Losing it and not finding it again…achieving sustainable weight loss

Losing a modest amount of weight – such as 5% to 10 % of total body weight – can improve the body’s ability to lower blood glucose levels and reduce heart disease risk factors. For the average 80 to 90 kg (180 to 200 lb) person, this would mean a loss of 5 to 10 kg (10 to 20 lb).

However, losing weight and achieving sustainable weight loss is difficult for most people. The weight loss industry knows this, and makes a tremendous amount of money on gimmicky weight loss programs and methods that are either ineffective or unsustainable.

The following suggestions regarding weight loss are aimed specifically at people living with diabetes.

Diets: Which ones work?
The very word “diet” is often perceived of as a temporary fix … i.e. you lose weight but then carry on as eating as you did before! However, making sustainable changes to your way of eating (i.e. your meal plan) is more likely to result in weight loss that stays lost!

If you are taking insulin to treat your diabetes, it is advisable to consult with a registered dietitian before making any changes to your meal plan. A sudden and sharp decrease in carbohydrates, which many “quick fix” diets propose, can result in low blood glucose levels if insulin is not adjusted properly. 

So which diets actually work? Those that are largely plant-based – such as vegan or calorie-restricted vegetarian – promote both weight loss and improved glucose control.

The Mediterranean diet is low in red meat and high in fruits, vegetables, nuts, seeds, legumes, cereals and whole grains, with fats supplied as olive oil. This diet helps reduce the risk of heart disease and improve blood glucose levels.

Popular weight-loss diets – such as Atkins, the Zone, Dean Ornish, Weight Watchers and Protein Power Lifeplan – are, over time, no more effective than a more straightforward approach that combines calorie restriction and consumption of lower-fat foods. Typically, it is difficult to stay on these popular diets for very long as they are not very satisfying.

To help people with diabetes stay on track with their weight, most diabetes education centres advise the following three principles: 1) consult Health Canada’s Eating Well with Canada’s Food Guide; 2) use the plate method for portion control; and 3) eat foods that have a low glycemic index. Other suggestions can be found in the Diabetes Diet articles and posts.

What about meal replacements?
Consuming one of the commercially available portion-controlled vitamin- and mineral-fortified meal replacement products (for example, Glucerna^®; see Product Directory for other meal replacements) can be an effective way for some people to lose weight. On any given day, people make about 200 food choices, such as when to eat, what to eat, how much to eat, whether to add dessert and when to stop. One reason why a meal replacement works is that it eliminates some of those choices.

Can diabetes medicines be changed to encourage weight loss?
Ask your doctor if your current diabetes medication encourages weight gain; if so, enquire if there is an alternative. Typically, medications that boost insulin (for example, gliclazide and glyburide) can cause weight gain, as can meal-time insulin (but not basal or bedtime insulin). Metformin and DPP-4 inhibitors are weight neutral, while GLP-1 medications (for example, Victoza^® and Byetta^®) can cause weight loss (on average, approximately 10 lb). A new diabetes medication called Invokana™ is also associated with weight loss.

What about surgery?
For people living with diabetes who are in the very obese range, bariatric or “gastric bypass” surgery has been shown to be effective over the long term for weight loss and improved diabetes outcomes. People who are interested in pursuing this option must first consult with their family doctor and then be referred to a specialist. Usually, the person is assessed by a team and there is a wait time and counselling involved. Although some provincial public health plans cover the costs associated with weight loss surgery, others do not; ask your healthcare team if weight loss surgery is covered in your province. As an alternative, some people seek private clinics, either here in Canada, or out of the country.

Four tips for weight loss

1. Decrease food intake. This sounds like such a simple principle, but the truth is that although many people eat healthy food, they simply eat too much of it. Portion size has gone up for all foods in the past 20 years. Restaurant portions are usually far larger than the portions that people eat at home and people generally eat away from home more now than before. So, a few guiding principles for decreasing food intake include the following: eat out less, get a smaller plate and don’t go back for seconds!
2. Add physical activity. Although possible, it is certainly more difficult to lose weight solely through diet, with no change in activity. The Physical Activity articles and blogs have some good, practical exercise suggestions.
3. Be mindful. Try not to eat while engaging in other activities. Society in general encourages us to eat while doing other things (for example, while driving, pushing a stroller, or watching a movie). In fact, the time that most people eat mindlessly is while watching television … think about it! As well, don’t drink your calories: any time calories can be consumed quickly – such as drinking specialty coffees, shakes or alcoholic drinks – is when more calories go in than are intended or needed.
4. Have a plan, get support and be accountable. Most people will be more successful at weight loss if they have a plan for change – usually small but manageable steps that they are likely to achieve over the long term. Many of the weight loss programs that are expensive succeed for two main reasons: 1) they offer support; and 2) there are regular weigh-ins, which means that participants remain accountable for their ongoing weight loss.