Our study further showed that among centrally obese patients, the weight-loss group had a higher risk of developing DN and diabetic retinopathy, but this risk was not significant among patients without central obesity. In this study, they lost about 7% of their body weight with changes in physical activity and diet. The American Diabetes Association recommends that people with prediabetes lose at least 5% to 7% of their body weight to prevent diabetes. A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their type 2 diabetes into remission. This drug isn’t appropriate for most people because obesity usually has multiple causes, not just alterations in single genes. However, reimbursement is better for semaglutide when prescribed at the lower dose levels to treat diabetes. A medication like semaglutide, with the cost of about $1,300 a month, is going to be prohibitive for many patients who could benefit. It’s likely that the dose will need to be adjusted when adding semaglutide, to reduce the risk of hypoglycemia. In addition to increasing the likelihood of remission, the effects on BP and lipids further support the integration of weight loss strategies into routine diabetes care, but only remission was able to modify disease trajectory, therapeutic burden and future complications. This highlights that weight loss can influence HbA1c but may not be sufficient to sustain long-term remission, as the progressive nature of type 2 diabetes likely erodes early benefits unless additional strategies are implemented to mitigate beta cell dysfunction. Similar results were achieved for remission after bariatric surgery in type 2 diabetes 16, 17 and are in line with secondary results of the Look-AHEAD study, reporting that participants with diabetes remission had a substantially lower incidence of CKD and CVD . While weight loss may improve intermediate markers of cardiovascular health, the long-term incidence of diabetes-related complications could be influenced by other factors. Increased Fiber Intake Improves Insulin Sensitivity In contrast, a recent randomized trial showed that time-restricting eating did not lead to additional weight loss than calorie restriction alone within 12 months . Nonetheless, this observation is in line with previous studies showing that individuals who used a self-guided approach were better at maintaining their initial weight loss compared with those who commenced a CWLP . Nonetheless, the current evidence thus far collectively highlights the role of exercise in long-term weight control after intentional weight loss . This is in accordance with previous findings in a systematic review of prospective studies with a minimum 3-year follow-up after weight loss. While some weight fluctuation is normal, a significant decrease in weight without intentional dieting can signal underlying health issues. Sudden, unexplained weight loss in individuals with diabetes is a serious red flag that shouldn’t be ignored. Don’t delay seeking help if you experience significant unintentional weight loss, especially if accompanied by other diabetes symptoms. For individuals with diabetes, weight loss can be a complex issue. Dietary fiber, also called roughage or bulk, is the part of plant foods your body can't digest or absorb. Carbohydrates include sugars and starches — the energy sources for your body — and fiber. Plants in your diet give you vitamins, minerals and carbohydrates. Talk to your healthcare professional about reasonable short-term goals and expectations. Lifestyle changes can help prevent type 2 diabetes, the most common form of the disease. You can help keep your blood sugar level in a safe range. These problems include a high blood sugar level, called hyperglycemia. If blood sugar isn't controlled, it can lead to serious problems. When you eat extra calories and carbohydrates, your blood sugar levels rise. Can weight gain from diabetes medication be prevented? Metformin’s weight loss is more modest than the medications listed above. It mainly lowers the amount of glucose made and absorbed by the body, and it makes the body more sensitive to its natural insulin. Using Ozempic or Victoza for weight loss is an off-label use of the medications. According to the trial’s findings, both dosages of empagliflozin significantly lowered HbA1C, body weight, and systolic BP over the course of both the short-term (24 weeks) and long-term (76 weeks) . The placebo-adjusted average change in body weight with empagliflozin was −1.7 kg in cohort 1 and −1.9 kg in cohort 2 . This study’s findings showed that empagliflozin significantly decreased weight, waist circumference, and adiposity in both cohorts of T2DM patients as compared to placebo . But that doesn’t cover people younger than 35—and a CDC study published in 2019 showed one in five adolescents and one in four young adults up to age 34 were already living with it. One of the challenges to bringing down prediabetes is identifying who has it, since many people aren’t automatically screened for the condition. “Metformin is a good tool,” Dr. Anam says, adding that studies have shown the drug can decrease the risk