Type 2 Diabetes and Weight Loss: Everything You Need to Know

If you have type 2 diabetes, knowing how your weight affects your condition can help you take better care of both. For example, losing just 5% to 10% of your weight can make your blood sugar much better and sometimes even make diabetes go away. This guide will teach you all you need to know about type 2 diabetes and how to manage your weight. You will learn about the relationship between diabetes and weight loss, whether it is easier or harder to lose weight with type 2 diabetes, which medications could help, and when to ask your healthcare professional about weight loss.^1,2

How type 2 diabetes and body weight are connected

Type 2 diabetes and weight are closely linked, and one can make the other worse. Most adults who get type 2 diabetes have extra body weight, but not all. When you have too much body weight, your body finds it harder to use insulin, which can cause insulin resistance. Over time, your pancreas can’t keep up with the body’s insulin resistance, so blood sugar levels go up.^3,4

Even a little weight loss can make your blood sugar better. Losing only 5% to 10% of your starting body weight can help you:

• Lower hemoglobin A1C and blood sugar levels
• Use the body’s insulin more easily
• Reduce the amount of diabetes medication you need
• Lower your risk of heart disease and stroke⁵

Also, losing a lot of weight (about 20% or more of your body weight) can help some people get rid of type 2 diabetes. This means their blood sugar goes back to normal without needing diabetes medicine.

Is it harder or easier to lose weight with type 2 diabetes?

Losing weight with type 2 diabetes can be harder than for people who don’t have it, but you can do it with the right plan. Some things that make losing weight harder when you have diabetes are:

• Insulin resistance makes it harder for the body to use sugar for energy, which can cause fat to build up.
• Some diabetes medicines, especially insulin and some pills, can make you gain weight as a side effect.
• The body’s hormone changes from diabetes can slow down your metabolism.⁶

Planned weight loss programs and new weight loss medicines work very well for people with type 2 diabetes. For example, the DiRECT study showed that 46% of people did not have diabetes anymore after doing an intensive weight management program. Only 4% of people who did not do this program stopped needing diabetes medication after the study was over.⁷

Furthermore, many of the newer medications, such as GLP-1 and GIP/GLP-1 receptor agonists, can treat diabetes and promote weight loss, and several other drugs are being studied.⁸ Additionally, Medicare and many Medicare Advantage plans cover services such as nutrition counseling, diabetes self-management and behavioral therapy for obesity, which can provide you with additional support.⁹

How to lose weight with type 2 diabetes

To lose weight with type 2 diabetes, you need a complete plan that includes healthy eating, exercise and changes in habits.

Create a calorie deficit

The way to lose weight is to eat fewer calories than your body uses. For most women, this means eating about 1,200 to 1,500 calories each day. For most men, it means eating about 1,500 to 1,800 calories each day. To lose weight slowly and safely, it is best to eat 500 to 750 fewer calories each day.¹⁰ But, not all calories are the same. It might be easier to fill your plate with foods that help you lose weight instead of counting exact calories. Make sure every meal follows the diabetic plate guide:

• Half of your plate should be non-starchy vegetables like leafy greens, broccoli, green beans and peppers.
• One quarter of your plate should have lean protein like chicken, fish, turkey, tofu, eggs or beans.
• One-quarter of your plate should have high-fiber carbs (whole grains, beans, lentils, starchy vegetables like sweet potatoes).¹¹

Eating the right kinds of food is just as important as counting calories, because foods with more fiber use calories when your body digests them.

Follow a balanced eating plan

No one diet works best for all people with diabetes. The American Diabetes Association says you should make your nutrition plan fit your preferences and culture. Evidence supports several eating patterns:¹²

• Mediterranean diet: Emphasizes vegetables, whole grains, healthy fats and lean proteins.
• Low-carbohydrate diets: Increased amounts of non-starchy vegetables and reduced carbohydrate intake.
• Low-glycemic index diets: Emphasize foods that maintain lower blood sugar levels.
• DASH diet: Originally designed for people with high blood pressure, is it also helpful for weight loss.
• Vegetarian and plant-based diets: Removes all animal products to reduce cholesterol, blood sugar and weight.

Evidence shows that several eating patterns work, so you should choose the one that you can stick with long-term.

Increase physical activity

Regular exercise is very important for losing weight and controlling diabetes. The American Diabetes Association says you should do at least 150 minutes a week of moderate exercise, like brisk walking or 75 to 150 minutes a week of harder exercise. Adding resistance training 2 to 3 times per week provides additional benefits and will help you maintain muscle mass while you lose weight.¹³

Doing resistance training 2 to 3 times each week gives extra benefits and helps you keep your muscles while you lose weight. Even breaking up prolonged sitting with short walks or simple exercises can improve your blood sugar levels.¹

Take medications as prescribed, and ask if they affect weight

Some diabetes medicines do not change weight or help you lose weight, but others can make you gain weight. Don’t stop taking any medicine by yourself. Instead, ask your doctor:

• Is my diabetes medicine helping me lose weight or making it harder?
• Are any of my other medicines changing my weight?
• Can another medicine help control my blood sugar and also help me lose weight?

Your doctor might help you change medicines to reach your goals for weight loss and blood sugar.

Address sleep and stress

Poor sleep and feeling very stressed can change your hormones. This can make you feel hungrier and make it harder to control your blood sugar. Some actions may help:

• Go to bed and wake up at the same time every day.
• Avoid using screens before bedtime.
• Try relaxation methods like deep breathing or yoga.
• Talk to your doctor if you snore loudly, stop breathing at night (sleep apnea) or feel very sleepy during the day.

