If you have type 2 diabetes and you’re overweight or obese, your doctor has probably told you that losing some weight can improve your health. You don’t need a dramatic change to see results: Losing between 5 and 10 percent of your total body weight can help you better control your blood-glucose and blood-pressure levels, which can limit complications.
After a diabetes diagnosis, many people initially try to lose weight through diet and exercise, but this doesn’t work for everyone. If you’re putting in the effort but aren’t seeing results, it’s okay to see your doctor for help.
“If patients haven’t lost 4 or 5 percent of their starting weight by 3 to 4 months, I would recommend a visit to an experienced MD, NP or PA for help with succeeding with weight loss,” said obesity researcher Donna Ryan, MD, associate executive director for clinical science at Pennington Biomedical Research Center at Louisiana State University, in an e-mail interview.
Doctors often prescribe medication for people with type 2 diabetes to aid with weight loss. Here’s why some people may need it and how it works:
Weight Loss Can Be Tricky
When you have diabetes, losing weight on your own can be difficult, even if you try valiantly.
Your body may resist your efforts to slim down if you’re overweight or obese, since it’s accustomed to being your current weight.
“The body is going to fight the weight loss and defend the body-weight set-point that has occurred due to a dysfunctional body-weight regulation energy-balance system,” said Caroline Apovian, MD, director of nutrition and weight management at Boston Medical Center and professor of medicine at Boston University’s School of Medicine, in an e-mail interview.
Additionally, some diabetes medications make it harder to lose weight, which is ironic: By listening to your doctor and taking the medicine that she prescribed for your diabetes, you’re actually creating a situation which makes it nearly impossible for you to follow your doctor’s advice to improve your diabetes through weight loss. You may even gain weight on medication! Insulin and sulfonylureas are common culprits.
“Weight loss will be more difficult for patients who are taking insulin,” said Gretchen Ray, PharmD, PhC, BCACP, CDE, associate professor of pharmacy practice at the University of New Mexico’s College of Pharmacy, in an e-mail interview. “[And] the sulfonylureas cause weight gain, because they increase insulin levels in the body by stimulating the pancreas to produce more insulin. Insulin is still an effective and often necessary option for the management of type 2 diabetes, but the likelihood of weight gain should be considered.”
Thiazolidinediones, which work by decreasing your resistance to insulin, can also make it harder to lose weight. Other drugs which people with diabetes may take – including some antidepressants, beta blockers and oral contraceptives – may also cause weight gain.
Certain Drugs Can Help
Fortunately, there are medications which can make it easier for people with type 2 diabetes to lose weight.
Medication may be more effective if you’ve only had type 2 diabetes for a short time – less than 10 years – and if you don’t need to take insulin or you take low doses of insulin. A doctor can best assess your situation.
“Obesity medicine physicians are the best specialists who can help the patient with type 2 diabetes,” Apovian said. “They can change medications that are exacerbating weight gain – such as insulins, sulfonylureas and thiazolidinediones – and put patients on medications that promote weight loss, such as GLP-1 agonists and SGLT2 inhibitors and metformin.”
Most people with type 2 diabetes are prescribed metformin, which helps to control blood-sugar levels. Research has shown that metformin can help to decrease appetite in some people, which may lead to weight loss, but this isn’t universal.
“Metformin is our first-line therapy,” Ryan said. “It produces about 2 percent weight loss, on average, but some patients will lose more. Like any medication, the more intensive the behavioral approach, the more weight can be lost.”
GLP-1 receptor agonists not only control your blood-glucose levels and help you produce more insulin, they make you feel full after meals, so you’re inclined to eat less at meals and between meals.
“The GLP-1 receptor agonists provide the greatest weight-loss effect of all the diabetes medication classes,” Ray said. “The GLP-1 receptor agonists will affect appetite. They promote satiety as one of their mechanisms, which ultimately results in smaller portions and weight loss.”
SGLT2 inhibitors help to lower blood-sugar levels by having the kidneys remove sugar through urine, and they may cause weight loss.
“The GLP-1 receptor agonists and the SGLT2 inhibitors do result in weight loss,” Ray said. These two drug classes are recommended in the recently updated American Diabetes Association pharmacotherapy treatment recommendations for patients in whom weight loss is a priority.”
Another medication, Xenical (orlistat), has been shown to produce weight loss among people with diabetes. It doesn’t affect appetite; rather, it keeps the intestines from absorbing some of the fat in food.
“Xenical reinforces adherence to a low-fat diet,” Ryan said. “[All of] these medications help reinforce dietary efforts, and patients will lose more weight than with diet alone.”
Other weight-loss medications, like Qsymia and Contrave, can reduce appetite, leading to weight loss.
Maintaining Weight Loss
One advantage of using medication for weight loss among people with diabetes: People who lose weight on their own through diet and exercise often regain the weight, but people who lose weight with the aid of medication are able to maintain the weight loss while they continue taking the drug.
“To me, one of the best things about medication if that they help patients keep weight off, and weight loss can be hard won,” Ryan said. “As long as patients stay on medications, the weight will stay down, but if they stop, there is usually regain.”