet followed by long-term weight maintenance (lifestyle changes and appetite-suppressing medication).

Key Points

  • Obesity is the main driver of type 2 diabetes, commonly interacting with chronological ageing and ethnic susceptibility.
  • Weight loss improves blood glucose levels in people with diabetes, and those with a short history of the condition may go into temporary remission.
  • Weight loss is not maintained long term in most individuals because body weight is vigorously defended.
  • Very low energy diets (VLEDs) allow rapid weight loss with maintenance of micronutrient levels.
  • Appetite-suppressing medication may be necessary as well as lifestyle changes after losing weight medically (VLED, bariatric surgery).
  • Many people can cease some or all diabetes medications after substantial weight loss.

Australia is in the midst of an obesity epidemic that is driving an epidemic of type 2 diabetes. This is already a major health problem in developed Western countries but its greatest impact will be in Asian countries, due to the greater risk of developing type 2 diabetes in Asian populations.1 

How does obesity lead to diabetes? When there is excess fat in the body some of it is deposited ectopically causing damage. Excess fat in muscle and adipose tissue leads to insulin resistance,2 and excess fat ingestion stimulates gluconeogenesis and is a major cause of hepatic insulin resistance.3 Finally, saturated fatty acids are a major toxin to beta cells.4

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It follows that losing weight both reverses insulin resistance and improves insulin secretion. Several studies have shown that substantial weight loss, either with a very low energy diet (VLED) or bariatric surgery, can greatly improve blood glucose levels.5,6 This is especially true if weight loss is achieved when diabetes is first diagnosed. 

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Figures

© ktaylorg/istockphoto.com. model used for illustrative purposes only.
© ktaylorg/istockphoto.com. model used for illustrative purposes only.
Professor Proietto is Professor Emeritus at the University of Melbourne, and Head of the Weight Control Clinic at Austin Health, Melbourne, Vic.