We know that a lot of adults in the UK are overweight or obese and those extra pounds can cause problems with our health, whether we have diabetes or not. Excess weight is linked with heart disease, high blood pressure, stroke and some cancers – as well as Type 2 diabetes.
Achieving a healthy weight, and maintaining it, is often easier said that done and it’s one of the hardest things to do for some people. Whether you want to lose or gain a few pounds – or are a healthy weight already – there’s lots of evidence to show that being a healthy weight will benefit your health. These benefits include better blood pressure, cholesterol and blood glucose levels and reducing your risk of developing any long-term health problems. And, most people say they also feel better about how they look.
Weight is a sensitive issue for many people and achieving your ideal weight is often easier said than done. For some people, losing weight can be straightforward but keeping the weight off becomes a herculean task, leading to fluctuations in their weight through the years. So, what are the positive steps you can take to lose any extra pounds – or to stop gaining any more?
In this section
- How do you know if you need to lose weight?
- How much weight should you lose?
- What's this about calories?
- How long should it take?
- Being motivated and staying on track
- What weight loss approach works?
- Different eating patterns for weight loss
- Other diets
- Weight loss programmes
- Physical activity
- Top tips
How your clothes fit you is usually a tell-tale sign. But your doctor, nurse or dietitian would probably calculate your Body Mass Index, or BMI, to see if you are a healthy weight for your height – and you can work this out for yourself at home, too.
Measuring your waist circumference can help you find out how much fat you have stored around your stomach. Measure yours now by finding the top of your hip bone and the bottom of your ribcage, and using a tape measure around your middle at a point midway between these. For many people, this is around the belly button. It should be less than:
- 80cm (31.5in) for White, Black and South Asian women
- 90cm (35in) for South Asian men
- 94cm (37in) for White and Black men.
Ideally you should aim for a target weight that gives you a BMI in the normal weight category. If you have a considerable amount of weight to lose, this may seem daunting and impossible to achieve. But you don’t have to do it all at once. Research shows that the more weight you lose, the greater the health benefits, but even losing just 5 – 10 per cent of excess weight will improve your health. Why not set an initial weight loss that moves you down a couple of BMI notches, or perhaps shifts you from one category to another? Remember, any weight you lose helps you to achieve your overall target – and you can always set new goals along the way. Over time, you gain more benefit by maintaining the weight you have lost.
After working out your BMI and measuring your waist circumference, you might find that your weight is already in the normal range category. But, if your weight is gradually increasing, now’s the time to act and shift those kilos before you end up becoming medically overweight. While many of us might like to slim down to a weight we were when we were 18, it’s important to be realistic about whether you can really achieve this. For most of us, this may not be practical. It’s better to focus on reaching a target weight that leaves you looking and feeling fitter and healthier. Once you’ve decided on a realistic weight goal, you’ll be able to work out how long it will take to reach this. If you are aiming to shed some weight, you will need to be aware of your daily calorie intake – and reduce it.
A calorie – kcal – is a unit of energy, which is in all the food and drink we consume. Your body uses energy for everything we do – from breathing and sleeping to exercising. When you eat, you’re replacing the energy you’ve used, which helps you to maintain a healthy weight.
We get calories from four main sources:
- Fat – contains 9kcal/g
- Carbohydrates – contains 4kcal/g
- Protein – contains 4kcal/g
- Alcohol – contains 7kcal/g
For the average adult, the recommended Reference Intake (RI) of calories needed per day is 2,000 for women and 2,500 for men. But, the number of calories you need per day varies depending on your age, gender, height, weight and level of physical activity.
If your weight is going up, it means that you are consuming more calories than you need and the excess is being stored mostly as fat, causing weight gain. But if you consume fewer calories than you need, you will lose weight. So, in a nutshell, you need to find a way to consume fewer calories than you are burning off if you want to lose weight.
You can do this by eating fewer calories than you eat now, or by doing more physical activity. For most people, it is better to do a bit of both – find a way to eat less and move more.
