Many people learn about having diabetes in their doctor’s office during an annual checkup. Most people when receiving such a diagnosis are surprised as they are asymptomatic, a term we use to describe having no symptoms.
Several tests can diagnose diabetes. The hemoglobin A1C can suggest elevations in blood sugar for the prior three months. The diagnosis of diabetes has been increasing in the U.S. population. However, there is one question, which I am often asked: Did my weight cause the diabetes or am I going to gain weight now that I have diabetes?
What is the difference between being overweight and being obese? We use the body mass index (BMI) to calculate the category. A person who is 160 pounds and 63 inches tall has a BMI of 28. This person is considered to be overweight. The calculator is a rough estimate of relative health per weight for people in this country. Although the formula has limitations, it is common for doctors and nurses to calculate and record your BMI as a metric of your health.
Underweight = 18.5
Normal weight = 18.5–24.9
Independent reporting for Pine Bluff & Jefferson County since 1879.
Overweight = 25–29.9
Obesity = BMI of 30 or greater
The diabetic research shows a complex relationship between obesity and diabetes development. Although the data cannot prove that obesity causes diabetes, there is a strong relationship between being overweight and obese and developing diabetes later in life. This reflects a global pattern and is often linked to the increase in food abundance.
Quitting smoking can also lead to surprising results. In several trials, individuals who recently quit had weight gain and an increased risk of developing diabetes.
To complicate matters further, some diabetic medications have also led to weight gain. Insulin has been shown to lead to an average weight gain of 14 pounds over 10 years, with most of the weight occurring in the first year of starting insulin. Lower doses have also been shown to lead to weight gain.
Metformin has not been shown to lead to significant gains and has fewer side effects, which is why physicians recommend it be used first.
Newer medications have shown improvements in diabetes management with weight loss. Classes of drugs, such as glucagon-like peptides 1 (GLP-1), have been used to treat diabetes with significant success for weight loss. Examples include semaglutide (Ozempic), liraglutide (Wegovy), etc. Not everyone is a candidate for these medications as they do come with significant side effects that need to be discussed by your prescriber.
Also, patients with weight loss without the use of medicines have observed improved blood sugar readings. Over time sustained weight loss can have other benefits including improved blood pressure. Weight reduction can also be achieved by medical nutrition therapy (MNT), which is a tailored dietary plan to the person’s lifestyle, medical history, and other personal factors.
Before medicines, though, we will always recommend diet and exercise lifestyle changes. Current recommendations by the American Diabetes Association recommend adults at risk for developing diabetes who are overweight or obese exercise 150 minutes per week, which equals to 30 minutes per weekday. There is also evidence to show that restricting calories per day can delay or avoid the development of diabetes. The data is mixed on intermittent fasting as people often overeat in between fasts.
If you are overweight or obese, you have an increased risk of developing diabetes. That risk is in relation to your genetics, lifestyle habits, and current diseases. Think about the daily steps you can take in implementing small change, which if done consistently lead to large outcomes. There is no excuse to delay exercise and diet changes now for a better future!
For more information, here are the following resources:
Magliano DJ, Islam RM, Barr ELM, et al. Trends in incidence of total or type 2 diabetes: systematic review. BMJ. 2019;366:l5003. Published 2019 Sep 11. doi:10.1136/bmj.l5003
Wu L, Wang X, Dong JY, Zhao YT, Lou H. Smoking Cessation, Weight Gain, and Risk for Type 2 Diabetes: A Prospective Study. Int J Public Health. 2022;67:1604654. Published 2022 Apr 14. doi:10.3389/ijph.2022.1604654
Hu Y, Zong G, Liu G, et al. Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality. N Engl J Med. 2018;379(7):623-632. doi:10.1056/NEJMoa1803626
ElSayed NA, Aleppo G, Aroda VR, et al. Introduction and Methodology: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S1-S4. doi:10.2337/dc23-Sint
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group [published correction appears in Lancet 1999 Aug 14;354(9178):602]. Lancet. 1998;352(9131):837-853.
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Dr. Naznin Jamal is a Jefferson Regional Medical Center hospitalist.