Weight Management for People with Diabetes
If you are overweight with type 2 diabetes, weight loss is an extremely effective treatment plan. A weight loss of 10 percent of your current body weight can greatly reduce your risk of getting diabetes, or improve your glucose control.
Just to convince you, here is a list of the benefits of weight loss for a person with diabetes:
- Reduce glucose and the need for medication
- Reduce insulin resistance and improve insulin sensitivity
- Reduce blood pressure and perhaps medication
- Reduce blood lipids (cholesterol and triglycerides)
- Reduce risk of heart attack, stroke, cancers, orthopedic problems (bones and joints)
- Improve sleep problems (such as sleep apnea)
How to Lose Weight
With diabetes, you need to lose weight in a gradual, healthy manner. Crash diets could play havoc with your blood sugar, and may not be balanced in protein, carbohydrate and fat. Some people with diabetes use a low-carbohydrate diet to lose weight. Research shows that many drop off the program because it is unrealistic to follow forever. A very low carbohydrate diet may be lacking in the nutrients from fruits, vegetables and whole grains. You need to establish healthy eating habits that will serve you well over time, and keep your weight off.
A pound of body fat is 3,500 calories. In order to lose a pound a week, you can take 500 calories a day from your diet, or a combination of increased calorie expenditure (exercise) and less calorie intake. Take 1,000 calories a day out, and you lose two pounds a week.
Use DiabetesCare.net’s BMI Calculator to assess your need to lose weight. Use our Nutrition Tracker to calculate a calorie level for weight loss, and then track your food intake each day.
Volumes of advice on how to lose weight have been written, yet there is no single easy way. Obesity is a complex problem, and many people struggle to control their weight. The following are the primary changes that can be effective.
Ten Basic Tactics to Lose Weight
- Portion control: If you have a diabetic meal plan from a registered dietitian, you already know about serving sizes. Use smaller plates and glasses, refrain from taking seconds, serve yourself less meat and starch and more vegetables, and share restaurant meals.
- Plate Diet: Fill half your plate with low-calorie vegetables (limit the butter, oil or cheese). Divide the other half into half, pacing four-ounces or so of low-fat meat in one section, and about one cup of low-fat starch/whole grain food in the other. You have a full plate, lots to eat, but fewer calories.
- Watch the Junk: Although you’ve learned that people with diabetes can work a little added sugar into their diet, junk foods, with sugar, salt and fat, should be rare in your diet. Select healthy snacks in the fruit, dairy or vegetable group to carry you over to balanced meals.
- Keep Food Records: Research shows that people who keep food records lose twice as much weight. Recording your intake, and counting calories and/or carbs, can teach you to make better food choices. Use the DiabetesCare.net MyCare Tracker to self-monitor.
- Manage Your Hunger: If you allow yourself to get too hungry, you will naturally overeat. Hunger management is a key element to weight control. Eat three balanced meals and low-calorie snacks if more than four-five hours pass between meals. If you get too hungry, you will grab the first food available, eat it fast, and eat too much. Learn to be aware of your hunger approaching and eat when hungry and stop when satisfied, not full.
- Be a Mindful Eater: Research shows we mindlessly consume 200-500 calories a day doing things such as nibbling while cooking, munching in front of the TV, or eating while playing on the computer. Keep food consumption enjoyable: eat at the table, chew food thoroughly, and slow down your eating speed.
- Manage Your Environment: Don’t tempt yourself by buying treats and keeping them in sight. Food cues such as the cookies in the jar can trigger extra calorie intake.
- Plan, Shop and Prepare: Take control of your food choices by menu planning, shopping regularly (not when hungry), and cook simple meals at home. Pack lunches more often. You will eat healthier and lose weight when you can limit the fats and control the portions.
- Eat Breakfast: Studies show that people who eat a nutritional breakfast have more success at weight loss and keeping it off.
- Diet Plans: Increase the fiber in your diet, eat 30-35 percent of calories from mostly healthy fat, and increase whole grains, fruits and vegetables. Get three servings of dairy a day or take a calcium supplement with Vitamin D. Consider using meal replacements—portion-controlled and calorie-controlled food (bars, soups, packaged entrees) and drinks (shakes) for one or two meals a day. Meal replacements can help minimize your food choices and decisions about food, offer better alternatives than what is available, give your diet plan structure and are very convenient.
Don’t forget that exercise is effective in weight loss. People who watch less than 10 hours of TV a week are more likely to lose weight and keep it off. Even if you aren’t ready for a formal exercise routine with cardio and strength training, consider using a pedometer to track your steps. You wear it on your waist, set at zero in the morning and wear it all day. Record your daily steps. Set a goal to slowly increase your steps each week. The recommendation is about 10,000 steps a day, or four miles of motion on your body. Pedometer use can be a fun way to motivate you to be more active in daily life. And, being more active will lower your blood glucose. Use DiabetesCare.net’s Exercise Tracker to help with your exercise program.
