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Diabetes Forecast

The Healthy Living Magazine

The Right Diet for You

A frank look at current weight-loss programs, from a diabetes point of view

By Meghann Moore, RD, CDE, MPH , , , ,

Neil Webb/The iSpot

More than 1.1 billion adults worldwide are overweight, and 312 million of them are obese. The link between excess body weight and type 2 diabetes is well established, with nearly 50 percent of men and 70 percent of women obese at the onset of diabetes. Needless to say, preventing obesity is a high priority for the prevention of type 2 diabetes and other chronic diseases.

Although type 1 diabetes is an autoimmune disease unrelated to overweight and obesity, people with type 1 are at risk of developing other health problems if they are overweight. Being overweight or obese increases the risk for diabetes-related complications regardless of your type of diabetes. On the flip side, losing weight can cut your risk of an early death by up to 25 percent; it can slash your risk of dying from diabetes and heart disease by 28 percent. It’s safe to say that you’ll probably have more energy and feel better if you take off some of those extra pounds, too.

Weight and Blood Glucose

Weight loss is a cornerstone of many a diabetes treatment plan. There is research to support the idea that blood glucose levels improve, evidenced by a reduction in A1C, when excess weight is shed and not regained. Other studies, however, demonstrate that weight loss is not associated with an improvement in blood glucose. Rather, those studies suggest that the improvement in blood glucose may have more to do with a decrease in total calorie intake.

Here’s what we do know: Early on in prediabetes, when insulin resistance rather than insulin deficiency is the biggest issue, eating fewer calories and/or losing weight can improve blood glucose levels and may boost insulin sensitivity by close to 60 percent. Once type 2 diabetes has progressed from insulin resistance to the inability to make enough insulin, weight loss in conjunction with blood glucose–lowering medication can improve blood glucose control. There are some type 2 diabetes medications on the market, such as those in the GLP-1 receptor agonist class—exenatide extended release (Bydureon), liraglutide (Victoza), and dulaglutide (Trulicity), for instance—that help to control blood glucose and also result in weight loss. Once insulin deficiency sets in and insulin is needed, the primary goal often shifts from losing weight to preventing weight gain.

But there’s another reason weight loss seems less attainable for people with type 2 diabetes. With high glucose levels, people burn more calories than normal because of increased protein turnover. Once blood glucose improves and protein breakdown decreases, energy expenditure drops back to normal. Fewer calories (in the form of glucose) are lost in the urine, too, which means less weight loss or, in some cases, weight regain.

This can understandably lead to feelings of anger, frustration, and hopelessness, all additional barriers to weight loss. Some diabetes-related complications, such as foot ulcers and nerve pain, can also interfere with physical activity, which is recognized as a necessary part of maintaining weight loss.

The Skinny on Research

The weight-loss industry offers many different programs, so one is sure to be a magic bullet, right? Not quite. Recently researchers reviewed the results of 45 studies of commercial weight-loss programs and compared the outcomes with a control group that received no weight-loss intervention or only some education or counseling. The study included Jenny Craig, Weight Watchers, Nutrisystem, Health Management Resources (HMR), Medifast, Optifast, SlimFast, Atkins, Ornish, and the Zone diet. After a year, the amount of weight lost was not associated with the diet type but rather with how well people followed whatever diet they were on.

It’s no surprise that many popular weight-loss programs target specific plans at people with type 2 diabetes (a few of the plans have guidelines for people with type 1 diabetes, too). One thing to keep in mind about very-low-calorie medically supervised diets, such as Optifast, Medifast, and HMR, is that much of the research highlighting their success involved obese or very obese people and didn’t always include those with diabetes. The results may not be the same for people with diabetes who are overweight rather than obese.

Another approach to weight loss with type 2 diabetes (but not type 1 diabetes) is bariatric surgery. Swedish researchers have determined that obese people with type 2 diabetes who receive bariatric surgery soon after diagnosis experience high rates of remission and health care cost savings compared with people with diabetes who don’t get the surgery.