of progression to type 2 diabetes, although to a lesser degree than lifestyle changes. Weight loss is a key strategy to reverse prediabetes, but it’s important to know that not everyone needs to lose a massive amount of weight, doctors say. Categorical weight loss and individual body weight change Unexplained weight loss, particularly when combined with increased thirst, urination, hunger, or fatigue, can be a key indicator of undiagnosed diabetes. Schedule an appointment with a doctor or diabetes specialist immediately if you are experiencing unexplained weight loss. Don’t delay seeking help if you’re experiencing unexplained weight loss alongside diabetes symptoms like increased thirst, frequent urination, or blurred vision. Early diagnosis and appropriate treatment can significantly improve diabetes management and overall health outcomes. Your health care professional may also How long you will need to take weight management medication depends on whether the drug helps you lose weight and keep it off and whether you experience serious side effects. Possible side effects vary by medication and how it acts on your body. For this reason, never take a weight management medication only to improve the way you look. A lifestyle program may also address other things that cause you to gain weight, such as eating triggers and not getting enough sleep. However, there are two essential factors in drug-treatment strategies for diabetes remission. Therefore, in order to ensure remission, maintaining weight loss is required, and continuous attention and the efforts of several specialists must be combined. Various eating plans have been developed to control weight and reduce cardiovascular risk levels in people with T2D. The glucose monitoring pattern of metabolic surgery is the rapid improvement in glycemic control in advance of weight loss. Insulin and weight gain: Keep the pounds off The study is supported by institutional grants from the University of Padova. Aggregate data are available on reasonable request to the corresponding author. Thus, beta cell failure and the intrinsic tendency to progression appear to take over even in the presence of marked weight efficacy. Despite these limitations, our study conveys clinically relevant messages. Many individuals were excluded due to missing data and, without assuming missing-at-random, it is impossible to determine whether included and excluded individuals truly differed in key features that could influence the outcome. Metformin significantly reduced the progression of T2DM in adults by 7–31%, but no average weight loss of more than 5% was found . Additionally, given that the majority of antipsychotic medications produce weight gain, metformin’s impact on weight gain brought on by these medications has been studied in numerous randomized trials . After 15 years, the metformin group’s average weight loss was 6.2% as opposed to the lifestyle group’s 3.7% . The Diabetes Prevention Program (DPP) is the largest program examining the advantages of metformin for weight loss . Two additional studies have demonstrated partial or complete diabetes remission, albeit at low rates of success. This diet may be a way for patients to navigate the modern obesogenic environment by avoiding highly processed foods and simple carbohydrates. Patients are counseled to achieve “nutritional ketosis” through a low-carbohydrate diet and to maintain ketosis by monitoring BHB levels in blood. Furthermore, the patients in Look AHEAD were predominantly middle-aged or older (mean age 59 years), with a mean BMI of 35.8 kg/m2, and the median time since type 2 diabetes diagnosis was 5 years. Exercise: 7 benefits of regular physical activity Dapagliflozin treatment did not significantly decrease psoas muscle index, and the absolute change in this index was not significantly different between groups.For some ethnic groups, these risks appear to occur at lower levels of BMI, particularly in people of South Asian origin; however, the relationship between weight and T2DM remains 3.As with any medicine, there is a risk of side effects when taking a GLP-1 agonist.Up to 20% of people receiving Ozempic for Type 2 diabetes reported nausea during clinical trials.Medical histories of cardiovascular disease, stroke, and health-related behaviors such as smoking status, alcohol drinking, and physical activity were obtained through the self-reported questionnaire.Risk of new-onset diabetes for subjects in the highest quartile of body weight variability compared with those in the lowest three quartiles according to baseline obesity status.