A safe and achievable target for a long-term healthier weight is to lose 1–2lbs (0.5–1kg) a week. To achieve this, you will need to consume about 600 fewer calories per day than your body needs to maintain weight. Increasing your physical activity will help you to burn off more calories and lose weight more quickly. Beware of cutting calories too low, without medical supervision, as this can put your long-term health at risk.
Once you have set a realistic target weight for yourself and know roughly how long it should take, you can start to devise a slimming plan that will work for you.
When you start a new challenge – such as trying to lose some weight – think about the questions ‘why?’, ‘what?’ and ‘how?’.
- Know why you are doing something.
Maybe you want to lose a few extra pounds to benefit your health and manage your diabetes more effectively. Or perhaps you are a healthy weight and want to make sure you can maintain it. Whatever the reason is, knowing why you want to do something will help you stay motivated and keep you on track.
- Decide what you are going to do
Having a specific target for weight management can help motivate you to stick at it – and will help you to measure your progress and see the positive changes you are making. You don’t have to aim for a big change all at once – you could set yourself smaller targets and work at it gradually. Plus, you’ll feel a sense of achievement each time you make your target.
- Work out how you are going to do it
You’re more likely to achieve your goals if you’ve got a plan in place from the beginning of how you’re going to do it. So, do your homework, speak to your dietitian (or ask you GP to make a referral).
There are many different dietary approaches to losing weight – but there’s no one-size-fits-all approach. Evidence shows that the best approach is the one that you are likely to stick to, so for a successful long-term weight loss, small and realistic changes are crucial. The key is to find a plan that you enjoy and fits in with your lifestyle.
For your overall health, it’s important that the eating plan is balanced – low in saturated fat, salt and sugar and contains all the essential nutrients and fibre. And, regular exercise is good for both your waistline and health – especially your heart.
There are a lot of eating plans or ‘diets’ for weight loss, but just a few of them have undergone rigorous research to determine whether they are safe and effective for people with diabetes. Most of the weight loss diets that have evidence for use in diabetes have been studied in people with Type 2 diabetes.
Low fat, healthy balanced diet
This is the conventional healthy, balanced diet that involves eating foods from all the five food groups. You’ll eat more fruits and vegetables, some starchy carbohydrates, proteins and dairy, but limit the amount of fat you eat.
The main principle of low-fat diets is that, gram for gram, fat contains more calories than any other macronutrient – so by reducing your fat intake you’ll reduce your calorie intake, too. However, it is not that straightforward. If you replace your fat with larger portions of starchy foods, you are less likely to derive much benefit. Therefore, it is important to look at your overall portion sizes and try to reduce portions of other foods, as well as the fat. Try replacing some of the reduced portions with more fruits and vegetables, which are generally lower in calories, so that you don’t feel hungry.
Try these other ways to reduce fat in your diet:
- Limit the use of oil in cooking.
- Reduce the amount of butter and spread you use.
- Opt for reduced-fat or low-fat alternatives for dairy and pre-packed foods whenever possible.
- Read the labels on pre-packaged food – if the fat per portion is red, choose something else.
There’s been extensive research into low-fat diets, which has shown that this approach can help you to lose weight, control your HbA1c and reduce your cardiovascular risk factors. There is also evidence that the positive changes gained from this dietary approach can be maintained for over four years.
There are several versions of a low-carb diet. The general principle of a low-carb diet is to limit means limiting the amount of carbohydrates you eat, and to get more of your calories from proteins and fat.
Practical ways of doing this include making sure that the limited carbohydrates you include in your diet come from good sources, like fruits and vegetables, pulses, dairy and wholegrain options of starchy foods, rather than foods laden with unhealthy fats and sugars like cakes, biscuits, pastries, and fizzy drinks. You will not derive enough benefit from a low-carb diet if you replace your carbohydrates with too much fat.
