By Sheri Colberg, PhD
It’s not enough to lose weight for diabetes management and prevention and better health — you really need to know how to keep it off after you lose it.
Currently, 90 to 95 percent of dieters who lose weight regain it within about a year, and repeating that cycle over and over is actually bad for your health and your diabetes. When you lose weight, what you lose is usually a combination of fat weight and some lean body mass (including muscle and water weight). Rapid weight loss usually causes greater lean body losses than slower weight loss. In either case, when you gain it back, it’s all fat, and you end up with a higher percent body fat (and lower insulin action) than if you’d never lost any weight in the first place.
Muscle mass is critically important as a place to store the carbohydrates that you eat, and the larger your storage capacity is, the better you can prevent your blood glucose levels from spiking after meals. Conversely, when you lose muscle through aging and dieting, you end up with less of it over time and a smaller glucose storage capacity — which is bad news for diabetes control. Engaging in regular exercise when you are dieting is critical for that reason, and adding in some resistance training as you are getting older is also vital to your long-lasting health.
So, how can you lose weight and then keep it off? You can learn a lot from what other successful "losers" have done to prevent weight regain. A current database of over 10,000 individuals called the National Weight Control Registry (www.nwcr.ws) has documented such successes. To be included in the registry, people must have lost at least 30 pounds and kept it off for at least a year (as documented by their health care provider).
The latest results from this database are in: Registry members, consisting of 80 percent women, have lost an average of 66 pounds and kept it off for 5.5 years. Interestingly, the "average" woman in the NWCR is 45 years of age and currently weighs 145 pounds, while the "average" man is 49 and 190 pounds. However, their weight losses have ranged from 30 to 300 pounds and the duration of weight loss from 1 to 66 years. Not everyone lost weight rapidly; in fact, some lost it over as many as 14 years.
The type of diet or meal plan that they followed to lose weight doesn’t appear to matter that much. By way of example, 45 percent of participants lost the weight on their own and the other 55 percent lost it by joining a program like Jenny Craig or Weight Watchers. Regardless, almost all of them (98 percent) had to modify what they were eating in some way to lose weight. What’s more, almost all of them (94 percent) increased their physical activity to lose weight, with the most common activity being walking.
There is also some variety in how the people in the Registry continue to maintain a lower body weight. Most report that they continue eating a low-calorie, low-fat diet and engage in high levels of activity. Interestingly, 78 percent of them eat breakfast every day; 75 percent weigh themselves at least once a week; 62 percent watch less than 10 hours of TV per week; and 90 percent exercise regularly, on average, about an hour per day.
With diabetes as an added variable, what are the key things that are going to work for you to lose weight and keep it off? The behaviors of the Registry members will generally work for you, but you also need to consider some other issues that are diabetes-specific. For example, when you either release or take large amounts of insulin or medications that cause your body to release insulin, it’s increasingly harder to lose weight. Insulin is a hormone that causes your cells to take up glucose, but it also promotes fat storage in the fat cells — and those don’t become resistant to the effects of insulin like your muscles do.
To lose weight and avoid gaining it back, you really need to focus on changes to your lifestyle that allow you to get by with the lowest amount of insulin possible — which you can accomplish by keeping your insulin action high with regular physical activity (including aerobic and resistance training) and moderating your intake of calories and carbohydrates in particular (which require greater quantities of insulin to process).
In truth, these are the key secrets for keeping off the weight you lose when you have diabetes:
- Exercise daily and include lots of movement throughout the day to burn extra calories (including standing more)
- Include resistance training as part of your workout at least two to three days per week to prevent loss of muscle mass caused by getting older and dieting
- Cut back on your intake of carbohydrates, particularly refined or highly processed ones (white flour, white sugar, white rice, white potatoes, etc.) to lower your insulin needs
- Greatly reduce your intake of empty calories — that is, those with few vitamins and minerals — including alcohol and refined and fried foods
- Check with your doctor about how to manage your diabetes with as few medications as possible as many of those used to treat diabetes cause weight gain
- Manage your stress levels to keep your cortisol levels lowers as high levels raise insulin resistance and promote fat storage
- Get plenty of sleep (most adults need seven to eight hours per night)
- Weigh yourself regularly to prevent backsliding before too much damage is done