(c) and (f) show the HRs of insulin initiation analysed with the Cox model. A dietitian can teach you how to measure food portions and become an educated reader of food labels. You can then adjust the dose of insulin accordingly. Because carbohydrates break down into sugar, they have the greatest effect on your blood sugar level. Diabetes raises your risk of heart disease and stroke by raising the rate at which you develop clogged and hardened arteries. Dietary fiber includes all parts of plant foods that your body can't digest or absorb. North Carolina eliminated GLP-1 coverage beginning October 2025 due to a budget stalemate in the legislature, but coverage was reinstated in December 2025, bringing the total number of states covering GLP-1s for obesity to 13 as of January 2026. For Medicare Part D, this model will be implemented in January 2027, following a separate short-term demonstration that will allow Medicare Part D enrollees to access obesity drugs beginning in July 2026. State Medicaid programs and manufacturers were requested to submit their intentions to participate by January 8, 2026, and the model is expected to begin in May 2026. In December 2025, the administration also introduced the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) model, a five year CMS Innovation Center (CMMI) model that intends to expand access to obesity drugs in Medicaid and Medicare by negotiating lower GLP-1 prices with manufacturers. That's because too much blood sugar can affect the way nerves work.You should feel comfortable asking whether your health care professional is prescribing a medication that is not approved for treating overweight and obesity.Remember to consult your doctor or a registered dietitian to determine your personalized carbohydrate target.So how do you find your secret sauce for weight loss?Within the SELECT population with BMI −2 at baseline, 15.0% and 14.3% of the semaglutide and placebo groups, respectively, were below the sex- and race-specific WC cutoff points.Low blood sugar is a more serious risk linked to GLP-1 agonists.Weight loss is crucial for disease prevention among individuals with overweight or obesity.According to a meta-analysis study that reviewed 16 randomized controlled trials, RYGB led to a lower fasting blood glucose and HbA1c than SG.29 Similarly, in the case of diabetes remission, there was variability in the remission rate by surgical procedure.30 Despite this variability, metabolic surgery has a higher remission rate than medical therapy. Nevertheless, patients with T2D tend to not comply with chronic treatment, especially lifelong medications, at the time of diagnosis and thereafter. In the light of the state of evidence for T2D reversal, physicians need to be educated on treatment options to achieve T2D remission so that they can actively play a part in counseling patients who may wish to explore these approaches to their disease. The weight gain can be frustrating because keeping a healthy weight is important to manage your diabetes. The way to diabetes weight loss is not through starvation. Drinking water before a meal can help with diabetes weight loss by helping you feel full more quickly, which may keep you from overeating. Since the positive outcome of several large scale trials demonstrated that lifestyle interventions among individuals at high risk for diabetes are effective for reducing disease incidence the high-risk strategy has been the policy paradigm for prevention of diabetes 2, 3. For moderate weight loss (−1.0 to −2.0 kg/m2) the OR was 0.72 (95% CI 0.52, 0.99). Weight loss in individuals at high risk of diabetes is an effective prevention method and a major component of the currently prevailing diabetes prevention strategies. In 2026, we expect high-dose oral semaglutide to match the efficacy of injections, making therapy even more accessible for frequent travelers.This is difficult to prove, and lean T2DM cases are used anecdotally by patients to question the link between obesity and T2DM.Fat accumulation within the pancreas can cause a progressive decrease in insulin production.The odds ratios for both factors became greater in the multivariable models compared to the univariate models, suggesting that the association between these metabolite factors and remission status is independent of these clinical variables.Toward that end, a low-calorie liquid diet has been successfully implemented in primary care in the United States.Choosing a medication to treat overweight or obesity is a decision between you and your health care professional.Early initiation of insulin therapy and the resultant improved glycemic control in patients with type 2 diabetes not only reduces macrovascular and microvascular complications but also improves the cardiovascular profile3; reduces glucotoxicity and blood glucose variability; decreases morbidity, mortality, and health care costs; and improves quality of life.4 Ryan and colleagues5 demonstrated that early insulin therapy also helps preserve and maintain function of pancreatic islet β‐cells in patients with type 2 diabetes.With the discovery of galegine at the beginning of the 20th century, many biguanides (such as synthelin A and B, biguanide, metformin, phenformin, and buformin) were developed and investigated as antidiabetic medications .How can health care professionals help patients achieve remission and sustain it over time? Semaglutide 1.0 mg dose combined with the SGLT2i, canagliflozin reduced weight by 5.1% and HbA1c by − 1.5% . Whether this yo-yo pattern of weight, as well as the yo-yo pattern on glycemia, is detrimental still needs to be determined. Because non-white races are developing