How to Lose Weight and Keep it Off
By Matthew Garza
Weight management is no easy task, but achieving and maintaining a healthy weight is important for your well-being, your diabetes management, and your overall health.
Why is managing your weight important?
Your weight can significantly impact your diabetes and put you at an added risk for additional complications, such as chronic kidney disease and cardiovascular disease, whether you have type 1 or type 2 diabetes.
Research shows that losing just a small percentage (5-10%) of your bodyweight can have major effects on your health – giving you more energy, making it easier to manage your diabetes, reducing your risk for complications, and improving your overall well-being.
Kim Carter Martinez, a political and legislative director for a labor union and owner of a consulting firm in Sacramento, Calif, has seen how transformational weight loss can be. She’s had diabetes for 26 years, and has long struggled to lost excess weight.
“I have been overweight since I was a child,” Carter Martinez said. “I lived most of my life morbidly obese, and seven years ago I lost almost 170 pounds [or around half of her body weight] through changes in my diet and exercise. I went from using 120 units of insulin a day to using about 12, and I have been able to maintain a great A1C for the last four years. My latest was 5.2%!”
Here are some ways you can start thinking about weight management.
Tips and tricks, centered on lifestyle changes
1. Focus on nutrition
Balanced, healthy nutrition is key when trying to reach your ideal weight. Making healthy recipes, cutting down on calories, and being intentional with the foods you are eating is important.
Eating nutrient-rich foods that nourish our bodies is the first step. Check out diaTribe’s article “What to Eat with Diabetes” for a good place to start. Eating more vegetables, whole grains, lean protein (like fish and chicken), nuts and seeds, and healthy fats and oils (like avocados and olive oil) can help you maintain a diet that gets you all of the vitamins, minerals, and fiber you need.
In addition, avoid foods that are high in calories but lack the nutrients that your body needs. Sugar-sweetened drinks and food, butter and margarine, refined grains (like white bread, white rice, and pasta), foods with added salt, and processed foods should be avoided as much as possible. Many of these foods can also lead to spikes in your glucose – doubling the reason to stay far away.
Food portion size is another critical component of weight management. It’s important to work on reducing the number of calories you’re eating with each meal – this may require some additional planning. Measuring your food (with the use of a kitchen scale and measuring cups) can help you keep track of exactly how much you are eating and meal prepping can help you plan ahead. Research has shown that portion sizes in the US far exceed what is recommended by the FDA (Food and Drug Administration) or the USDA (US Department of Agriculture) – you can learn more about portion control from the USDA here. Being mindful of how much we are eating is just as important as what we are eating.
“I weigh and track my portions in the Carb Manager and My Fitness Pal apps,” said Carter Martinez, who attributes much of her weight management success to healthier eating and exercise.
There are certain eating plans that have been shown to help people with diabetes with weight management. These often focus on low calorie or low carbohydrate foods and can include:
Low-carb – This eating plan focuses on limiting the number of carbs you eat – you should aim to eat 45-60 grams of carbs at each meal (or less than 30 grams for very low carb eating plans). This can help you manage your weight and your glucose levels.
Keto – A keto (or ketogenic) eating plan focuses on high fat, low carb meals. The eating plan is designed to force the body to burn fats rather than carbohydrates for energy.
Mediterranean – A Mediterranean eating plan encourages you to eat more plant-based foods (vegetables, nuts, seeds, whole grains, fish, and extra virgin olive oil) and less meat.
DASH – The DASH (Dietary Approach to Stop Hypertension) eating plan is very similar to the Mediterranean plan. It focuses on limiting the amount of fat you are eating and encourages you to eat more vegetables, whole grains, fat-free dairy products, lean meats, and nuts.
Intermittent fasting – Intermittent fasting or time-restricted feeding focuses on when you eat more than what you eat. In these eating plans you will fast for a set number of hours (or a full day) in between meals and it can help reduce the number of overall calories you are eating.
