There has been much discussion lately about how much weight loss is needed to put type 2 diabetes into remission.
I was a speaker at a symposium at the recent European Association for the Study of Diabetes (EASD) meeting in Stockholm (video recording can be viewed for free here – note this presentation is intended for health care professionals), where we discussed that amongst people who are fairly early in their type 2 diabetes (6 years or less), existing data shows us that 10-15% weight loss with lifestyle changes can put diabetes into remission.
A new study presented at the EASD meeting demonstrated that even in people with type 2 diabetes and healthy range to mildly elevated weight (BMI 21-27), weight loss of about 10% with dietary intervention can induce remission of diabetes. (This was attributed to reduction of excess fat in the liver and pancreas, and reminds us that BMI should not be a diagnostic tool for obesity. BMI captures only weight vs height, and does not reflect body composition (ie how much is fat vs muscle), nor whether excess fat is actually impairing health).
As I pointed out in our panel discussion at the EASD symposium (start at 75 minutes on the video recording), while these data are informative and important, this does NOT mean that people with type 2 diabetes (nor their health care team) should simply set a 10-15% weight loss target.
As the recently release American/European (ADA/EASD) consensus statement advises, weight management targets must be individualized. This is because we need to consider many individual factors. Here are just a few of these:
- What is the weight history and trajectory? For a person who has been gaining weight, keeping weight stable would be a success. For a person who has already lost 30lb (13.6kg), losing another 10-15% may not be reasonable nor appropriate.
- The genetics of obesity are very different from person to person, with well over 200 genes so far discovered that contribute to weight (BMI) or body composition. For some people, losing 10-15% weight may be much more difficult, due to their body’s powerful genetically engineered biology that defends their weight (unless they get help from medications or bariatric surgery).
- What other health conditions are present that may benefit from weight loss, and how much weight loss would we need to see to improve those conditions? What health conditions are present that may make it more difficult to lose weight?
- For some people, 10-15% weight loss may be excessive. For example, in older people, the obesity paradox teaches us that carrying a little excess weight seems to be associated with longer life as we get older. Also, some people who lose a lot of weight may become sarcopenic (depletion of muscle); muscle is good weight that we want to hang on to.
Most importantly – setting a weight loss target can set a person up to feel as though they have failed, if they haven’t reached that target. If a patient of mine with type 2 diabetes loses say 7% weight, doesn’t go into diabetes remission, but feels better, improves their blood sugar, reduces their diabetes medication needs and blood pressure medication needs, has less knee pain and more energy, we celebrate this success! Maybe their diabetes would go into remission 15% weight loss, but this may not be an achievable target for that person.
I will take this one step further, to say that it is usually best NOT to set percentage weight loss targets. The goal in weight management is to improve health (metabolic, mechanical, mental, and quality of life), not to change the numbers on the scale. That being said, the numbers on the scale may be important to some people, and in those cases, it’s okay to include weight loss targets. If weight loss goals are being set, it’s important that they are realistic (in accordance of what we might anticipate from a particular treatment). We need to set individualized goals that include what is important to the person, goals that focus around improving health, and celebrate any successes that we achieve!
PS – For more on whether remission of type 2 diabetes should be a goal at all, check out my recent blog here.
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