Tried-and-True Approaches

While there are many different approaches to weight loss, what works the best over the long term is intensive behavioral modification, including:

  • Self-monitoring: recording foods and amounts in a food journal or app
  • Stimulus control: eliminating triggers, such as a bowl of candy within easy reach
  • Contingency management: having a plan in place to give you access to healthy food—but not too much of it
  • Stress management: avoiding high-stress situations and chronic stress, both of which can trigger comfort eating and make it more challenging for you to make healthy choices
  • Modeling: hanging out with people who don’t overeat and who make healthy choices in foods and beverages while also being physically active
  • Social support: finding a source of encouragement, whether in person or online, for your weight-loss and maintenance efforts
  • Cognitive approaches: practicing mindful eating and other therapeutic approaches known to help with binge eating

No matter how you choose to lose weight, take it one step at a time. And be patient: You did not gain your extra weight overnight, so don’t expect to lose it that quickly either. You’re more likely to drop pounds when you make a realistic, achievable action plan based on a few measurable goals. For example, instead of the general goal of eating better, get specific: Plan to pack a quarter cup of nuts as an alternative to vending-machine snacks. Or aim to call a friend for a comforting chat instead of emotionally eating.

The same goes for exercise: Don’t just tell yourself you need to move your body more. Schedule a walk during lunch Monday through Friday. Another helpful strategy for weight loss includes visualizing how you’ll feel once you reach your goal—where you will be, who you will be with, and what you will be doing.

Also consider any challenges you could face that will prevent you from sticking to your action plan. What will you do when a colleague brings cupcakes into work? How will you alter your exercise plan when it rains? Come up with strategies to address these potential conflicts ahead of time so that when the time comes you’re prepared.

If you have a considerable amount of weight to lose, break your overall goal into smaller, more quickly reached chunks. Overwhelmed with the goal of dropping 80 pounds? Celebrate each time you lose an additional 10 pounds and reward yourself for getting there—buy yourself a new piece of clothing or get a massage (hint: food rewards are not the best idea if you’re trying to lose weight). And remember: Losing weight is tough, no doubt, but even a 5 to 10 percent reduction from your starting weight is meaningful and can reduce your blood glucose and high blood pressure, too.

Body Fat Facts

  • 1.1+ billion: Number of adults in the world who are overweight
  • 312 million: Number of adults in the world who are obese
  • 9%: Percentage of the world’s population with diabetes
  • 50% Men/70% Women: Percentage of people who are obese at the onset of diabetes

Diet Program Details

Not sure if a given eating plan is right for you? We dug through dozens of studies so you don’t have to. Read on to get the skinny on popular weight-loss programs for people with diabetes.

Atkins

A lower-carb eating plan that starts at 20 to 25 grams total daily carbohydrate (minus fiber) and tops out at 80 to 100 grams daily, the Atkins 20 program is designed for people with prediabetes and type 2.

Results: After four years, obese people with type 2 diabetes who got 20 percent of their total daily calories from carbohydrate sources (versus the typical 55 to 60 percent) lost an average of 7 percent of their starting weight and lowered their A1C from an average of 8 percent to 6.8 percent.
Pros: Free online tracking tools, meal planner, shopping list, and carb counter
Cons: May be difficult to sustain low-carb eating long term
Packaged foods required? Optional
Resources: atkins.com, The New Atkins Made Easy: A Faster, Simpler Way to Shed Weight and Feel Great—Starting Today by Colette Heimowitz (Simon & Schuster, 2013)

The Diabetes Breakthrough

Following this at-home guide, which is based on the Joslin Diabetes Center’s 12-week Why Wait program, participants eat do-it-yourself meal replacements and follow a 1,200- to 1,800-calorie daily meal plan.

