Diabetes Without Weight Loss

An Evidence-Based Guide

Diabetes affects millions of people worldwide. Despite what you might have been told, weight loss isn’t required for effective treatment. This guide explains how to manage diabetes using evidence-based approaches that don’t involve dieting or weight loss.

What Is Diabetes

Diabetes occurs when your body has trouble regulating blood sugar levels. Think of insulin as a key that allows sugar to enter your cells for energy. With diabetes, either your body doesn’t make any keys, or the locks on the surface of your cells don’t work properly so the keys are no longer as effective (insulin resistance). 

Main Types of Diabetes:

  • Type 1: An autoimmune condition where the body stops producing insulin
  • Type 2: A condition involving insulin resistance where cells don’t respond properly to insulin
  • Gestational: Develops during pregnancy due to hormonal changes
  • Medication induced: Usually this is caused by taking long-term steroids
  • Secondary: Usually caused by disease of the pancrease

Important Facts About Diabetes

What Actually Causes Diabetes?

Diabetes has many contributing factors:

  • Genetics (primary factor)
  • Autoimmune responses (Type 1)
  • Insulin resistance (Type 2, although this is also seen in Type 1)
  • Hormonal changes
  • Inflammation
  • Stress
  • Medications
  • Environmental factors

The Truth About Weight Loss and Diabetes

Despite common beliefs, the evidence for weight loss as a treatment is surprisingly weak:

  • Long-term studies show no clear link between weight loss and improved outcomes
  • Weight cycling (losing and regaining weight) can worsen insulin resistance
  • Stress from pursuing weight loss can affect blood sugar regulation
  • Changes often blamed on weight could be caused by weight stigma and chronic stress

How Weight Stigma Affects Your Care

Weight stigma in healthcare can seriously impact diabetes treatment:

  • Effective treatments may be delayed because of concerns about weight gain
  • Less effective treatments may befavoured because of their side effects of weight loss
  • Side effects of medication may be ignored in pursuit of weight loss
  • You might be pressured into harmful  diets even though weight cycling worsens insulin resistance
  • The stress of forced weight loss attempts could worsen blood sugar control
  • Important symptoms might be dismissed or blamed on weight
  • Repeated negative healthcare experiences can make it difficult to attend follow-up appointments

How To Treat Diabetes Without Weight Loss

Medications

Several effective medications exist that work regardless of body size:

  • Metformin (Glucophage, Glumetza)
    • Well-established safety profile
    • Can be taken long-term
    • Available in slow-release form
    • Side effects can be minimized with slow introduction
  • SGLT2 Inhibitors 
    • Invokana (canagliflozin), Farxiga (dapagliflozin), Jardiance (empagliflozin)
    • Protect heart health
    • Cause urinary frequency and increased thirst
  • GLP-1 Receptor Agonists
    • Injections: Ozempic (semaglutide), Victoza (liraglutide), Trulicity (dulaglutide)
    • Tablets: Rybelsus (oral semaglutide)
    • Different options have varying side effect profiles
  • DPP-4 Inhibitors
    • Januvia (sitagliptin), Trajenta (linagliptin)
    • Generally well-tolerated
    • Minimal side effects
  • Sulfonylureas
    • Gliclazide, Glipizide, Glibenclamide
    • Longer-established medications
    • Can cause hypos so require careful monitoring
  • Insulin
    • Multiple types and brands available
    • Effective when needed
    • Not a sign of failure

Evidence-based monitoring

  • No less than 3 months in between each A1c check
  • Individualized targets based on your specific situation
  • Focus on trends rather than individual readings
  • Appropriate monitoring schedule based on medication type
  • Target A1c should be Individualized to your situation, not determined by your weight, and based on multiple factors including:
    • Overall health
    • Age
    • Other medical conditions
    • Quality of life considerations
    • Risk of complications

Your Rights as a Patient

You deserve healthcare that:

  • Treats your symptoms effectively
  • Doesn’t delay proper treatment by focusing on weight loss
  • Considers all available treatment options
  • Respects you and takes your concerns seriously
  • Provides appropriate medication when needed
  • Includes regular monitoring without weight stigma

Getting Good Care

Medical stigma and negative healthcare experiences can make it difficult to attend follow-up appointments. Many people find themselves delaying or avoiding medical care to protect themselves from further harmful interactions. While this is a completely understandable response to stigma, it can lead to missed opportunities for support and preventive care. When working with healthcare providers:

  1. Refuse to engage in weight-focused discussions
  2. Ask about all the different evidence-based treatments available to you
  3. Request clear explanations of medication choices
  4. Discuss side effects and management strategies
  5. Seek regular monitoring without weight stigma

Weight Loss Won't Treat Your Diabetes

Making Treatment Decisions

You are the expert on your own life and needs. When evaluating diabetes treatment options, consider:

  • Your current symptoms and their impact on your life
  • Medication side effects and tolerability
  • Quality of life factors
  • Personal preferences
  • Long-term sustainability

Important Reminders

  • Diabetes is not your fault
  • Weight loss doesn’t improve health outcomes 
  • Weight loss doesn’t provide long-term solutions
  • Weight cycling worsens insulin resistance
  • Evidence-based treatments work regardless of size
  • You deserve respectful, effective, weight-inclusive healthcare

Try This Script

“I have researched the benefits and risks of intentional weight loss for diabetes. I do not wish to pursue this approach and do not consent to discussing my weight during consultations.”

Remember: Diabetes is a serious but treatable condition. Early diagnosis and proper treatment can significantly improve your health outcomes. You deserve evidence-based care that treats your actual symptoms, not just advice about weight loss.

This information, produced by Dr. Asher Larmie, is provided for educational purposes and should not replace professional medical advice. Always consult with healthcare providers for personal medical decisions. For more detailed information and resources, check out his self-paced course.