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Intensive Weight Loss Programs Might Help Reverse Diabetes

The views expressed are those of the author and are not necessarily those of Scientific American.

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Intensive weight loss lifestyle diabetes remission

Image courtesy of iStockphoto/Pejo29

Type 2 diabetes has long been thought of as a chronic, irreversible disease. Some 25 million Americans are afflicted with the illness, which is associated with obesity and a sedentary lifestyle, as well as high blood pressure. Recent research demonstrated that gastric bypass surgery—a form of bariatric surgery that reduces the size of the stomach—can lead to at least temporary remission of type 2 diabetes in up to 62 percent of extremely obese adults. But can less drastic measures also help some people fight back the progressive disease?

A new randomized controlled trial found that intensive weight loss programs can also increase the odds that overweight adults with type 2 diabetes will see at least partial remission. The findings were published online December 18 in JAMA, The Journal of the American Medical Association. “The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented,” wrote the authors of the new paper, led by Edward Gregg of the Centers for Disease Control and Prevention.

The study tracked 4,503 overweight adults with type 2 diabetes for four years. About half of the subjects received basic diabetes support and education (including three sessions per year that covered diet, physical activity and support). The other half received more intensive lifestyle-intervention assistance. This second group received weekly individual and group counseling for six months, followed by three-sessions each month for the next six months, and refresher group sessions and individual contact for the subsequent three years. The interventions aimed to help individuals limit daily calories to 1,200 to 1,800—in particular by reducing saturated fat intake—and to help them get the recommended 175 minutes per week of physical activity.

After two years about one in 11 adults in the intervention group experienced at least partial remission of their diabetes, meaning that a patient’s blood sugar levels reverted to below diabetes diagnosis levels without medication. Only about one in 60 in the control group, which received only basic support and education, saw any remission after two years. The findings suggest that “partial remission, defined by a transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes,” the researchers noted.

The improvement, however, was not indefinite for everyone. After four years, only about one in 30 people in the intervention group were still seeing an improvement in their condition. Researchers think that regaining weight and falling behind on diet and physical activity goals increase the risk that people will return to a diabetic state.

About one in 75 in the intervention group saw complete remission of their diabetes, in which glucose levels returned to normal without medication.

The study did not find, however, that individuals in the lifestyle intervention group had lower risks for heart trouble, stroke or death than did those in the control group. “This recently led the National Institutes of Health to halt the [trial],” noted David Arterburn, of Group Health Research Institute in Seattle, and Patrick O’Connor, of HealthPartners Institute for Education and Research in Minneapolis, in an essay in the same issue of JAMA. Similar results have come out of studies looking at more intensive medical treatment of diabetes. “A more potent intervention—bariatric surgery—already appears to achieve what intensive medical and lifestyle interventions cannot: reducing cardiovascular events and mortality rates among severely obese patients with type 2 diabetes,” they noted.

As with any disease, however, prevention is the best strategy. “The disappointing results of recent trials of intensive lifestyle and medical management in patients with existing type 2 diabetes also underscore the need to more aggressively pursue primary prevention of diabetes,” Arterburn and O’Connor noted. One recent study found that compared with no treatment at all, lifestyle interventions reduced the onset of type 2 diabetes by 58 percent in people with pre-diabetes (and the medication metformin reduced the onset rate by 31 percent). Bariatric surgery seemed to reduce the onset of diabetes in obese patients by 83 percent, Arterburn and O’Connor pointed out in their essay.

For people who already have diabetes, however, those who are still in the early stages and those with the biggest weight loss and/or fitness improvement had the best odds for beating the disease. And even if lifestyle interventions aren’t capable of dialing back the disease entirely, any reduction—whether through lifestyle or other changes–in the need for medication and in medical complications due to diabetes can be considered an improvement in managing the disease, which already costs the U.S. health system $116 billion each year and is estimated to affect 50 million Americans by 2050.

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. oliviagreen23 7:18 pm 12/18/2012

    I’ve never been a huge fan of these “lose weight quickly” type articles. The problem with most of the methods is that, most people end up putting the weight straight back on.

    If you want to lose weight permanently, then visit: Thanks to the great diet plans and workout routines, I’m currently in the best shape of my life and look great. Furthermore, the weight is staying off!

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  2. 2. ladybin3 9:26 pm 12/18/2012

    The food was changed in the USA, UK and Australia 30 years ago when dangerous food chemicals from the USA was allowed into European.