Results: Participants with type 2 diabetes had a 50 to 60 percent decrease in diabetes medications and an average 6.4 percent decrease in weight after five years. A1C decreased from an average of 7.26 to 6.37 percent at the 12-week mark.
Pros: Emphasizes a protein-rich eating plan and strength-training exercises and includes tips on building fitness and overcoming psychological barriers
Cons: With meal replacement shakes twice a day—and only six snacks and 14 dinner menus to choose from—this could get boring.
Packaged foods required? No
Resource: The Diabetes Breakthrough by Osama Hamdy, MD, PhD, and Sheri Colberg, PhD (Harlequin, 2014)

Dr. Neal Barnard’s Program for Reversing Diabetes

The plan features a low-fat, plant-based eating plan for type 2 diabetes, with about 10 percent of calories from fat, 15 percent from protein, and 75 percent from carbohydrate sources such as vegetables, fruits, grains, and legumes.

Results: 43 percent of people reduced diabetes meds, versus 26 percent on a typical eating plan. People following the plan also lowered their A1C by 1.23 points (those on the traditional eating plan dropped theirs by only 0.38 points), lost 14.3 pounds (7½ pounds more than those on a typical eating plan), and saw a significant decrease in LDL (“bad”) cholesterol.
Pros: Portion sizes, calories, and carbohydrate grams are unrestricted.
Cons: It may be unappealing and challenging for some to adopt this vegan (no animal products) plan.
Packaged foods required? No
Resource: Dr. Neal Barnard’s Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs by Neal D. Bernard, MD (Rodale, 2008

HMR Weight Management (Health Management Resources)

HMR is a medically supervised weight-loss program that includes three or more shakes, two or more main dishes, and five or more servings of fruits and vegetables per day, plus daily exercise and healthy lifestyle skills.

Results: After 12 weeks, obese people with type 2 diabetes had lost 14 percent of their starting weight. Overall, participants decreased oral diabetes medications by up to 57 percent.
Pros: The methodology includes response to hunger: If you feel hungry, eat another shake, main dish, or more fruits and veggies. The plan includes weekly phone coaching sessions.
Cons: Heavy reliance on shakes and limited packaged meal choices could get old fast.
Packaged foods required? Yes
Cost: About $10 per day initially, then $16 per day
Resource: healthysolutions.com

Jenny Craig for Type 2

The program features one-on-one diet and exercise counseling with prepackaged foods for 1,200 to 2,300 total daily calories. It’s aimed at an average weekly weight loss of 1 to 2 pounds, or 1 percent of current weight.

Results: Participants with type 2 diabetes lost an average of about 10 percent of their starting weight by the one-year mark, but after two years the average weight loss was down to about 7 percent, with the average A1C lowered to 6.9 percent. Fasting glucose and triglyceride levels were also reduced.
Pros: Teaches behavior modification tips and is appropriate for type 2s on insulin who are followed closely by their primary care provider
Cons: Not available for people who require special diets (gluten free, vegan, kosher, halal) or have celiac disease
Packaged foods required? Yes
Cost: $15 to $23 per day for food on top of a $99 enrollment fee and $19 monthly program fee
Resource: jennycraig.com

Medifast

The program specifies four to five Medifast meals, one to two “lean and green” self-prepared meals, and healthy snacks to achieve 800 to 1,600 total calories daily.

Results: 40 percent of people with type 2 diabetes using Medifast lost at least 5 percent of their starting weight by week 34 versus 12 percent for people who chose their own foods based on healthful diet recommendations.
Pros: Medifast recognizes the needs of people with type 1 and type 2 diabetes. Health coaching is available through the Take Shape for Life program.
Cons: Meal replacements may get boring over time.
Packaged foods required? Yes
Cost: First order is $10 to $13 per day. After that, it costs $14 to $18 daily.
Resource: medifast1.com

Mediterranean Diet

The many versions of this plant-based eating plan stress that meals are best when shared with others and savored. Daily exercise is encouraged.

Results: After a year, people with type 2 diabetes significantly improved their fasting blood glucose and reduced their A1Cs by an average of 1.2 percentage points. Weight loss, however, wasn’t consistent among the studies.
Pros: There’s plenty of variety: The emphasis is on in-season fruits, vegetables (especially dark leafy greens), legumes, nuts, minimally processed whole grains, olive oil, herbs, spices, and fatty fish twice a week.
Cons: Research has been done primarily in Mediterranean countries, so it’s unknown whether the results are generalizable to other populations.
Packaged foods required? No
Resources: Multiple books, including The Mediterranean Diet for Beginners: The Complete Guide (Rockridge Press, 2013)

Nutrisystem D

This meal delivery program, which includes four to five Nutrisystem meals or snacks daily supplemented with fresh fruits, vegetables, dairy, and nuts, aims for 1,200 to 1,500 total daily calories.