diabetes with lower BMI, it is important to have more cost-effective, sensitive and specific measurements to assess adiposity, especially in those who develop T2DM at lower BMIs . The quality of the adipose tissue function plays an important role in insulin resistance. But certain semaglutide side effects, such as dehydration, can result in headaches. They can suggest treatments for lessening the appearance of wrinkles or increasing fullness in your face. But if you’re concerned about possible changes to your appearance, talk to your healthcare team. For fast relief, your healthcare team may suggest an OTC antacid. They may need to adjust your medications or check for an underlying cause. Several reasons may explain the observation that the mean treatment difference was −12.5% in STEP 1 and −8.7% in SELECT. Potential contributors may include a possibility of higher drug exposure in lower BMI classes, although other explanations, including differences in motivation and cultural mores regarding body size, cannot be excluded. The analysis did reveal that tolerability may differ among specific BMI classes, since more discontinuations occurred with semaglutide among lower BMI classes. If an individual experiences early symptoms of diabetes, such as persistent thirst, blurred vision, or chronic fatigue, selecting the right therapy becomes a vital step toward long-term longevity. Ultimately, personalization is not a luxury—it’s a necessity in safe and effective diabetes care. Likewise, a woman recovering from gestational diabetes may have distinct nutritional needs during breastfeeding compared to a non-pregnant adult. Weight loss strategies in diabetes care must be tailored to the individual. Increasing physical activity, regardless of weight loss, may reduce CVD risk factors,15 and reduce HbA1c by approximately 0.6% in adults with type 2 diabetes.16The causes of overweight and obesity are likewise complex. For people with type 2 diabetes who are overweight or obese, even modest weight loss (5–10%) may provide clinical benefits, including improved glycaemic management, blood pressure and lipid profiles, especially early in the disease process.8–10 Lifestyle-induced sustained weight loss contributes to the prevention, or delays the progression, of diabetes.11–13However, the relationship between weight loss and clinical benefits is complex. Among heavier subjects (baseline BMI ≥35 kg/m2), the proportions achieving ≥5% weight loss were 30% to 49% and 47% to 68% of those receiving semaglutide 0.5 and 1.0 mg, respectively, versus 6% to 27% receiving comparator treatments. In general, greater absolute weight loss in kg was observed in subjects with higher baseline BMI for both semaglutide doses as well as for comparators, with the exception of insulin glargine in SUSTAIN 4. Overall, 3918 subjects with type 2 diabetes who were treatment‐naïve (SUSTAIN 1) or on a background of glucose‐lowering drugs (metformin, sulfonylureas, thiazolidinediones in SUSTAIN 2 to 4 and basal insulin ± metformin in SUSTAIN 5) were randomized to once‐weekly subcutaneous (s.c.) semaglutide 0.5 or 1.0 mg or comparator treatment (Table 1). There is strong and consistent evidence that obesity management can delay the progression from prediabetes to type 2 diabetes (2–6) and is highly beneficial in treating type 2 diabetes (7–18). Obesity is a chronic and often progressive disease with numerous medical, physical, and psychosocial complications, including a substantially increased risk for type 2 diabetes (1). The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Weight loss was defined as a decrease of at least 5% body weight within 6 months before the diagnosis of T2DM in the absence of intentional dieting and diuretic therapies. Among the 1025 inpatients (recruited from January 2010 to December 2012), we excluded 25 type 1 DM inpatients and 11 latent autoimmune diabetes in adult inpatients and therefore recruited a total of 989 (507 men and 482 women) participants in this study. Thus, we designed an observational study to investigate the relationship between weight loss prior to the T2DM diagnosis and diabetic complications in hospitalized patients with T2DM, which is the population with the highest proportion of diabetic complications. Patient and disease factors are used to determine the optimal weight loss target. Patients who received liraglutide had better glycaemic control as well as an additional 4.2 kg weight loss compared to placebo after 26 weeks Combining anti-obesity medications is becoming more popular because the mechanism of the modalities appears to be complementary. This study, however, shows the benefit of combining bariatric surgery with modern diabetes medicine to thus further amplify the benefits of each modality. Fatigue The challenge is to identify those patients at high risk of developing diabetes and obesity-related complications with lower weight, fat deposition, or minimal adipose dysfunction.If blood sugar isn't controlled, it can lead to serious problems.For example, in the US pooled analysis mentioned above, mortality rates were higher in normal-weight participants (284.8 