Benefits of Weight Loss
Research has shown that if you are pre-diabetic and overweight the most effective way to reduce your risk of developing type 2 diabetes is to lose weight. Even small decreases in weight through diet and exercise can have a big impact as it reduces your risk for developing diabetes by a whopping 58 percent!
We realize that having just been diagnosed, some good news goes a long way. The good news is that the research indicates that when a person loses weight when they are first diagnosed they have fewer negative health effects, live longer and enjoy a higher quality of life!
Uncontrolled Type 2 Diabetes
When diabetes goes uncontrolled you may not feel well. Since many people with type 2 diabetes are overweight, losing weight and maintaining that new weight will help you control your blood sugar and help you feel better.
Persons with Diabetes and other Medical Conditions
Weight loss helps individuals better control their blood sugar, cholesterol and blood pressure. And, when a person with diabetes controls these levels, it helps to reduce their risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.
Other Medical Conditions:
High Blood Pressure: About 70 percent of people with diabetes have high blood pressure. Adults with diabetes are two to four times more likely than people without diabetes to die of heart disease or experience a stroke. Controlling your weight helps you control your blood pressure.
High Cholesterol: Cholesterol is affected by weight, blood pressure and blood sugar. If your blood sugar and blood pressure are high, your cholesterol numbers may be high which could place you at risk for heart disease. Controlling your weight helps you control your cholesterol!
Choosing the Best Weight Loss Program
What to Look For in a Weight Loss Program:
- A focus on reduced caloric intake to achieve weight loss, in addition to carbohydrate counting and healthy eating.
- Data for both short term and long term results.
- Program materials that are Diabetes Specific – need clear information on maintaining healthy blood sugar levels and adjusting medication as needs will change with weight loss.
- Provides good support and responsiveness if you get stuck or have questions.
- Clear information on cost – upfront and ongoing.
- Provides easy to follow information for reduced calorie diet and physical activity.
- Does not make promises that weight loss is "easy" or "permanent."
- Provides specific skills for maintaining weight loss – acknowledging there must be different than motivation and skills to lose weight.
- Promotes lifestyle changes you can embrace long term including the critical importance of regular physical activity.
Weight Loss Program Options
Medically Supervised Weight Loss Plans - supervised by a Physician
Medical weight management programs provide comprehensive support and lifestyle change education to support individualized weight loss needs. These programs can utilize proven high protein products and techniques to address medical conditions that can be successfully managed or resolved with weight loss. Your doctor can help identify an effective program.
- Medical staff monitors your progress at each visit and monitors important medical indicators including blood pressure and lab tests for A1C and electrolyte balance.
- The physician will adjust medications that can be reduced or eliminated as requirements frequently change with weight loss and improved health status.
- Provides appropriate Medical Supervision for use of nutritionally complete Very Low Calorie Diets (VLCD). These diets provide significant weight loss in 8-12 weeks with follow by transition to continued Low Calorie and Weight Loss Maintenance Programs to support long-term weight management.
- The physician can prescribe weight loss medications, if appropriate.
- Office visits may be covered by your medical insurance plan.
Tip: Search for a program that specializes in an overall care plan for people with diabetes.
Commercial Weight Loss Program (not medically supervised)
Commercial weight loss clinics are staffed by motivated counselors that have been trained to teach you how to follow their diet program and to support you throughout the process. The clinic might be a franchise for a national chain or a privately owned business that has helped a lot of people in your community. The program may or may not offer medical supervision during you visits.
- Regular one-on-one visits with a counselor to provide a customized program tailored to meet your preferences and needs.
- Can provide you a coach/cheerleader to help keep you on track.
- Meal plans provided to suit your calorie and carbohydrate requirements.
- May offer group meetings and special motivational promotions.
- May provide updates to your physician to coordinate your care plan.
Tip: Find a program that is conveniently located with a knowledgeable staff. Before you start, ask for references and information on the program to share with your physician or diabetes educator. Be sure the program provides information that is developed especially for dieters with diabetes.
Weight Loss Surgery (hospital affiliated program)
Specialized bariatric surgical procedures can be provided for qualified patients that are severely overweight. There are a variety of bariatric surgical procedures utilized to limit stomach function or capacity. Many programs will promote pre-surgical weight loss for better post-surgical outcomes.
- Individuals with type 2 diabetes are often able to reduce or eliminate diabetic medications.