Results: After three months, 80 percent of program participants with type 2 diabetes had lost about 5 percent of their starting weight, an 18-pound average weight loss. The average A1C dropped by 0.7 percentage points, and waist circumference and total cholesterol were reduced as well.
Pros: Registered dietitians and certified diabetes educators are available by phone or chat line. Track your progress, receive activity recommendations, and browse recipes online or through Nutrisystem’s NuMi app, which syncs with many fitness trackers.
Cons: Unknown whether weight loss continues after one year
Packaged foods required? Yes
Cost: $10 to $12 per day
Resource: nutrisystem.com

Optifast

During this 26-week, medically supervised program—which features meal replacements, education, counseling, and support—participants aim for only 800 calories daily.

Results: Overweight people with type 2 diabetes had decreases in weight, blood glucose, blood pressure, and total cholesterol levels after six months.
Pros: Optifast is appropriate for people with type 2 and people with type 1 if closely monitored by a diabetes specialist (the plan includes recommendations for basal and bolus insulin).
Cons: At the one-year follow-up, participants had regained most of the weight they lost, and their A1C levels returned to the starting value.
Packaged foods required? Yes
Cost: Varies by city, clinic, and weight-loss goal
Resource: optifast.com

Paleolithic (Paleo) Diet

Versions of this eating plan (also known as the Hunter-Gatherer, Caveman, and Stone Age diets) include unprocessed fruits, vegetables, nuts, seeds, olive and coconut oils, fish, grass-fed meats, poultry, and eggs. The diet typically restricts grains, dairy foods, legumes, potatoes, refined sugars, refined oils, and processed foods.

Results: In a three-month comparison of Paleo eating, the Plate Method, and glycemic index–based eating, type 2s following the Paleo plan had lower average A1Cs, triglycerides, diastolic (bottom number) blood pressure, weight, body mass index, and waist circumference, as well as higher average HDL (“good”) cholesterol.
Pros: Availability of various books and online guidance, support, and recipes for this eating approach
Cons: Data on weight loss, A1C, and other benefits after three months are unknown. Study sample size was small.
Packaged foods required? No
Resource: thepaleodiet.com (among many others)

SlimFast

This program replaces two daily meals with a SlimFast shake, smoothie, or bar, and encourages a 500-calorie healthy meal and three 100-calorie snacks.

Results: After 12 weeks, obese people with type 2 diabetes using SlimFast meal replacements lost between 6.4 and 6.7 percent of their starting weight, while those following an exchange diet plan lost only 4.9 percent. SlimFast users also experienced significant reductions in total and LDL cholesterol, which were not seen in the exchange diet group.
Pros: A do-it-yourself-plan, SlimFast is less expensive than other meal replacement programs and provides healthy recipes.
Cons: Meal replacement and snack choices are very limited. There’s minimal professional guidance and support.
Packaged foods required? Yes
Cost: About $7 a day for SlimFast meal replacements
Resources: slimfast.com

Weight Watchers

The program kicks off with a two-week introduction without tracking food points, then transitions to the PointsPlus program, which requires participants to track all foods based on a point system that takes into account calories as well as nutrients.

Results: After a year, people (without diabetes)on the program lost two times as much weight as those receiving only weight-loss advice.
Pros: Weekly support meetings include weigh-ins, group discussions, and behavioral counseling. The program emphasizes nonstarchy vegetables, lean protein, and whole grains, but no foods are off limits.
Cons: The program may be cost prohibitive if you need to lose a lot and wish to remain in the program until reaching your goal weight. The group format may not appeal to all.
Packaged foods required? Optional
Cost: Varies by region; the national average is less than $10 per week for the enrollment fee and weekly meetings.
Resources: weightwatchers.com

 
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