all-cause deaths, 99.8 cardiovascular deaths and 198.1 non-cardiovascular deaths per 10,000 person-years vs. 152.1, 67.8 and 87.9 per 10,000 person-years, respectively, for the same events in overweight or obese participants) 9.The program’s goal was to evaluate the safety and effectiveness of liraglutide in T2DM patients when used alone or in combination with other antidiabetic medications 128,129.The relationship between nausea‐ or vomiting‐related events and semaglutide‐induced weight loss was assessed in a mediation analysis.Many people with diabetes who are prescribed metformin lose around 2% to 3% of their body weight within the first year of starting the drug.Canagliflozin (Figure 1h) is SGLT 2 inhibitor that has received FDA approval to treat hyperglycemia in T2DM patients with diet and exercise .But those hormones also can raise your blood sugar. Weight cycling may cause an accumulation of trunk or visceral fat that would explain the increased metabolic risk independent of total adiposity . Weight gain results in the disruption of the metabolic steady state, which indicates a state of hyperglycemia with reactive hyperinsulinemia. Hazard ratio was adjusted for age, sex, smoking status, alcohol consumption, physical activity, income, hypertension, dyslipidemia, and fasting plasma glucose. Meal timing is also an important factor in weight management, and higher-calorie breakfasts in combination with overnight fasting may help to prevent obesity. Some macronutrient composition-based diets, such as the ketogenic diet or high-protein diet, could be considered in some cases, although the potential risks and long-term effectiveness remain unknown. In this review, we identified evidence-based dietary strategies for weight management based on these three components. Ideally, future studies will be designed to ensure clinical differences in weight loss as well as balanced use of other cardioprotective interventions. Therefore, while all available weight-loss drugs show some promise in the management of obese patients with T2DM, their exact role is as yet uncertain. Prescription medications approved for long-term use to treat overweight and obesity The phase 3 VERTIS SITA2 trial randomly assigned 464 T2DM patients managed with metformin and sitagliptin to receive ertugliflozin 5 mg, 15 mg, or placebo . The newest SGLT-2 transporter inhibitor FDA-approved for the treatment of T2DM is ertugliflozin (Figure 1k), which is thought to be similarly safe to other SGLT-2 inhibitors . In a recent randomized trial, empagliflozin 10 and 25 mg were combined to metformin and tested on 637 adult patients with T2DM . But your blood sugar stays high when your pancreas can no longer keep up with your body's increased demands. When glucose can't get into cells, your blood sugar rises. If you have type 2 diabetes, your cells don't respond to insulin as they should. Insulin "unlocks" cells throughout the body to let glucose in, where they use it for energy. When this happens, your pancreas releases insulin into the blood. There are two main groups of type 2 diabetes medicines that lower blood sugar and also may lead to weight loss. Patients with an improved understanding of the detriments of postponing insulin treatment, the causes of insulin‐related weight gain, and the patterns of weight gain with different insulins may develop a sense of being in better control of their treatment and may become more motivated and involved in the management of their diabetes therapy. Finally, several studies have shown resolution of type 2 diabetes after Roux‐en‐Y gastric bypass surgery in approximately 84% of patients, with a significant reduction in fasting plasma glucose very shortly after the procedure and concurrent reductions of C‐peptide and insulin levels.48 However, even with bariatric surgery, significant changes in lifestyle and eating habits are required for long‐term success. In fact, in the Diabetes Prevention Program trial, over 10 years of follow-up, participants who were highly adherent to using metformin 1,700 mg/day lost almost 5% and maintained it without regain for 10 years (38).A total of 3297 T2DM patients were randomly assigned to receive either volume-matched placebo, semaglutide 1 mg once weekly, or 0.5 mg .In children a controlled randomised beverage trials of sugar sweetened beverages vs artificially sweetened over 18m demonstrated a weight increase of 6.35 kg in the sugar-free group as compared with 7.37 kg in the sugar group.Although a genetic predisposition results in an increased susceptibility among some individuals, excess weight, due to poor diet and insufficient physical activity, is the key modifiable risk factor .Healthy snacking is encouraged in a diabetes-friendly diet, but mindlessly grazing can lead to the consumption of extra calories and weight gain.We used the national health screening database of adults aged 20 years or older in the whole population of Korea who had been screened in 2012.The baseline characteristics of patients in the dapagliflozin group were similar to those of the non-SGLT2i group.The chance of diabetes remission correlates with percentage