Weight Management in Diabetes at Leeds Hospital

Weight management in diabetes means finding sustainable ways to reach and stay at a healthier weight, using changes such as diet, physical activity, and sometimes medication or surgery. It's a central part of managing type 2 diabetes in particular, since carrying extra weight makes it harder for your body to use insulin properly.

What conditions does it treat?

Weight management is relevant across a number of situations:

• Type 2 diabetes: Where around 85 to 90% of people carry excess weight, which increases insulin resistance and makes blood glucose harder to control
• Prediabetes: Where losing weight can delay or reduce the risk of it progressing to type 2 diabetes
• Type 1 diabetes: Weight itself doesn't cause type 1 diabetes, but losing any excess weight can still help reduce your risk of complications and may reduce how much insulin you need.

What are the benefits of weight management in diabetes?

Research shows that losing even 5 to 10% of your body weight can bring real benefits: your diabetes may become easier to control as your body makes better use of insulin, you may need less medication, and your cholesterol and blood pressure may improve, lowering your risk of heart disease and stroke. Many people also report feeling more energetic, more mobile, and more confident.

If you have type 2 diabetes, losing a larger amount of weight, around 15kg (2 stone 5lbs), as quickly and safely as possible after diagnosis gives you the best chance of remission, where your blood glucose returns to a normal range without needing diabetes medication.

It's worth knowing that the evidence isn't entirely clear-cut. One large study found that an intensive weight-loss programme improved risk factors like cholesterol and blood pressure, but didn't actually reduce the number of heart attacks and strokes that happened over time. Weight loss still helps in many other ways, but it isn't a guarantee against every complication.

Are there different types or approaches?

There's no single approach that works for everyone, so it's worth finding one that suits your life and that you can stick with. Common approaches include eating fewer calories than you use, following a particular eating pattern such as a low-carbohydrate or Mediterranean-style diet, and building in regular physical activity, alongside education and ongoing support from your healthcare team.

Other popular options, such as intermittent fasting or a low glycaemic index diet, don't yet have strong evidence specifically for weight loss in people with diabetes, though a low GI diet can still help with blood glucose control.

More structured options exist too. A low-calorie diet (around 800 to 1200 calories a day) or a very low-calorie diet (under 800 calories a day, usually using meal-replacement shakes or soups) can produce faster results, but should only be tried with medical supervision, especially if you take insulin or certain other diabetes medications.

Some people are prescribed weight-loss medication such as GLP-1 injections, and for those with a significant amount of weight to lose, weight-loss (bariatric) surgery is sometimes recommended. For people with type 2 diabetes, this is considered a direct treatment for the condition in its own right, not just a way to lose weight, since it changes gut hormones, increases bile acid production, and improves how the body responds to insulin.

What happens before you get started?

Before making changes, it helps to know where you're starting from and to get your healthcare team involved, especially if your diabetes is treated with insulin or certain medications.

• Work out your BMI and measure your waist size, since waist measurement shows fat around your middle that BMI alone can miss (aim for less than 80cm for women, less than 94cm for most men, and less than 90cm for South Asian men)
• Talk to your healthcare team before starting a new diet or increasing your physical activity, particularly if you take insulin or a sulphonylurea, since this can affect your risk of low blood glucose (hypos)
• Set practical, achievable goals rather than aiming for big changes all at once, such as adding one extra walk a week or changing one meal at a time
• Ask your healthcare team about local or online weight-management programmes and support available to you.

What does it look like over time?

There's no fixed timeline, since this is an ongoing process rather than a one-off treatment. Many people find it helpful to track their weight and activity regularly, for example using a weight-loss planner or app, to stay motivated and notice patterns.

Your healthcare team will usually review your medication as you lose weight and become more active, since your insulin or other diabetes medicines may need adjusting, sometimes reducing, as your body's needs change. Don't adjust doses yourself without their advice.

For some people with type 2 diabetes, especially those who lose a significant amount of weight soon after diagnosis, blood glucose can return to a normal range without medication, known as remission. For most people, though, weight management is a long-term, ongoing part of living well with diabetes, and your weight may go up and down along the way; this is normal and doesn't mean you've failed.

What are the risks and things to consider?

Weight management is generally safe, but there are things worth being aware of:

• An increased risk of low blood glucose (hypos), particularly if you take insulin or a sulphonylurea and increase your activity levels or reduce what you eat without adjusting your medication
• Very low-calorie diets (under 800 calories a day) can be risky without medical supervision, particularly if you take insulin or other diabetes medications
• If you have type 1 diabetes and are underweight or struggling with your appetite, being too restrictive with food isn't advised; the right approach is different for everyone
• Weight-loss medications and surgery carry their own separate risks and aren't suitable for everyone; your healthcare team can advise on both
• Keeping weight off long-term can be harder than losing it in the first place, and your weight may fluctuate over time; this is common and doesn't mean the approach has failed.