- Insurance may provide for dietary counseling and follow-up.
- Surgical change in your digestion mechanically limits the amount of food you can consume or your ability to derive calories from the food.
- Can provide dramatic levels of weight loss and allow you to increase your mobility making it easier to be more physically active.
Tip: Choose a program that provides long-term clinical support for long-term success.
Diabetes Counseling – Certified Diabetes Educator (CDE)
For one-on-one support and education you may prefer to meet with a nurse, dietitian, pharmacist, exercise physiologist, and podiatrist or other qualified medical professional who has been educated to help people with diabetes. As a Certified Diabetes Educator they will help you understand your condition, adjust your lifestyle, and how to modify behaviors as you develop skills to successfully manage diabetes. CDE’s attend educational training regularly and must take recertification exams every five years.
- Professional assistance to help you start on the right path for long-term health or provide you with assistance if you are having difficulty with carbohydrate balance or adjusting insulin.
- Typically have a close working relationship with your physician and will assure that your medications are adjusted when needed.
- Regular review of lab tests to monitor your A1C and electrolytes.
- Personalized Diabetic Weight Loss Plans.
- Initial visits may be covered by medical insurance.
Tip: Working with Certified Diabetes Educator can be especially helpful when you are first learning about how to manage your diabetes. Your physician may be able to provide you with a referral.
Online Weight Loss Programs
Over the past five years there has been a dramatic increase in the number of weight loss programs available on the Internet. With expanding technology and increasing ease of access, online programs can be an appealing option. These programs can provide helpful tools for support as well general guidance and may also offer or recommend weight loss products for purchase.
- Provide easy access to a variety of products and possible tools to monitor and track your diet and activity
- May provide motivational messages and connection to other dieters through forums, email and other social media outlets
- Can connect you to educational or product information, and possibly provide information directly to your medical provider
Tip: Look for recommendations from your Diabetes Care Professional for websites that will help you monitor and guide your progress. Keep in mind that website tools or apps are only effective when paired with smart nutritional goals within a well-designed eating plan.
Grocery Store Meal Replacements/Diet Foods
There are a variety of products on the grocery store and pharmacy shelves that promote weight loss. These products are promoted as lower calorie, fat or carbohydrate contents and can help support healthy weight management. For every food purchase it is important to know the products you select will provide you with the necessary nutrients to meet your personal dietary needs.
- Products are easy to obtain at a variety of local shopping locations
- Can simply portion control and be easy to prepare
- Products often list diabetic food exchanges on the packaging
- Makes it easy to know exact level of carbohydrate, sugar, fat, sodium or other nutrients you are tracking to manage your diabetes
Tip: If choosing meal replacements look for products designed for persons with diabetes or with about equal levels of high quality protein and carbohydrate (15-20 grams) and 20-30 percent of the Recommended Daily Intake (RDI) for essential nutrients and about 200 calories. Added fiber is a plus.
Weight Loss Books
Every week of the year you can pick up a new book with the latest and greatest way to lose weight. It is amazing how the titles alone can make weight loss sound so simple. But if you have diabetes there are some very important aspects you need to consider before you invest your time and money to purchase that next new title off the shelf.
- May provide a new approach or give you motivational ideas from a perspective that you can understand
- Can provide new concepts/information specific to your situation or interests
- Products often list diabetic food exchanges on the packaging
- Often include educational surveys or questionnaires along with tips for success
- Will generally have meal plans and recipes to let you get started right away
- May share testimonials, inspirational stories and pictures about how others have had great weight loss success
Relearn Portion Control
Typical portion sizes of foods that individuals consume have grown over the years. Following a weight loss program is a great time to focus on the appropriate portion sizes. Many programs will use pre-packaged foods which can help you to relearn portion size.
Tip: Use measuring cups and a food scale two days a week to measure all your foods before putting it on your plate. Consider using a smaller dinner plate and remember to fill half the plate with vegetables and fruits, a quarter with protein and a quarter with starch. You could also try pre-portioned frozen meals, shakes or bars to learn appropriate serving sizes without needing to measure or weigh your food.
Avoid Sweets and High Fat Desserts
Healthy eating is important for everyone. However, paying close attention to the frequency and portion size of the sweets (cakes, candy, cookies, and pies) is especially important for individuals with diabetes. These simple sugars spike your blood sugar levels and many of these foods are high in fat and calories.
Tip: When there is a special occasion, enjoy a healthy balanced meal first, one that focuses on vegetables and protein. Then, take your time to really savor a small portion of dessert at a level that still fits your healthy eating plan.