weight loss , but several non-weight loss-dependent mechanisms also contribute. As weight regain is common, such interventions should include long-term, comprehensive weight maintenance strategies and counseling to maintain weight loss and behavioral changes (60,61). When integrated with behavioral support and counseling, structured very-low-calorie meals, typically 800–1,000 kcal/day, utilizing high-protein foods and meal replacement products, may increase the pace and/or magnitude of initial weight loss and glycemic improvements compared with standard behavioral interventions (21,22). When provided by trained practitioners in medical settings with ongoing monitoring, short-term (generally up to 3 months) intensive nutrition intervention may be prescribed for carefully selected individuals, such as those requiring weight loss before surgery and those needing greater weight loss and glycemic improvements. Some commercial and proprietary weight loss programs have shown promising weight loss results. In contrast with previous clinical studies on Caucasian T2DM patients7, 31), the Japanese T2DM patients from the present study typically had a BMI of less than 30 kg/m2(overweight but not obese). It has been demonstrated that short-term dapagliflozin treatment effectively improves muscle insulin sensitivity in T2DM patients, indicative of beneficial effects of SGLT2i on skeletal muscle function and quality28). However, SGLT2i-induced stimulation of energy intake and excessive appetite could also offset the beneficial effects of SGLT2i on weight reduction and fat loss27); thus, adequate dietetic therapy is clinically important to gain the full benefits of SGLT2i treatment. Dipeptidyl peptidase 4 (DPP-4) inhibitors showed a neutral or mild weight loss effect. It is important that they know if they lose weight and improve their body’s efficiency, they may require less medication. Thus, observations suggest that after having diabetes for a long period of time, significantly improving pancreatic function and achieving remission may prove to be more difficult, compared to achieving remission early in the natural history of the disease. People who have had shorter diabetes duration are also more likely to undergo remission. It’s also important to understand the relationship between diabetes and other health concerns. Remember, proactive management empowers you to prevent weight gain and improve your overall health. Furthermore, seeking guidance from a healthcare professional experienced in managing diabetes within your specific regional context is paramount. This is difficult to prove, and lean T2DM cases are used anecdotally by patients to question the link between obesity and T2DM. Despite the strong relationship between weight and T2DM, not all individuals who are obese or overweight will develop diabetes, and not all individuals diagnosed with T2DM are overweight. After the crisis, there was a rebound in population weight, followed by a 140% increase in diabetes incidence, and in turn by a 49% increase in the mortality rate from diabetes. A recent survey conducted in Cuba provides a good example of the strong association between population-wide weight change and risk of death from T2DM and CVD 6. Insulin helps glucose move from your blood into your cells. Insulin is a hormone that helps your body to turn glucose from food into energy for your cells. Meglitinides (“glinides”) are another group of diabetes medications. Another group of medication that causes diabetes weight gain is thiazolidinediones (TZDs or “glitazones”). Only a randomised clinical trial can definitively answer the question of whether weight loss programs reduce the risk of mortality or other outcomes. The participants had provided information on whether weight loss was intentional, helping to overcome the confounding effect of weight loss resulting from comorbid conditions. While this clearly demonstrates the effect of weight loss on glycaemia, long-term follow-up data are needed before this approach can be more widely recommended, as discussed later. At the time the UKPDS study started (1977), HbA1c had not been widely adopted as the best measure of glucose control, and the World Health Organization then recommended an FPG level of 7.8 mmol/l (140 mg/dl) for the diagnosis of diabetes compared with the current level of 7.0 mmol/l (126 mg/dl) today. Similarly, in the Finnish Diabetes Prevention Study, adults at high risk of developing T2DM who were randomised to intensive dietary and exercise counselling had a 58% reduction in the risk of developing diabetes after 4 years compared with the usual-care group (who received general information about lifestyle and diabetes risk) 23. Remember portion control; smaller, more frequent meals can help regulate blood sugar levels throughout the day. Focus on whole grains like brown rice and millets, which are readily available and offer sustained energy release, crucial for blood sugar management. Up to 80% of Type 2 diabetes cases can be delayed or prevented through lifestyle changes, a powerful statistic highlighting the impact of proactive steps. But combining