When weight loss is recommended for a person with pre-diabetes or type 2 diabetes, it may be confusing. What should you do to start losing weight and what are the options? In 2013, the American Association of Clinical Endocrinologists (AACE) published an algorithm (process) for an individual and their healthcare team to help evaluate appropriate ways for weight loss. AACE recommends weight loss for obese and overweight people to help improve blood glucose, blood pressure and blood lipids levels. Visit the American Association of Clinical Endocrinologists website to view their algorithm. 

factors and options to succeed at weight loss with prediabetes and type 2 diabetesWhat is the definition of overweight and obese?
Organizations such as The American Heart Association (AHA) and The Centers for Disease Control (CDC) use body mass index (BMI) to evaluate if a person is overweight or obese.  (2, 3)
•    An adult who has a BMI between 25 and 29.9 is categorized as overweight.
•    An adult who has a BMI of 30 or higher is categorized as obese.
To calculate your BMI visit the National Heart, Lung, and Blood Institute and use their Body Mass Index Tool
In the United States of America, nearly 70 percent of all adults are overweight or obese. (2)

Where to start?
Ideally, it is best to be evaluated by a registered dietitian or certified diabetes educator so they can help you develop a plan that meets your needs as a person with diabetes that desires weight loss. This is called individualized nutrition therapy. (4)
Medical Nutrition therapy (MNT) is another term you might see. This term is a legal definition of nutrition counseling by a registered dietitian in the United States. (5)  Medicare covers MNT for diabetes. (6) See if your state requires private insurance to cover the treatment of diabetes or where low cost diabetes services are provided in the United States. Find out about the Affordable Care Act. Call your insurance to see what will be covered for you. 

What can you expect when you see a dietitian for diabetes which includes the need for weight loss? 
I tell my patients we need to evaluate their nutrition needs, calories needed for safe weight loss, special requirements for medications they take and any food interactions, healthy food choices and fluid recommendations. Preferences, allergies and intolerance to foods must be included as well as readiness for behavior change. Patients usually begin by setting healthy goals to achieve.  Many of my patients also have permission from their doctor to exercise. We discuss ideas and strategies for exercising at least 150 minutes per week. I encourage these patients to wear a pedometer to track their steps and get immediate reinforcement. I may recommend that my patient see a physical therapist or a cardiac treatment center for exercise if needed. Read my previous blog on Motivating and Encouraging Exercise
MNT follow-up on a regular basis is important to provide reinforcement, more education, and to tweak the plan as necessary. Most of my patients also have families with whom discussions regarding benefits of a heart healthy, diabetes friendly diet are appreciated. Recommended sleep amounts and relaxation techniques can also be included in discussions with the object of decreasing stress and mindless eating where it may be problematic. 

Medications for Weight Loss
If a patient’s physician deems it medically appropriate, a medication for weight loss may be recommended. Some diabetes medications including Exenatide (Byetta, Bydureon), liraglutide (Victoza ) (6) and metformin (7),  help to decrease blood glucose and have the side effect of weight loss in many people. These drugs may or may not be appropriate for you.  
Sometimes people ask and are put on medications specifically for weight loss. When considering these medications the benefits as well as the side effects should be discussed and evaluated.

For information on these drugs click on the links: These medications should always be accompanied by nutritional therapy.

Weight Loss Surgery
When BMI is over 35 and nutritional therapy is not effective, doctors may consider the option of weight loss surgery.  This is an option that the American Association for Clinical Endocrinologists has in their algorithm. Types of surgery are:

Weight loss in people who are overweight or obese is recommended for most all people with diabetes. It has a positive effect on one’s health. There are many options to help a person achieve success. Make sure that if you need to lose weight, you talk over the options with your healthcare team. You should ask for follow-up on an ongoing basis to attain the goals that are healthy for you.

To learn more about a medical, non-surgical weight loss program that has been shown to have a profound impact on managing type 2 diabetes, please click here to visit our partners at Robard.

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