Since the amount of carbohydrate has the biggest effect on blood glucose levels after eating, many people with diabetes need to have some level of carbohydrate restriction. Review of evidence shows that low-carb diets can help people with Type 2 diabetes lose weight and improve blood glucose control.
If you treat your diabetes with insulin or any other medication that puts you at risk of hypoglycaemia (low blood glucose levels), following a low-carb diet may increase this risk. However, your diabetes team can help you adjust your medications to reduce your risk of hypos.
Very low calorie diet
Very low calorie diet (VLCD) involves restricting your daily calorie intake to fewer than 1,000kcal a day, and in some cases between 450 and 800kcal a day. This is achieved through usual foods, liquid foods (proprietary formula) to replace meals or a combination of the two.
If you choose a very low calorie diet, meal replacement products are available to buy as ready-made milkshakes or powdered milk that need some preparation, snack bars and soups. If you decide to use any of these products for total meal replacement, make sure that the product you buy provides all the essential nutrients in the stated servings. If you are doing a partial meal replacement, try to eat more fruit and vegetables as part of your meals, to make sure you’re getting enough fibre.
There is evidence that VLCLD significantly improves HbA1c and results in weight loss in people with Type 2 diabetes. You might have heard more about these diets recently, with results of a small study reporting possible reversal of Type 2 diabetes in people who consumed 600kcal/ day for eight weeks. However, the researchers are currently undertaking a larger study to better understand how the results can be replicated in real life.
Because this is a restrictive diet, it is not recommended in the long term – generally up to 12 weeks. You’ll need medical supervision to make sure that you’re getting all the essential nutrients you need. If you’re on insulin or certain diabetes medications,you may also need support to adjust your medications to prevent hypos. You might also need to test your blood glucose more often.
This is a diet largely based on plant foods and includes a lot of vegetables, beans and pulses, nuts and seeds, wholegrain breads and pasta, and olive oil. It also includes some dairy (milk and yogurts), eggs and fish in moderation. Red meat and processed foods are usually avoided, and wine is included in moderation.
Although the majority of studies on this diet have taken place in Mediterranean countries, there is evidence that the Mediterranean-style diet can promote weight loss, improve blood glucose control and help reduce cardiovascular risk in people with Type 2 diabetes.
Low Glycaemic Index (GI) diet
Glycaemic index is the ranking of carbohydrate-containing foods based on their immediate effect on blood glucose levels. Foods that break down slowly are assigned a lower GI, and these are deemed to be better for you, especially as they tend to raise blood glucose levels slowly.
People who follow a low GI diet, opt for carbohydrate-containing foods that have a low GI. Several reviews have concluded that this dietary approach improves blood glucose control in people with diabetes as well as helps to reduce cardiovascular risk. Although there is some evidence that low GI diet can promote weight loss in people without diabetes, the evidence for weight loss in people with diabetes is insufficient.
There are other popular diets like the Intermittent fasting (e.g. the 5:2 diet) and the Paleo diet etc. These diets have not been included here because there is not enough evidence for their use in people with diabetes. Whether you choose to try one of these eating plans, or another type of diet, it’s essential that you discuss your plans with your diabetes team. They can make sure you have the right information and the support you need to be successful with your weight loss plan.
Trying to eat more healthily and leading a more active lifestyle is not easy for everyone. You may need more support and choose to join a weight-loss programme. Commercial weight-loss programmes are likely to involve one, or a combination of, the following:
- calorie-controlled weight-loss eating plan
- individual, group or internet support
- meal replacements, such as milkshakes, ready meals or bars
- psychological support.
Choose a programme that provides support and education to make sure that the weight loss you are promised is realistic and sustainable. Remember to let your diabetes team know if you are starting a new programme, as it may affect your blood glucose levels and medication.
What should I look for in a weight-loss programme
There are a lot of new – and some fad – weight-loss programmes on the market. It is important that you know what to look for in choosing a ‘diet’ or a weight-loss programme. Before you choose, ask yourself:
- Is the weight loss offered realistic?