semaglutide with other blood sugar-lowering medications, such as insulin and sulfonylureas, raises the risk of low blood sugar. High-protein diet has been popularized as a promising tool for weight loss because it improves satiety and decreases fat mass.43 Dietary guidelines for adults recommend protein intake of 46–56 g or 0.8 g/kg of ideal body weight per day.44 Thus, if dietary protein consumption exceeds 0.8 g/kg/day, it is considered a high-protein diet. However, energy intake and energy expenditure are dynamic processes influenced by body weight and influence each other.11 Thus, interventions aimed at creating an energy deficit through the diet are countered by physiological adaptations that resist weight loss. In light of this, physicians should encourage weight loss in all patients with or at risk of T2DM, and should consider the impact on weight when choosing the most appropriate glucose-lowering therapies for these patients. We thank the participants of the Health Professionals Follow-up Study, the Nurses’ Health Study, and the Nurses’ Health Study II for their contributions and long-term commitment to scientific research.This may be one of the reasons why some people using Wegovy or Ozempic are reporting hair loss during treatment.For those of European descent, a healthy BMI is 18.5–24.9 kg/m2, overweight is 25–29.9 kg/m2 and obese is ≥30 kg/m2.2,3 Different classification criteria may apply to other population groups.For many people with diabetes, exercise and dietary changes aren’t enough to lose significant weight.Small, frequent meals can help prevent blood sugar spikes.The state obesity drug coverage landscape will continue to evolve as states respond to the recent announcement of the BALANCE model (see Box 1) and as states contend with budget challenges and the federal Medicaid spending cuts in the 2025 reconciliation law.Sometimes health care professionals use medications in a way that’s different from what the FDA has approved.We used clinical data from the Department of Nephrology and Endocrinology at the PLA 148th Hospital. Several DSFs were used in both the Look AHEAD study and the Why WAIT program for the initial 6–20 weeks to enhance initial weight reduction . We previously showed that patients with T2D who consumed DSF for breakfast had a lower glucose excursion compared to oatmeal with the same calorie content . Minimizing the loss of lean muscle mass during weight management is essential for long-term maintenance of weight loss. That evaluation includes review of dietary history and/or 24-h dietary recall and review of adherence to dietary recommendations during previous attempts of weight management. Over the last two decades, supervised nutrition therapy became one of the most effective methods of diabetes and weight management. And for practical tips to improve your diabetes management, read our guide on 10 Proven Tips for Effective Diabetes Management. For individuals in India and tropical regions, access to diabetes specialists and endocrinologists may vary. This is especially crucial in India and other tropical countries where access to timely healthcare can sometimes be a challenge. Dot plot of skeletal muscle mass before and after 6 months of dapagliflozin or non-sodium-glucose co-transporter 2 inhibitor (SGLT2i) therapy as measured using a bioelectrical impedance analyzer Dot plot of soft lean mass before and after 6 months of dapagliflozin or non-sodium-glucose co-transporter 2 inhibitor (SGLT2i) therapy as measured using a bioelectrical impedance analyzer Including loss to follow up and variations in numbers between the two treatment groups, we set a sample size of 50 in total. In addition, other demographics variables that potentially affect glycemic control, such as race/ethnicity, region, socioeconomic status, or duration of diabetes, were not available for this analysis.Unintentional weight change may be attributed to some underlying diseases, but we assumed that body weights of patients with such diseases would not increase again within a relatively short period of time.The study findings indicated that for every 1 percentage point reduction in body weight, the likelihood of recovering from diabetes increases by approximately 2 percentage points.A recent survey conducted in Cuba provides a good example of the strong association between population-wide weight change and risk of death from T2DM and CVD 6.Meal replacements are useful and can produce weight loss similar to or better than food restriction alone.Further, in a study conducted by Bonora et al. to evaluate the impact of dulaglutide on weight loss in people with T2D, it was reported that those with higher baseline BMI experienced numerically greater absolute weight loss.Phase 2 studies with this drug (42) suggest that we can expect twice as much weight loss as is now achievable with antiobesity medications.Diet is a key part of any weight loss plan, but for those with diabetes it’s even more important. After 12 weeks, patients who lost ≥ 5% of their weight were classified as high responders while who had lost ≥ 10% were classified as super-responders, and those