Diabetes: Weight Loss Not As Healthy as Avoiding Weight Gain

Diabetes is associated with weight gain and loss may not help.

Not getting fat in the first place appears to be more effective than losing weight later for middle-aged adults trying to dodge the diabetes epidemic, according to a joint British and Swedish study.

The study estimated that if everyone with a BMI of roughly 30—which is considered obese and puts people at high risk—participated in a commercial weight loss program and maintained a weight loss of 5.6% of their pre-diet weight for 10 years, only 8.2% of diabetes cases could be prevented. By contrast, the study estimated that 21.9% of diabetes cases could be prevented if there was a populatio- wide weight maintenance of plus or minus of about six pounds.

No matter what their baseline weight, subjects who put on no more than about six pounds over a 10-year period had a 52% decrease in risk of acquiring type 2 diabetes, the study found.

“We have shown that a population-based strategy that promotes prevention of weight gain in adulthood has the potential to prevent more than twice as many diabetes cases as a strategy that only promotes weight loss in obese individuals at high risk of diabetes,” said the study’s lead author, Adina Feldman PhD, a career development fellow at the University of Cambridge’s Prevention of Diabetes and Related Metabolic Diseases Program.

Feldman and her co-authors from Cambridge and Umea University in Umea, Sweden followed a cohort of 33,184 of Swedish men and women from 30 to 60 years old. Some time from 1990 to 2013, these participants attended two medical evaluations that were 10 years apart. The mean body mass index (BMI) of the test population was 25 at the start of the study and 26.9 at the 10-year follow-up. Diabetes was detected in a little over three percent of these participants after 10 years.

Weight maintenance was defined as a weight change of plus or minus about six pounds between baseline and follow-up or a BMI change of 1. Participants with a BMI of less than 10 or with an increase or decrease of more than 20 between baseline and follow-up were excluded from the cohort.

The study controlled for confounders such a as sex, smoking, and a family history of diabetes.

More attention has been paid to weight loss than weight maintenance to prevent type 2 diabetes, the authors wrote. Their findings, however, suggested there might be some benefit in a shift.

“While primary weight maintenance in adulthood is challenge, it should be considered in contrast to the even more difficult challenge of weight loss and subsequent secondary weight maintenance,” the study added.

The researchers were not optimistic about how easy it might be to prevent population-wide weight gain. Programs for example, to tax sugar-sweetened beverages have had limited success, the study said. In addition there is not much evidence that that individual or community type efforts limiting weight gains among normal weight populations.

“The barriers and facilitators associated with primary weight maintenance are complex, and any effective approach will require changes to policy, environments and health care systems, and incorporate multiple levels of components,” the study said.

The study’s limitations included excluding participants who self-reported diabetes, which could have underestimated the amount of diabetes in the sample population, the authors wrote.

"Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants", appeared in the February 6 issue of BMC Public Health; Dr. Feldman’s comments in a news release.

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