“One of the things that worked for me was that I looked into intermittent fasting,” said Michael Hattori, a registered nurse and diabetes care and education specialist from Monterey, Calif., who was diagnosed with type 2 diabetes two years ago. He had to tinker to find a pattern of eating that worked for him, but eventually he figured out a system that helped keep his cravings at bay – without having to dramatically change what he was eating.
2. Get out and get active
Proper nutrition is one of the most important factors for achieving your ideal weight; the other most important factor is increasing your physical activity and exercising regularly.
“When I found out I had diabetes, that really spurred me to get my act together,” Hattori said. “I started exercising regularly and over the period of a year, I lost 42 pounds, which contributed to keeping my diabetes under control.”
Even though he has had to battle a few injuries, he said that walking has been his mainstay for his weight and his glucose. “Just walking for 15 to 30 minutes after a meal makes a huge difference and helps maintain weight,” he said. “Any time you move your muscles, you’re doing exercise.”
The ADA recommends that most adults with diabetes should aim for at least 150 minutes each week of moderate to vigorous intensity activity spread over at least three days. In addition, you should try to engage in two to three sessions of resistance exercise (like lifting weights) on nonconsecutive days and two to three sessions per week of flexibility or balance training per week (such as stretching or yoga).
If it’s been a while since you last got moving, take things slow at the beginning. Focus on lower intensity activities for shorter intervals of time at first, and then gradually build up from there. Going on a short walk each day is a great place to start. Exercise looks different for everyone – some people like to go out and run, other prefer to weight lift, and still others prefer yoga, dancing, or even just a walk around the neighborhood.
“I've done many different kinds of exercise,” said Carter Martinez. “Lately I've been doing reformer Pilates in small group classes with a teacher at my local Pilates gym. I’ve also done CrossFit and met with the trainer from that gym to learn methods and techniques. I generally change up what I'm doing every year or two – I like being able to challenge myself to do new things that I couldn’t do at my heaviest.”
It’s important to remember that having diabetes can sometimes pose additional challenges to exercising – especially for those who take insulin – so talk to your doctor about the best ways to stay safe and be sure to monitor your glucose levels before, during, and after exercising.
To learn more about exercising with diabetes read our articles on the subject:
Want to Stay Active or Get More Exercise? Strategies for Glucose Management
Exercise Well with Your CGM – Recommendations, Glucose Trends, and Strategies
Exercising Well with Diabetes Using Automated Insulin Delivery
3. Setting small, achievable goals
Weight management is all about taking things one step at a time and focusing on changes you can make that you can sustain over the long term.
This most likely means that losing 20 pounds just one month before your summer beach vacation may not be the healthiest or most realistic way to achieve your goal. Extreme diets and unhealthy amounts of exercise might help you lose weight quickly, but it’s difficult to maintain this level for very long, and they can lead to rebound weight gain. Instead focus on things that can help you gradually reach your ideal weight. In addition, if you are curious to see how the small changes you make affect your glucose but you do not have a personal continuous glucose monitor (CGM), talk to your doctor about trying professional CGM.
“I started out small, eliminating soda and Starbucks drinks from my diet and gradually shifted my eating over time to how I eat now,” Carter Martinez said. “I eat keto all of the time – at home, at work, while traveling, at meetings and friends’ houses, even restaurants. For the most part, I can make my diet work in any situation and this has made it easy for me to transform this into a habit.”
Whatever goals you do set, make them fun, simple, and realistic, and be sure to hold yourself accountable.
4. Build a support system and stay positive
Staying motivated while trying to achieve your ideal weight can be difficult, especially if you feel like you are going at it alone. Finding others who can hold you accountable (and vice versa) can provide the emotional support needed to keep going even when the journey feels tough.
Support can come in many different forms. It might mean your family is making changes to eat healthier with you, maybe it means finding a friend to walk or run with, or it could mean joining an online community or support group.
“One of my nursing friends is also a fitness instructor and she’s been a great coach and is very supportive,” said Hattori. “She’ll call and text me and check if I exercised that day. It’s been really helpful to have a cheerleader out there since it can be difficult to find the motivation to exercise.”
He added: “Having personal support and someone to hold you responsible and check on you, for me, is what works the best.”
