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Background: Diabetes and obesity -
Why lose weight?
In a UK study which reviewed the diabetic clinic records of 263 obese patients with Type 2 diabetes or impaired glucose tolerance who died in 1985 to 1986 (1) :
- an average weight loss of 1kg in the year following diagnosis of diabetes was associated
with an increased survival of 3-4 months
- a 15-20 per cent weight loss in obese patients in the first year after diagnosis of Type 2
diabetes returned their life expectancy to that of non-diabetic people
Sustained moderate weight loss can also improve glucose control and lipid profiles and thus reduce the risk of complications, such as diabetic retinopathy and renal damage. In a study of the effects of a weight loss of 6.9-13.6kg (> 5 per cent of body weight) for 12 months (2):
glucose levels were reduced by 15 per cent
insulin levels were 48 per cent lower
triglycerides fell by 20 per cent
HDL-cholesterol increased by 46 per cent.
Preliminary results from the Swedish Obesity Study (SOS) of over 1,700 men and women showed surgery induced weight loss of approximately 30kg over two years to be associated with (3):
a 60 per cent reduction in plasma insulin
a 25 per cent fall in glucose and triglyceride levels
a 10 per cent reduction in blood pressure.
This degree of weight loss resulted in a 14-fold reduction in risk of developing diabetes and a three- to four-fold reduction in the development of hypertension, hypertriglyceridaemia and low HDL cholesterol levels.
Significant evidence shows that losing moderate amounts of weight (5-10 %) and maintaining the weight loss has genuine health benefits in reducing illness and death not only in type 2 diabetes, but in dyslipidaemia, cardiovascular disease, and obesity-related cancers.
Professor Gareth Williams (Department of Medicine, University of Liverpool): More than 80 % of Type 2 diabetes patients are obese; this worsens the prognosis of their diabetes.
Professor Hans Hauner (Diabetes-Forschungsinstitut, Heinrich-Heine-Universität, Dusseldorf): Weight management must be the key element of each treatment strategy.
Professor John Foreyt (Department of Medicine, Baylor College of Medicine, Houston, TX): Lifestyle modification is difficult for patients to achieve unless they encompass a behavioral modification programme tailored to the individual patient.
Three case studies were presented in this section.
Management of obese patients with Type 2 diabetes should be based on an integrated weight management programme that includes diet, lifestyle modification and pharmacotherapy.
(1) Lean MEJ, Powric JK, Anderson AS et al. Obesity, weight loss and prognosis in type 2 patients. Diab. Med. 1990: 7: 228-233
(2) Wing RR, Loeske R, Epstein LH et al. Long-term effects of modest weight loss in type 2 diabetic patients. Arch. Int. Med. 1987: 147: 1749-1753
(3) Sjöström L, Närbro K, Sjöström D. Costs and benefits when treating obesity. Int. J. Obesity 1995: 19(Suppl. 6): 9-12