- Are you getting all the nutrition you need from this programme?
- Does the programme give support and education?
- Has a healthcare professional been involved?
- Does the programme offer advice on your diabetes (especially if you are at risk of hypoglycaemia)?
Make sure you include physical activity as part of your weight-loss plan – there’s evidence that a combination of changing what you eat and being more active is an effective way to manage your weight. And regular physical activity not only promotes weight loss: it can also help improve blood glucose, blood pressure and blood cholesterol levels.
Adults should aim to be active every day. During one week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least five days a week. How do you know when you’re doing moderate intensity activity? You’ll be breathing more heavily, but can still speak or hum – not sing. Try:
- taking a brisk walk
- going for a bike ride
- going swimming
- playing tennis
Alternatively, you can get similar results and health benefits by doing 75 minutes of vigorous intensity activity spread across the week, or a combination of moderate and vigorous intensity activity. Vigorous intensity acitivity is when you’re working really hard. You’ll only be able to say a word or two and will be heavily perspiring. Try running or cycling at a faster pace to normal.
At least two days a week, do some physical activity that will improve your muscle strength. This can be something as simple as carrying your food shopping home from the supermarket or grocery shop.
All adults should minimise the amount of time spent being sedentary (sitting) for extended periods.
These recommendations are intended to help people maintain a healthy weight. If you’re aiming to lose weight, you may have to do more than the above general recommendations. But all physical activity will help you to improve your health, and if you have not been active for a while, you can start increasing you physical activity levels gradually.
If you’ve started increasing your physical activity levels, you might find that, while you’re losing inches round your waist, there’s not much change on the scales. This can be frustrating, but don’t worry – you’re still doing your overall health a lot of good. Losing some inches around your waist can help to manage your diabetes better, and reduce your risk of cardiovascular diseases.
Before you start any new physical activity, speak to your diabetes team, who can make sure you have all the information you need about how your diabetes might be affected. This is particularly important if you treat you diabetes with insulin or certain diabetes medications, as doing more physical activity may increase your risk of hypos so your medications may need adjusting.
Being overweight makes diabetes control difficult because it can lead to insulin resistance, making it hard for your body to use insulin properly. If you have Type 2 diabetes, losing excess weight is the most effective way of managing your condition. Apart from the feel-good factor, there’s lots of research to show that losing weight improves blood glucose, blood pressure and blood fats (cholesterol) levels and has long-term health benefits.
If you manage your diabetes with insulin and/or tablets, you may need your doses to be adjusted as you lose weight and become more active. Your diabetes healthcare team can advise you about any changes to your medication, and your dietitian can help you design a weight-loss programme that works for you.
- Be clear about your goals and write them down. Keeping a food diary can help you identify habits you've got into without realising, such as that cup of tea with biscuits mid-morning; the hunk of cheese you nibble on while cooking dinner or that glass of wine in front of the TV. It can also highlight triggers, such as raiding the fridge when you're hungry after work or eating chocolate when you're upset.
- Be prepared – think ahead to take account of holidays, special events etc
- Think about obstacles that may affect your weight loss and devise a plan to beat them
- Visualise your success by thinking about how it will feel when you achieve your goals. See it, feel it and remember it.
- Get a good night's sleep – research has shown that if you are tired you feel hungrier and are more likely to crave fatty and sugar foods.
- Avoid restrictive diets with an all-or-nothing approach. By following a diet that allows the occasional treat, you're more likely to stick to it. If you have one bad day it won't undo all your hard work, so don't be hard on yourself – even the most successful dieters have off days. Move on, tomorrow's another day.
- Enjoy the food you eat. If you like so-called 'dieting' foods, like rice cakes, cottage cheese or celery then by all means include them, but you're not so keen, eat what you enjoy but keep to sensible food portion sizes. This way you are more likely to feel satisfied and stick to your weight-loss plan.