In an analysis paper in the BMJ, Mike Lean, professor of nutrition at Glasgow University, argues that giving tablets to reduce blood sugar (the main treatment for type 2 diabetes) only addresses the symptom. “Virtually everyone with type 2 diabetes is two or three stone [12-19kg] above their ideal weight,” says Lean. “One of the great tragedies is that we’ve known this for about a hundred years and all the treatments have ever done is reduce the blood sugar – this is the consequence, but what drives it is the weight.”
Lean says the easiest indicator of someone at risk of type 2 diabetes is a fat tummy. A man with a waist over 91cm (36in) or a woman with a waist over 81cm (32in) could both be on the path to the condition. Another paper in Frontiers in Endocrinology describes a programme of high-intensity exercise as a way of preventing type 2 diabetes developing in people with risk factors. But: “You can’t run off diabetes,” says Lean. He says evidence suggests most people need to lose more than 12kg. But studies show woeful remission rates (0.14% of 120,000 US patients who were followed up for seven years).
Lean is more optimistic, as his team is involved in a programme called Counterweight Plus, which a pilot study showed led to a third of people losing more than 12kg. The programme involves drinking formula shakes with a total of 820 calories for six to eight weeks, before reintroducing food that includes a lot less fat, and ideally no alcohol. The programme is being further evaluated and Lean says he is not pushing his own Counterweight Plus solution – people should ask their GPs for any evidence-based weight-loss programme. The rewards of weight loss are high. Not having type 2 diabetes any more (as long as you don’t regain weight) means not only no tablets for diabetes and no complications, but often the reversal of any high blood pressure, too.