The treatment of type 2 diabetic patients recommends losing weight since the benefits of weight loss have long been recognized in medical science. Although achieving sufficient weight loss to reach an ‘ideal’ bodyweight is remote but, this does not imply that treating obesity is fruitless; moreover, modest weight loss of 5–10% in obese patients with type 2 diabetes is found to bring a variety of long-term clinical benefits [1].
Improvements have been noted in all modifiable risk factors such as HbA 1c levels, hypertension, dyslipidemia, self-esteem and overall quality of life. Trimming few kilograms of weight can also pay many long term health benefits such as reducing their risk of chronic kidney disease, depression and eye disease, and other ailments – and save you money on health care expenses. Moreover, improvements in these risk factors have a favourable effect on mortality.
Maintaining Glucose Level
Losing bodyweight has a direct influence on blood glucose level by lessening insulin resistance and simultaneously improving both hepatic and peripheral insulin sensitivity [2]. Several studies showed that the benefits are proportional to the amount of weight lost. A study by Wing et al. [3]showed that a weight loss of 10% of total body weight reduced HbA1c levels by 1.6%. Correspondingly, there was a reduction in the need for oral diabetic agents.
High Blood Pressure
Several controlled studies have looked at the relationship between weight loss and blood pressure reduction. Weight reduction can reduce blood pressure independent of sodium intake and the UKPDS (The UK Prospective Diabetes Study) recommends controlling blood pressure (BP) of 140/85 mmHg in Type 2 diabetes to reduce the risk of cardiovascular and macrovascular complications [4].
It is essential to losing weight for type 2 diabetic patients because it is found in research that a weight loss of more than 10 kg has been shown to reduce the risk of hypertension by 26%. A more realistic intervention may be to prevent further weight gain, as it is estimated that a 1 kg increase in weight is associated with a 5% increase in the risk of hypertension. [5] Given the present evidence, weight reduction should be considered an effective measure in the initial management of mild-to-moderate hypertension.
Dyslipidemia
Type 2 diabetes mellitus leads to dyslipidemia, like high serum triglyceride levels and low high-density lipoprotein (HDL) cholesterol levels, which are known risk factors for coronary artery disease. Lifestyle interventions such as diet, physical activity, weight loss, and smoking cessation are an integral part of any diabetes management plan.
Raised serum triglyceride levels lead to an increased clearance of the more protective HDL cholesterol from the circulation and an increase in the more atherogenic LDL cholesterol. Weight loss can help to reverse this process and promote a more favourable shift in the LDL cholesterol profile of an individual, through the generation of larger and less dense LDL particles, which are less of an atherogenic threat [6].
After a long term study on newly diagnosed diabetic subjects, Lean et al. found that modest amounts of weight loss of 9 kg had associated improvements in lipid and lipoprotein levels [7].
Quality of life
Losing weight improves patients with type 2 diabetes self-esteem, as well as their overall quality of life. Diabetes itself is a chronic condition, which severely affects daily living. It is estimated that the average person with diabetes is willing to trade away 12% of his remaining life in return for a diabetes-free health state [8].
One study published in the New England Journal of Medicine claims that even modest weight loss can lead to improvements in diabetes and other markers of health. They did not found notable improvements in longevity but the patients certainly lived better. Study participants who lost 5-10 per cent of starting weight and increased their fitness showed:
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- reduced need for medication;
- improved mobility;
- reduced severity of sleep apnea; and,
- improved sexual functioning.
It’s widely accepted across the obesity research and treatment community that even a 5-10 per cent weight loss can have significant benefits on health. Losing weight has long-range health benefits for type 2 diabetes patients—even if the person regains the weight, the author claimed in a study. For the average patient, each kilogram of weight loss was associated with a three- to four-month prolonged survival and a 10 kg weight loss predicted the restoration of about 35% in life expectancy [7].
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Reference
[2] Klein S. Outcome success in obesity. Obes Res 2001 (4): 354S–358S.
[3] Wing RR, Koeske R, Epstein LH, Norwark MP, Gooding W, Becker D. Long term effects of modest weight loss in type 2 diabetics. Arch Int Med 1987; 147: 1749–1753.
[4] Ramsey LE, Williams B, Johnston JD, MacGregor GA, Poston L, Potter JF. British hypertension management. Br Med J 1999; 319: 630–635.
[5] Huang Z, Willett WC, Manson JEet al. Body weight, weight change and risk for hypertension in women. Ann Intern Med 1998; 128: 81–88.
[6] Griffin BA. Liporotein atherogenicity: an overview of current mechanisms. Proc Nutr Soc 1999; 58: 163–169.
[7] Lean MEJ, Powrie JK, Anderson AS, Garthwaite PH. Obesity, weight loss and prognosis in type 2 diabetes. Diabet Med 1990; 7: 228–233.
[8] Brown GC, Brown MM, Sharma S, Brown H, Gogin M, Denton P. Quality of life associated with diabetes mellitus in an adult population. J Diabetes Comp 2000; 14:18–24.