who failed to achieve a 5% loss of their weight were classified as low responders . No discernible difference was seen between the two groups’ average weight loss, which was 1.49 kg for the once-weekly exenatide group and 1.89 kg for the twice-daily exenatide arm . A total of 375 T2DM patients who were taking oral medications or were drug-naïve were randomly assigned to receive either the novel formulation of exenatide once per week or twice daily for 28 weeks . The exenatide group had better glycemic control and had lost an average of 1.5 kg more weight than the placebo group, according to the data . But when you have diabetes, you need to know how foods affect your blood sugar levels. Sustainable weight management is key to preventing these complications and improving overall health. A balanced diet incorporating regional produce and culturally appropriate strategies is essential for sustainable weight management. High-carbohydrate and high-fat diets can worsen weight fluctuations. Overall, with significant weight loss through restricting calories or other strategies, patients have a high likelihood of achieving remission, particularly if they have a greater baseline pancreatic function and have had diabetes for a shorter time. Patients should also know that obesity contributes to increased blood glucose levels due to insulin resistance and that the more weight patients put on, that may mean they need more medication. A balanced diet that achieves weight loss not only improves blood glucose levels but also may reduce cardiovascular risk factors. Studies of weight loss through restricting calories or metabolic surgery have found that people with type 2 diabetes who start with greater pancreatic function at baseline, prior to the intervention, are more likely to undergo remission. Recently, the Diabetes Remission Clinical Trial (DiRECT), conducted in primary care practices in the United Kingdom, examined type 2 diabetes remission rates in participants who lost weight, starting with a very low-calorie diet and sustaining the weight loss over time. Low-fat and low-carbohydrate diets are good options for initial weight loss; in some cases, a ketogenic diet could be a viable alternative. The Atkins diet has gained popularity as a non-energy-restricting, low-carbohydrate, high-protein, and high-fat diet.45 In addition, diets high in protein with normal amounts of carbohydrates have been used to improve metabolic parameters.46 Diets with higher protein intake can provide significant benefits to prevent weight regain.47 A satiating effect is most significant with high-protein diets, and this effect helps decrease energy intake and maintain successful weight loss. Low-carbohydrate (low-carb) diets have been widely used not only for weight reduction, but also to manage T2DM; many randomized controlled trials have been conducted.32,33 A low-carb diet is defined as a carbohydrate intake below the lower boundary of the macronutrient distribution range for healthy adults (45%–65% of total daily energy)34 and encompasses a range of carbohydrate intake from 50–130 g/day or 10%–45% total energy from carbohydrates.35,36 With carbohydrate intake 37 A low-fat diet usually consists of a dietary composition of fat ranging from very low (≤10% of calories from fat) to more moderate (≤30% of calories from fat and 24 However, randomized trials have failed to demonstrate better weight-loss maintenance by reducing energy intake from fat than other dietary interventions.25 The results of a meta-analysis did not support use of low-fat diets over other dietary interventions for long-term weight loss.26 The least effective bariatric surgery for long-term results in patients with T2D is laparoscopic adjustable gastric banding (LAGB) . Bariatric surgery may induce partial or complete remission from T2D for several years . This model was used in the DPP, Look AHEAD study, and Why WAIT program, where it was described in detail 39, 55. Resistance training is especially important since diabetes is known to worsen sarcopenia (muscle loss that frequently occurs with aging) . And you've probably noticed that even people who take the weight off have a hard time keeping it off. However, as all participants in VIP underwent OGTTs, the risk of surveillance (ascertainment) bias of the outcome is minimised. When diabetes is ascertained through self-report or from general practice medical records, there is a danger of differential over diagnosis in groups at high risk, i.e., with a high BMI. Furthermore, follow-up studies show that shorter term interventions can have a long-lasting effect on risk factors and diabetes incidence – the so-called ‘legacy effect’ – years after the lifestyle interventions have finished 19. However, a weight loss of this magnitude is not typical of routine care, and may have contributed to the lower than expected event rate in the control group. In the control group, use of potentially cardioprotective agents including metformin, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and statins was higher, potentially neutralising any effect of weight loss on cardiovascular outcomes.