Plan Your Exercise
Plan to engage in physical activity most days of the week. Being active brings a host of physical and psychological benefits and is the best predictor of maintaining weight loss. When you expend energy your muscles need more glucose to use as fuel, so be aware that your blood sugar levels tend to decrease when you exercise.
Tip: If you are on medications to control you blood sugar it is important to measure your blood sugar before and after exercise. You may find that eating a protein snack with some carbohydrate before you exercise helps reduce the severity of the drop in blood sugar that exercise will cause.
Visit Your Doctor to Monitor Your Medication Needs
It is common that your muscles will be better able to respond to the insulin as you lose weight. This may impact the insulin your body produces or your medications.
Tip: It is very important that your monitor your blood sugar and, if applicable, have your medications adjusted by your physician when making diet and exercise changes.
Include more Dietary Fiber
A great way to slow down the normal rise in blood sugar after a meal is to include some fiber! Adding fiber is simple– choose whole grains, and a variety of fruits and vegetables or take a supplement. Scientists keep finding more beneficial aspects of eating fiber beyond satiety, especially for persons with diabetes, including lowering cholesterol levels and supporting the immune system.
Tip: Include 3-5 grams of fiber with each meal and work your way up to having at least 30 grams of fiber a day. It is best to consume at least half of your fiber from healthy foods like fresh fruits and vegetables or whole grain bread and cereal products.
Eat at Regular Intervals
Eating at regular intervals will help keep your blood sugar balanced and will provide you with a steady supply of nutrients over the course of the day.
Tip: Do NOT skip meals and make sure each of your meals includes some protein to help you feel full and support the balanced release of carbohydrate.
Good Sources of Protein
On a weight loss diet you need to include "high quality protein" from foods like milk, egg whites, soy and lean meats. These protein sources provide essential compounds called amino acids that are necessary for building lean muscle and a healthy heart. Protein also helps you feel fuller and less hungry.
Tip: Most medical weight management programs promote the use of a meal replacement product. When choosing a meal replacement product, look for milk or soy protein to be the first ingredient. Limit or avoid using products that have gelatin as one of the first three ingredients. Gelatin alone cannot provide the nutrition to keep your body strong, and other proteins like beans or grains will have extra calories.
Vitamins and Minerals (Micro-nutrients)
When losing weight, your food selections will be decreased. Be extra careful that you are still getting all the vitamins and minerals your body needs to function and be healthy. Vitamins and minerals are essential antioxidants and play a key role in many of the chemical functions in the body. Since many of these nutrients can only be found in foods, it is important to include a multi-vitamins and mineral.
Tip: Consider including foods or supplements high in antioxidants. Extra sugar in your blood resulting from diabetes may lead to tissue damage and good nutrition can help slow the process.
Sodium, Potassium and Magnesium
High blood pressure (hypertension) is common among individuals with diabetes. Keeping your potassium level up and your sodium level down can help manage your blood pressure level.
Tip: Look for programs that promote vegetables, fruit, whole grains and low or fat-free dairy products every day.
Water and Fluid Balance
Drinking enough fluids supports the metabolism of food and your ability to safely exercise. To maintain adequate fluids you should drink 48 to 64 oz. (six to eight 8-oz. servings) of fluids each day. In addition to water, fluids can include coffee, tea, diet beverages and milk.
Tip: Look for low and zero calorie beverages to help maintain your daily fluid intake.
Foods can be classified based on how much they raise your blood sugar. If the carbohydrate in food is broken down easily it will increase in blood sugar more rapidly and is a "high glycemic index" food. This is true of foods that contain a lot of sugar or simple carbohydrates. Foods with complex carbohydrates, like whole grains, or that contains very little carbohydrate have a "low glycemic index" which helps keep blood sugar level more even.
Tip: Consider low glycemic snacks that are low carb, have some protein and about 100 calories. Examples include: 1 oz. of string cheese, 10 almonds, or 3 celery sticks with 1 Tablespoon of peanut butter.
Benefits of Weight Loss Maintenance Programs
- Creates a defined plan and support system for "steps to take" if your weight starts to increase.
- Provides trained staff to support your long-term goals and help you create effective support strategies.
- Promotes additional skills to broaden your focus beyond a diet to a healthy lifestyle.
- Utilizes best practices of dieters who have successfully lost weight and kept it off for multiple years.
- Will generally have meal plans and recipes to let you get started right away.
- Offers activities or options to meet or communicate with other who have successfully transitioned to maintaining a healthy weight.
Tip: Look for a program with enthusiastic staff that specializes in lifestyle skills beyond dieting. Keeping weight off is different and needs specialized techniques. Using meal replacement supplements with a good source of protein once or twice a day can continue to help support a healthy weight.