For people with diabetes who are overweight, sustained weight loss can have many positive effects, including lower blood glucose levels, better cardiovascular health, and better sleep. While most weight-loss advice is aimed at people with Type 2 diabetes, many of whom are overweight or obese, being overweight with Type 1 diabetes carries risks, too.
No matter what type of diabetes a person has, excess weight tends to increase insulin resistance. With increased insulin resistance, more insulin or other blood-glucose-lowering medicines are needed to keep blood glucose levels in target range. Losing excess weight lowers insulin resistance and often allows a person to lower his doses of insulin or other medicines. For people with Type 2 diabetes, it may mean being able to stop insulin or other medicines altogether. (People with Type 1 diabetes always need to take some insulin, even at a healthy weight.)
While there are many approaches to losing excess weight that can be successful, weight-loss programs that use a team approach and are medically supervised can be especially effective at putting people who need to lose weight on track for success. In programs that take a team approach, endocrinologists, registered dietitians, and other people who are working to lose weight work together to form a support system and a sense of accountability during the process.
How it works
For Terry Sharp, 56, who was diagnosed with Type 2 diabetes about 20 years ago, a weight-loss program with a team approach helped him lose weight and reduce the amount of insulin he needed to take. Despite being active his whole life, Sharp’s weight was “never going down,” and his blood glucose remained high, he says. In 2010, during a routine visit to his endocrinologist, Sharp weighed in at 277 pounds and was told he needed to lose weight. “[My doctor] told me I was doing half the work,” he says, referring to his regular exercise but less-than-healthy diet. “But I was getting zero results.” So Sharp joined the University of Arkansas for Medical Sciences’ (UAMS) Weight Loss and Metabolic Control Clinic, located in Little Rock, Arkansas.
“I didn’t tell anyone at first,” Sharp says. “I was afraid I’d fail. I followed the plan, got control of my diet, and, pretty soon, I saw results.”
“Diabetes is one of the few diseases that can be managed with diet,” says Registered Dietitian Betsy Day, manager of the UAMS clinic. “But patients must be proactive.”
The clinic offers a 16-week program that incorporates meal replacements, behavior modification classes, and medical supervision, says Day. There are two endocrinologists on staff, which sets the UAMS clinic apart from other weight-loss programs and is important because people with diabetes need monitoring by medical professionals, she says.
Before beginning the program, potential participants undergo an initial evaluation, including tests of kidney and liver function, blood glucose measurements, and blood cholesterol and triglyceride measurements, Day says. The initial lab tests are repeated after the first four weeks, and routine monitoring is also conducted.
The program does not rely on weight-loss medicines, says Monica Agarwal, an endocrinologist at the UAMS clinic. Those who enroll in the program are taught to set realistic goals and encouraged to understand that lifestyle changes must be sustained to lose weight and maintain the loss, Day says.
“We empower [participants] to focus on a weight that’s obtainable and maintainable,” she says.
The first eight weeks of the UAMS program focus on behavior modification, including psychological aspects, Day says. The second eight weeks are “nutrition 101,” during which participants learn about carbohydrates, proteins, micronutrients, and macronutrients, as well as the importance of physical activity, she says.
The UAMS clinic provides Health One meal replacements through its program, which are also used by nine other similar clinics across the country, Day says. For the first six weeks, participants eat only the meal replacements. This is to help them avoid worrying about cooking or shopping and instead focus on appropriate portions and calorie intake. After that, fruits, vegetables, and lean meats are gradually added, she says.
Ultimately, the appropriate amounts of carbohydrates, proteins, and fats vary for each individual, and total caloric intake must be individualized to achieve specific weight-loss goals. This is why a team approach that includes a registered dietitian is so useful in ensuring the weight-loss success of individuals with diabetes.
Participants in the UAMS program are encouraged to keep food journals both during the program and after it ends, Day says, because it “puts them back to problem solving, and they have to take ownership.” Weekly weigh-ins also encourage accountability, she says. “There’s no shame, but it keeps them mindful and accountable.”
At the end of the program, most participants have not yet reached their weight-loss goal, Day says. So program staff work with participants to establish an individualized plan to continue on their journeys.
“They have to get out of their comfort zones and get involved with what they eat versus going through a drive-thru window,” Day says.
While about 40% of those in the UAMS program have diabetes, it is open to anyone seeking weight loss, Day says.