    The food today causes insulin resistance If you have insulin resistance you hold fat and have a hard time losing weight. You can eat very little and the weight still does not come off.

    Stubborn insulin will hold fat and diets won’t work. When researchers used a specialized diabetes diet on overweight people all lost weight even those who did not have diabetes. See here

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  3. 3. msadesign 7:25 am 12/19/2012

    Count and journal calories consumed (use an app like the excellent LoseIt, or paper and pencil). Move around more.

    Pretty simple really. Eat less, move more.

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  4. 4. sjanine40 8:33 am 12/19/2012

    I have had weight problems until my dietitian recommended I use Fat loss factor and I am really impressed with the results. I recommend this reading this review

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  5. 5. mvaneekhout 10:51 am 12/19/2012

    This is not surprising news nor is it a breakthrough. A breakthrough would be a cure for Type 1 Diabetes which always seems to live in the shadow of T2D in terms of research and public attention.

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  6. 6. robroy77 12:09 pm 12/19/2012

    It amazes me that news sources are reporting this study as an indication that diet and exercise can help people experience diabetes remission.

    If you actually read the study and think through the implications it’s clear that diet and exercise are, at best, only marginally effective means to moderate diabetes symptoms and, at worst, completely ineffective.

    Even after an incredibly intensive therapy of diet and exercise, only ~ 11% saw even a partial remission of diabetes and this dropped to a measly 7% at 4 years.

    Imagine you’re an endocrinologist treating an obese type II diabetic. They walk in and you tell them they MUST diet and exercise strictly to improve their diabetes. Your patient then asks you what are the odds that a year of super intense diet and exercise will lead to even a partial improvement of their diabetes? 11%! So there is a 90% chance that all their effort will lead to no measurable partial remission of their condition.

    They’d laugh in your face.

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  7. 7. kwitz02 12:00 am 12/20/2012

    Weight loss programs are helpful to maintain weight. Here you have shared very informative blog post on Intensive weight loss programs.

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  8. 8. jameshedm88 9:31 pm 12/29/2012

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  9. 9. bucketofsquid 4:04 pm 01/4/2013

    How wonderful – 4 out of 8 posts are advertisements. Only mvaneekhout and robroy77 even bothered to read and discuss the blog post. Both make very good points.

    My personal experience consists of being very thin until my mid 30s and then gaining weight at an accelerating pace. My blood pressure was usually so low that they had trouble getting a reading. At 41 I had a heart attack.

    Now my blood pressure is in the normal range which is much higher than I’m used to but it is nice to be able to stand up without getting light headed. I radically altered my diet and began to do intensive cardio work-outs several times a week. Funny thing, while the meds keep my cholesterol low, my weight is rising steadily and my triglycerides are consistently slightly above what the doctors like. After several years of this my % of body fat is lower than it has been since I hit 30 but my weight is the highest it has ever been. My cardiologist in particular says the BMI is idiotic and should be ignored because it can’t handle the difference between % of body fat and % of muscle mass. Muscle mass is generally good and fat is generally bad when it exceeds a certain % of total weight.

    As far as I can tell, type 1 diabetes is completely beyond the victims control. Type 2 diabetes is almost always self induced. As far as I’m concerned it is a waste of money to try to find a cure for type 2. All of the research money should be spent on the sufferers of type 1 diabetes. They didn’t do anything wrong and suffer. The type 2 sufferers did do something wrong and should not be rewarded for it.

    High fructose corn syrup, Hydrogenated oils and some modified food starches and certain industrial chemicals commonly found in the home or in food have all been linked to fatness and obesity. It isn’t hard to avoid these things if you pay attention but even when you point out the actual products such as room sprays, perfumes, cleaners, storage and cooking utensils, people get angry and blame you for telling the truth.

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  10. 10. dbextel 1:52 pm 01/12/2013

    Check out the link below, when you do, you’ll see why these guys are considereded not just an additional “fat loss” program, but they’re on the cutting edge of exactly what many think about, me consisted of, to be a lifestyle motion that sets an entire new standard of long-lasting (FOREVER) fat loss.

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  11. 11. pearlramirez 8:25 pm 12/26/2013

    Thank you for sharing this helpful Blog! It really means a lot to me. I follow a weight loss program from ExerciseAholics. Now I know that all weight loss program might help reverse Diabetes, which is really a good thing. Diabetic persons should try this now.

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  12. 12. berta10 4:02 am 10/13/2014

    Thanks for sharing this informative post. I recently started my weight loss programme but I didn’t start with such an intensive programme. fitness riyadh

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