On Nutrition

When someone gets a diagnosis of diabetes or prediabetes, the first advice they’ll probably receive is to lose weight. But is weight loss the only option? Is it the best option? Is it even necessary? What if you’ve already spent years trying in vain to lose weight and keep it off? What if you set dieting aside years ago, maybe as part of recovering from an eating disorder or because you accepted that your body is just not meant to be smaller? What if you’re already thin?

I’ve had newly-diagnosed-with-diabetes clients who were, thanks to the genetic hand they were dealt, naturally thin. They rarely exercised or paid attention to nutrition, because they didn’t “have to.” Translation: if you’re thin, your health behaviors don’t matter. Except they do, and that’s true regardless of what you weigh and whether or not your health behaviors lead to weight loss. Weight is not a behavior, and it does not equal health. That cuts both ways — just because someone’s thin doesn’t mean they’re healthy, and just because they’re not thin doesn’t mean they’re not healthy.

Research from the National Institutes of Health-funded Diabetes Prevention Program is framed as demonstrating that people with prediabetes can prevent or delay developing diabetes by losing a modest amount of weight. But what gets second billing are the nutrition improvements and increased physical activity — behaviors that are weight-neutral because they have benefits regardless of weight — that are likely responsible for the observed reductions in diabetes risk.

Indeed, despite regaining much of the lost weight within five years, participants randomly assigned to the nutrition-exercise-weight loss group developed diabetes an average of two years later than the group randomly assigned to take metformin, and four years later than the group that took a placebo.

One concern about diabetes is that it increases the risk of developing cardiovascular disease. It’s notable that the NIH-funded Look AHEAD (Action for Health in Diabetes) study was stopped early because the intensive weight loss program did not reduce risk of cardiovascular disease in people with longstanding Type 2 diabetes when compared with a control group that received three yearly group sessions on diet, exercise and social support.

So if not weight loss, then what? Many factors outside of our control affect health, but as for what you can control, look to behaviors and habits. A good example is the Association of Diabetes Care & Educations Specialists’ ADCES7 Self-Care Behaviors, which were developed to promote successful and effective diabetes self-care:

  1. Healthy coping, which includes having a positive attitude towards diabetes self-management, positive relationships, psychological well-being and good quality of life.
  2. Eating a wide variety of quality, nutritious foods that suit food preferences, age, activity levels, personal health and other factors.
  3. Being active by participating in daily physical activity — both planned and unstructured — of the type, duration and intensity that you prefer.
  4. Taking medication exactly as prescribed.
  5. Monitoring blood sugar and blood pressure, as well as mood, sleep, symptoms and various aspects of self-care.
  6. Reducing risk of episodes of high or low blood sugar and diabetes complications with good health habits.
  7. Becoming a more effective problem solver by learning more about diabetes, using your own past experience with self-management to adjust your plan going forward, and collaborating with your health care providers when making decisions and setting goals.