Last updated: Apr 04, 2008
woman-jogging
The point is not to get skinny. The point is to gain the benefits of exercise.
(ISTOCKPHOTO)

About eight out of every 10 people with type 2 diabetes are overweight or obese, and excess weight—particularly around the belly—is a major cause of type 2 diabetes.

Some people can even "cure" the disease with massive weight loss (including bariatric surgery).

However, the relationship between weight and type 2 diabetes is a tricky one.

Complex relationship between genes, weight, and diabetes

An unexplained weight loss is sometimes a sign that's something wrong. So when you are finally diagnosed and treated you may actually gain weight.

In addition, it's not clear if extra weight causes diabetes, or if some underlying genetic component contributes to both. "A lot of folks who are overweight and who are sedentary won't get diabetes. So there's an important genetic contribution to developing diabetes that's out of people's control," says William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta. "Secondly, it may be actually harder for folks with diabetes to lose weight, that that may be part of the disease as well."

Certain diabetes drugs, such as sulfonylureas, thiazolidinediones, meglitinides, and insulin, are associated with weight gain, too. However, the blood-sugar-lowering benefits of these drugs outweigh the risks of gaining weight. (Others, such as Byetta and metformin, may result in weight loss).

While it may feel like the deck is stacked against you—particularly if you've lost and regained weight in the past—you should still make an all-out effort to shed excess pounds. Now that you have type 2 diabetes, the goal isn't to get back into your high school jeans, but to prevent heart attacks, save your vision, and avoid amputations.

Trying to lose weight is important

With diabetes, trying—even if you never see skinny—matters. Exercising and watching what you eat (as well as taking medication, if necessary) can help lower your blood sugar and help prevent serious complications, even if you don't lose a lot of weight.

If you do lose weight, it will likely:

  • Lower your blood sugar, which may allow you to delay or cut back on medication.
  • Cut insulin resistance.
  • Curb blood pressure and cholesterol, which can reduce your risk of heart attack, kidney failure and other serious complications.

And you don't need to lose that much weight to benefit.

"People used to think it was necessary to lose tons of weight," says Sharon Movsas, RD, a diabetes nutrition specialist at the Clinical Diabetes Center at Montefiore Medical Center in New York City.

Losing just 5% to 7% of your weight is associated with lower blood pressure, lower cholesterol, lower blood sugar, and reduced insulin resistance. "It's sort of a relief for people that modest weight loss can help," says Movsas.

Sometimes a dramatic weight loss can even reverse type 2 diabetes, but that's more likely to occur in younger, obese patients who shed pounds soon after diagnosis (and haven't had the disease for years without knowing it).

Even if you still have diabetes after you shed weight, you have reduced your risk of complications.

"Only about 10 percent of patients with diabetes in my clinic have been successful at losing weight," says Larry Deeb, MD, a past president of medicine and science for the American Diabetes Association. "But we continually, patiently work with people who need to lose weight because it has its own benefits for people with type 2 diabetes, independent of exercise."