Contributor: Megan Muñoz, RN, MSN, CMSRN, CDCES
In partnership with
Has your diabetes care included weight loss conversations at some point? Is the focus on weight loss really as beneficial as it sounds? If weight loss is a challenge, what other goals can you focus on to improve your heart health and minimize your risk for heart disease?
Let’s first take a moment to recognize how hard losing weight can be and how hard it can be to keep it off. Research studies show weight loss is difficult to sustain - particularly when it is related to strict dieting. For example, a 2007 review of weight loss studies by researchers at UCLA showed dieting was the largest predictor of weight gain. Yes, dieting had the exact opposite effect than intended.
National guidelines in countries like Australia include “Grade A” evidence showing lifestyle changes are not effective in keeping weight off. Specifically, weight regain happens within two to five years after loss. More recently, in early 2020, an international consensus statement was released with a goal to end stigmas around obesity. With a stacked deck of outstanding researchers, the discussion included the complexity of body size. In short, body size is impacted by a number of factors and not easily changeable for most people.
Now let's turn to weight and heart disease. Is fixating on weight loss the right approach to lowering our risk?
Not really, especially if you experience "yo-yo" dieting, which causes weight swings. Studies have linked weight swings from dieting to an increased risk of heart-related events, including death. If you have a history of heart disease, those risks go up significantly. One study showed the chances of heart attack, stroke, or death increased more than 100% in those with the largest weight swings compared to those with the smallest weight swings.
To go a step further, weight stigma is increasingly prevelent and is linked to several health risks. When your medical team fixates on your weight, it can make it harder to get the medical care you need, when you need it. I’ve witnessed many episodes of inappropriate or delayed diabetes care for larger people. That alone can increase risks like heart disease.
Since people living with diabetes are already at increased risk for heart disease, it’s apparent we need a better solution than weight loss to reduce heart risks. One thing you can do is shift your focus from body size to self-care behaviors. Research shows this creates a safer, more impactful direction for health.
A large 2012 study analyzed risk of death in participants based on the number of health habits each engaged in routinely. Researchers then went a step further and separated the impact of these habits based on body size. They found that as the number of health habits increased, body size mattered less. In fact, "overweight" or "obese" participants who did all four health habits consistently had a nearly identical risk of death to those with a "normal" BMI!
Other studies show similar results, with a 2019 study concluding that “focusing on improving fitness may potentially provide a greater reduction in mortality than weight-loss interventions.” Another recent study (with over 250,000 participants) showed having healthy cholesterol, blood pressure, A1C, and microalbumin levels, along with refraining from smoking, reduced the risk of heart disease. In this study, those with diabetes (type 2 in this case) had a similar risk for heart disease as those without diabetes when these factors were healthy.
Bottom-line, actions are important and powerful. And lucky for you, there are many actions that can improve your overall diabetes health: like improving social connections, being active, eating more fruits and vegetables, getting consistent sleep, taking medications consistently, attending medical appointments, cutting out smoking, and so on. Working on these things can typically result in improved health regardless of what your weight does in response to them.
Megan Muñoz is the creator and host of Type2andYou with Meg, the first podcast by a Certified Diabetes Care and Education Specialist dedicated to people living with type 2 diabetes. Her passion to reduce diabetes stigmas is evident in her podcasting, content contributions, and live presentations. Megan holds a bachelor's and a master's degree in nursing, along with certifications in medical-surgical nursing and diabetes education. She works with people living with all types of diabetes in both the inpatient and outpatient settings.