Almost 26 million children and adults in the USA (8.3% of the population) have diabetes. There are two major forms: type 1 and type 2, which account for 90% to 95% of cases. In people with diabetes, the body does not make enough of the hormone insulin or doesn’t use it properly. Insulin helps glucose (sugar) get into cells, where it is used for energy. If there’s an insulin problem, sugar builds up in the blood, damaging nerves and blood vessels. Diabetes can lead to heart disease, stroke, kidney failure, foot and leg amputations and blindness.
A large federal study of whether diet and weight loss can prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes ended two years early because the intensive program did not help. However, those who lost a modest amount of weight and kept it off received many long-term health benefits such as reducing their risk of chronic kidney disease, depression and eye disease. They also had better blood sugar control, improved quality of life and fewer hospitalizations.
Researchers at 16 institutions had organized a long-running clinical trial to measure the effect of weight loss, enrolling more than 5000 obese or overweight people ages 45-75 with Type 2 diabetes. They averaged 200 pounds. Half of the group was then assigned to an intensive lifestyle intervention that involved eating less — 1200 to 1800 calories a day — and putting in at least three hours of moderate exercise a week. They received counseling and attended meetings to help them stick with the program.
Those people lost an average of 8.6 percent of their body weight in the first year, which isn’t easy. The people in the control group, who didn’t get the lifestyle help, lost only 1 percent of body weight in that first year. Both groups managed to avoid major backsliding, which typically happens with weight loss trials. The intervention group gained some weight back in years two through five, but ended up with a 6 percent loss over 10 years. The control group lost weight gradually and was down about 4 percent at the end.
Since excess weight is considered a risk factor for both cardiovascular disease and diabetes, the researchers hypothesized they’d see improvements in both. Instead they had to stop the trial early, after almost 10 years, because there was no difference between the two groups in the incidence of heart attacks and strokes. The results were published in the New England Journal of Medicine.
Researchers insist the trial wasn’t a failure. “Weight loss is still important, but the reasons why it is important are different than we thought,” says Rena Wing, a professor of psychiatry and human behavior at BrownUniversity and chairman of the Look AHEAD (Action for Health in Diabetes) study. The weight-loss group had better glycemic control and lower systolic blood pressure, spent less money on medications, had less sleep apnea, and was more likely to have a partial remission of diabetes. They were less likely to land in the hospital. And perhaps most importantly, they felt better.
Gary Foster, director of the Center for Obesity Research and Education at Temple University in Philadelphia, says the study shows that weight loss gives people with diabetes “a pretty big bang for their buck. It looks like there are whopping effects on kidney disease.” Foster says the other impressive result is that the people who lost weight were able to keep most of it off, contrary to the popular wisdom that just about everyone who loses weight eventually gains it back.
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