Support can also come from weight management programs and apps that can help hold you accountable. Programs such as WW (formerly Weight Watchers), Noom, and Jenny Craig can provide support and guidance for proper nutrition to help you manage your weight, while apps like MyFitnessPal or Fitbit can keep you moving and exercising regularly.
It’s important to remember that support also comes from within. Having a positive mindset and focusing on encouraging self-talk can go a long way in keeping you on track while trying to manage your weight. Weight management journeys are hardly ever a straight line, and there will be days that are much harder than others – don’t discount the progress you have made and know that little wins can be just as important as big ones.
Options out there for losing weight that go beyond lifestyle changes
Though making lifestyle changes is usually the first option for weight management, when exercise and nutrition aren’t enough, and weight remains a significant health risk, there are other interventions that can have a dramatic effect on your weight as well.
Medications: There are many different kinds of medications designed to help you manage your weight. Often these medications work by helping you feel less hungry. Other medications work by making it harder for your body to absorb fat from the foods you eat. You can find a list of FDA-approved medications for weight management from the NIDDK here.
GLP-1 receptor agonists: These medications were initially designed to help people with diabetes manage and lower their glucose levels. Because they slow stomach-emptying and increase feelings of fullness, they have also been studied (and approved) for weight management in addition to helping lower glucose. The FDA-approved GLP-1 receptor agonists for weight management are Saxenda and Wegovy (approved this year). In clinical trials, people taking Wegovy (in addition to diet and physical activity changes) lost, on average, 14.9% of their body weight after about 16 months, compared to only 2.4% weight loss in participants using the meal plan and exercise regimen without Wegovy. Similarly, in clinical trials, people taking Saxenda lost, on average, 8% of their body weight compared to only 2.6% in the placebo group.
“I am on Trulicity [a GLP-1 receptor agonist for treating diabetes, different from Saxenda and Wegovy] now, and it’s making a world of difference,” Hattori said. He explained that since starting on this new drug his appetite is no longer a problem and his GMI (glucose management indicator), which is like an estimated A1C based on your CGM readings, is currently at 5.7%.
Surgery: Also called “weight-loss surgery,” these procedures alter your digestive tract (stomach and intestines) and have been around for decades, with about 250,000 surgeries being performed in the US each year. However, it is important to know that bariatric surgery is not for everyone. The ADA recommends that this intervention should really only be considered for those with a BMI greater than 35 kg/m2 whose diabetes or other lifestyle comorbidities are unable to be managed with lifestyle changes or medication.
Surgery can lead to dramatic weight loss effects – on average people can lose 15-30% of their bodyweight depending on which surgery they have – but as with any intervention, the amount of weight you might lose will vary and is heavily impacted by lifestyle changes as well. In addition, those who undergo these surgeries require lifelong lifestyle support and annual medical monitoring (at a minimum). In the US, the three most common procedures are gastric banding, gastric sleeve, and gastric bypass. Each of these procedures is slightly different and you can learn more about them here.
Though all of these procedures are safe, it’s important to know that some of them are irreversible and each of these procedures can have effects on hormones and gut bacteria. In addition, these procedures can be very costly. Talk to your healthcare team about whether you could be a good candidate for any of these procedures.
Being mindful of potential risks
Managing your weight safely is key. Women and girls with type 1 diabetes are 2.5 times more likely to develop an eating disorder than their peers (there is not enough research on other populations to indicate an increased prevalence). Be on the lookout for the warning signs of an eating disorder in yourself or your loved ones, such as rapid weight loss with normal or heavy eating, high A1C, physical exhaustion or excessive exercising, increased appetite, mood changes, decreased concentration and motivation, and reoccurring diabetic ketoacidosis without an explanation.
If you are concerned that you or someone else with diabetes may be experiencing disordered eating, contact the Diabulimia Helpline or We Are Diabetes. In addition, the National Eating Disorders Alliance is a resource for anyone with or without diabetes.
The bottom line
Weight management is hard but not impossible. By taking small steps to change things like diet and exercise and by talking to your doctor about other options if these lifestyle changes don’t work you can make progress toward achieving – and maintaining – your ideal weight.