Though he did not start the UAMS weight-loss program with a “numeric goal” in mind, Terry Sharp says he hoped to reduce his medicines and lead a healthier life. He learned to make lifestyle changes and lost nearly 50 pounds. He had been taking the insulins glargine (brand name Lantus) and glulisine (Apidra), and, once he lost weight, was able to drastically reduce the amount he used, going from “four shots a day to one,” he says.
Reducing the amount or number of medicines one takes is a “success that you can’t quantify,” Day says.
Agarwal says making lifestyle changes can dramatically improve the quality of life for people with diabetes. After weight loss, many people are able to stop taking or reduce insulin and/or oral hypertensive (high blood pressure) drugs, she says. She says many people, like Sharp, can go from three or four injections a day to only one after making small dietary and lifestyle changes, and losing only 5% to 10% of their body weight.
That amount of weight loss has also been shown to prevent or delay the onset of Type 2 diabetes in people considered to be at risk of developing it. In the Diabetes Prevention Program (DPP), a major multicenter clinical research study reported on in 2002, participants who set a goal of losing 7% of their body weight by adopting a healthy diet low in calories and fat and increasing moderate-intensity physical activity, such as brisk walking, to a minimum of 150 minutes per week were dramatically less likely to develop Type 2 diabetes.
The format of the DPP has now been adopted by YMCAs throughout the United States to help more people avoid developing Type 2 diabetes. In the YMCA Diabetes Prevention Program, a trained lifestyle coach educates participants about nutrition, stress reduction, being more physically active, and staying motivated. The course starts with 16 one-hour sessions, followed by monthly meetings for up to a year.
The ADA Standards of Medical Care recommend a target weight loss of at least 7% of body weight and a minimum of 150 minutes of moderate physical activity, such as walking, at least three days a week for people considered to be at risk of developing Type 2 diabetes.
Dr. William Bestermann, the medical director of Chronic Condition Management at Holston Medical Group in Kingsport, Tennessee, also applies a team approach to weight loss at his clinic, similar to UAMS, with the person needing to lose weight at the center, and physicians and dietitians providing education and support.
“We talk with patients about their barriers and facilitators to weight loss and work together to address them. Ignoring these practical issues is a recipe for failure,” he writes in “Incorporating Practical Lifestyle Management for Obesity,” published in 2010 in a supplement to The Journal of Family Practice.
“By working closely with the patient, understanding and addressing specific areas of concern, and taking small steps and building on success, we have had patients lose impressive amounts of weight,” he says.
Dealing with setbacks
After his weight loss, Terry Sharp decided not to continue with the UAMS program. But after about 15 pounds “crept back on,” he reenrolled in January 2012, with a goal to lose another 40 pounds, he says.
“My goal is to develop the discipline to follow through,” he says, adding that the team effort has greatly contributed to his weight loss success. “I tried it on my own and it didn’t work. It’s given me the time to pay attention to myself and take time for me.”
Day says it is common for individuals to come back to the program, and that it can take up to three tries for people to fully maintain weight loss.
The program taught Sharp to be conscious of what he eats and to read labels. Sharp says his biggest challenge has been controlling what he eats on the weekends, which are not as structured as his weekdays. “The slippery slope is real,” he says.
Sharp says controlling his environment and enlisting the support of his family have been essential. He sometimes brings the program’s meal replacements to restaurants to ensure he knows what he’s eating. Sharp, the Development Director at Boy Scouts of America in Little Rock, Arkansas, has inspired others in his office, even those who do not have diabetes, to join the program.
In addition to eating better, Sharp began exercising more. He now walks three miles a night on his treadmill while watching ESPN. Before beginning the program, he walked about half a mile a day, he says.
The UAMS clinic epitomizes the “value of social and community support” in weight loss, says Day. Patients work together toward a common goal, and “having people clapping for you reinforces what you’re doing,” she says, adding that having someone to “commiserate with” is also valuable.
Finding a program
In addition to lowering blood glucose and blood pressure and improving heart health, losing excess weight relieves stress on joints, makes moving around and breathing easier, and often gives a person more energy.
Agarwal encourages people with diabetes to consult their physicians before beginning any type of weight-loss program, because a person’s blood glucose level should be checked often during the process.
“It is best to let a health-care professional help,” Agarwal says.
According to Day, there are programs and clinics similar to the one at UAMS all over the United States. Your health-care provider may know what’s available in your area or, if you live near a hospital with a diabetes care center, try calling and asking if they have a supervised weight-loss program for people with diabetes. Once you find a program, be sure to ask the questions listed in “What to Look For in a Weight-Loss Program” to make sure it’s a program that will work for you.