But remember, many medicines for insomnia can also make you gain weight. It is best to sleep well at night without any help.

Participate in intensive behavioral programs

Programs that have regular counseling sessions and clear plans work best. The American Diabetes Association suggests at least 16 sessions over 6 months. These sessions focus on changing eating habits, getting more exercise and learning new habits. These programs teach you how to set goals, track your progress (tracking food intake, physical activity and daily weight) and how to manage stress.¹⁰

These programs teach you how to set goals, track what you eat, your exercise and your daily weight and manage stress.

Most people gain weight before they get type 2 diabetes. Then, they may lose weight after they find out they have it, especially if they change their lifestyle or start some medicines. Knowing this pattern can help you see warning signs and take action.

Weight gain before diagnosis

Research shows that about 71% of people gain weight in the 3 years before they find out they have diabetes. Of these, 32% gain more than 0.5 kg/m² (half of a BMI point) each year. This weight gain is often a contributing factor to developing diabetes in the first place. Younger age, poverty and lower education levels are associated more weight gain.¹⁴

Weight changes after diagnosis

Weight gain often causes diabetes. However, after treatment, many people will start to lose weight. This weight loss often results from improved diet, increased physical activity and the effects of certain diabetes medications. However, some diabetes medications can cause weight gain, so it’s important to discuss medication choices with your healthcare professional.¹⁴

How type 2 diabetes affects your ability to lose weight

Type 2 diabetes causes problems in the body that can make losing weight harder, but knowing about these problems helps you handle them better.

Insulin resistance is the main reason why people with diabetes have trouble losing weight. When your cells don’t react well to insulin, your body makes more insulin. Higher insulin levels make you store more fat and make it harder to lose weight.

Diabetes medicines can affect weight differently. Insulin and sulfonylureas often cause weight gain, while metformin is weight-neutral, and newer medications like GLP-1 receptor agonists promote weight loss. Furthermore, medications for other conditions, such as depression, high blood pressure or sleep, can affect weight. Your healthcare professional can help you choose medications that support your weight loss goals.

The good news is that weight loss improves insulin sensitivity, creating a positive cycle where losing weight makes it easier to continue losing weight and better control your blood sugar.⁶

Can weight loss be a sign of type 2 diabetes?

Yes, losing weight without trying can be an early sign of type 2 diabetes, especially if you have other symptoms too. This kind of weight loss is different from losing weight on purpose by eating healthy and exercising.

When your blood sugar gets very high, your kidneys try to take out extra sugar in your urine. This process, called glycosuria, makes your body lose calories and can cause weight loss without trying.¹³ You might also have to urinate more than usual, feel very thirsty, feel tired and have blurry vision.

When to see a doctor if you’re concerned about weight loss from diabetes

You should call your doctor right away if you have any of these symptoms:

• Unintentional weight loss of more than 5% of your body weight over 3 to 6 months
• Weight loss accompanied by excessive thirst, frequent urination or extreme fatigue
• Symptoms of very high blood sugar, including confusion, rapid breathing or fruity-smelling breath

Make an appointment if you:

• Are struggling to lose weight despite following your treatment plan
• Have gained significant weight after starting diabetes medications
• Want to discuss weight loss plans or medications
• Need referral to a registered dietitian or diabetes education program

Overview of weight loss drugs and clinical treatments for type 2 diabetes

Several medication options can help you achieve and maintain weight loss while managing your diabetes. The most effective weight loss medications for people with type 2 diabetes are GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists.¹⁵

GLP-1 receptor agonists

These medicines work by copying the body’s hormones that control hunger and blood sugar. Semaglutide (Ozempic, Wegovy) can help people lose 9.6% to 14.9% of their weight when used with healthy habits. Liraglutide (Victoza, Saxenda) is another option in this class that promotes both weight loss and improved blood sugar control.¹⁶

Dual GIP/GLP-1 receptor agonists

Tirzepatide (Monjuaro, Zepbound) is another choice in this group that helps with weight loss and better blood sugar control. This medication works on two hormones at the same time, so it is very helpful for both weight loss and diabetes.⁸

SGLT2 inhibitors

SGLT2 inhibitors cause a small weight loss of about 2-3 kilograms (4-6 pounds) and also help control blood sugar. These medicines stop the kidneys from taking back sugar, so the sugar leaves the body in the urine. Canagliflozin, empagliflozin and dapagliflozin are the primary agents in this class.¹⁶

Older combination medications

Canagliflozin, empagliflozin and dapagliflozin are the main drugs in this group.

Phentermine-topiramate causes the most weight loss among older medicines. In clinical tests, about 54% of people lost at least 10% of their body weight. The medicine helps by making you feel less hungry and feel full faster.

Naltrexone-bupropion causes a smaller weight loss of about 3 to 5% in people with diabetes. This medicine works in the brain to lower hunger and help people feel full. Common side effects are feeling sick, headache and trouble with bowel movements.

Orlistat has been used for more than 20 years. It helps people lose a little weight by stopping about 30% of fat from being absorbed. Its small benefits and stomach problems (gas, diarrhea and sudden need to have a bowel movement) limit how much it can be used.¹⁷

Achieving a lower weight and lower blood sugars

While weight loss can be more challenging with diabetes due to insulin resistance and certain medications, achieving even modest weight loss of 5% to 10% helps blood sugar levels, lowers the risk of heart disease and stroke and may make diabetes go away in some people.

Successful weight management uses several methods: eating planned meals that have fewer calories, exercising for at least 150 minutes each week, and getting strong support with regular check-ins. For many people, newer medicines like GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists can help a lot with weight loss and better blood sugar control.

References

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