This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! Reader Cheryl let me know about an article that truly horrifies me. The title is “Type 2 Diabetes Experts: Weight Loss is (Almost Always) More Important than Glucose Control.” (As usual, I don’t link to articles with harmful content, but provide enough info for it to be found online if someone wishes to do so.)
This is my wheelhouse, as close as I can get without actual medical/nutrition degrees. I've been reading studies about diabetes and body weight for over 25 years now, because when I was diagnosed with diabetes I was told that "insulin is only for bad diabetics" and that I "had to be lying" about what I ate because my blood sugars were so high and I was very sick. I got a better doctor, and then started reading research papers and studies. I started a mailing list for diabetics who didn't want to diet-for-weight loss because pop culture insisted you had to lose weight or you would DIE! (People actually called me selfish for refusing to go on a severely restrictive weight loss diet.)
There's been a lot of work since then to find real causes of diabetes, both type 1 and type 2, that don't rely on the lazy "Because you're fat." Until the late '90s, when there was a huge push for weight loss drugs and using BMI as the standard of "weight" and "health," you'd find in a list of symptoms of type 2 diabetes as "unwanted weight gain." They've known for decades that insulin resistance often causes weight gain in people with glucose intolerance. And if you go to the diabetes forum on reddit, you'll see the same story over and over again: "I gained weight, my doctor said I was 'pre-diabetic' and had to lose weight, I lost weight, six months later I was diagnosed with diabetes. How could this happen when I did everything right?" (Because body weight and insulin resistance are a complicated loop, but once you have IR you're on the track to type 2 diabetes no matter how much you weigh.)
They're pretty sure that the plasma C14:0 ceramide (a type of lipid) is one of the root causes of insulin resistance. Exercise independent of weight change can reduce the C14:0 ceramide which in turn can reduce insulin resistance. (There are also believed to be types of insulin resistance caused by antibodies and autoimmune disorders.) Note that the C14:0 ceramine is also indicated in non-alcoholic fatty liver disease.
Saying that even "people who aren't ob*se can benefit from weight loss" is horrific. That's like saying that people with no sign of cardiovascular disease can benefit from shunts (which we now know don't work, either).
The latest "sure cure for fat people" that's really a diabetes drug which is being handed out like candy off-label is terrifying. I'm fully expecting for it to go down like Phen-Fen and Rezulin as drugs promising diabetes cures, health, and thinness and instead causing too early death and disease.
I could blather on for pages but I've hijacked your comment section enough. :)
Thank you for taking time to write this, when I shared it to others, I led with this intro post about my personal experience with 2 practitioners who were both obsessed with weight loss as a front line T2 treatment:
"If you have pre-diabetes or T2, please read this: Some of you know that I've been on a long journey attempting to balance my blood sugar and to limit the progression of T2 diabetes (my mother's side of the family has a history of T2). After years of this, it finally became clear to me that I was dealing with medical fatphobia to the exclusion of actual good medical diagnostic work. I had 2 separate practitioners outline their recommended treatment protocols for me, which I followed obsessively. In both cases, I even lost 10% of my then body weight, which is reputed to create statistically significant improved health markers. Both practitioners treated medication such as metformin as a "failure" of some sort.
Here's the painful truth: those recommended measures, including 3 years eating strict keto, did not produce the promised results, in spite of my weight loss. In one case, this led to a practitioner yelling at me and trying to shame me as she believed I couldn't possibly have followed her directions if I wasn't getting the improved markers she expected.
In the other case, I suffered through medical misdiagnosis as my weight was perceived as the front line cause of all problems--this led to me going years with a worsening gall bladder condition, which resulted in a near emergency surgery to finally remove my gall bladder in May of this year. I cannot even describe to you how much this has improved not just my quality of life, but a sweeping swath of my health markers! (C-Reactive protein dropped from 14.3 to 1.4 within 3 months of the surgery, for instance. It had been high for years.)
At any point when I had what were gall bladder symptoms, my PCP assumed it was weight related and would send me out for things like heart stress tests--and these tests all came back with good results. At that point, because my PCP assumed weight must somehow still be the source of the issue, he would simply stop there, and not pursue any other evidence-based diagnostic work because clearly any symptoms I was having that couldn't be related to weight must be outlier experiences that didn't indicate I had other problems to be pursued. (I had gallbladder symptoms going back to 2017.)
Why does this matter? If you are a person who is pre-diabetic or already has T2, it's critical to know that diet and exercise can only impact 30% of what is behind the tipping point into T2. In fact, genetics makes up a larger proportion of impact, along with social determinants of health. Even stress and insomnia dramatically skew blood sugar levels, which anyone who tests their blood sugar regularly can easily confirm. People who have a trauma background (which can include things like trauma related to growing up in a racist society, for instance) are effectively steeped in stress hormones which can rather permanently alter blood sugar levels skewing toward pre-diabetes and T2. So no, I didn't "eat yourself into T2."
My own PCP, while blinded by his over focus on my weight, even conceded that science doesn't actually know if the endocrine disruption happens first and then causes weight gain, or if it's the other way around. But the public assumption is simply that people eat themselves into T2 and caused this particular health issue themselves--which is not substantiated.
The article suggesting new treatment protocols prioritizing weight loss over blood sugar control that is about to come out or has just been released features a "debate" between doctors and a doctor moderator who are all paid by weight loss industry and NovoNordisk. If you watched "Dope Sick" on Hulu, many of the marketing tactics NovoNordisk has used for GLP-1 agonist drugs are a direct lift from the playbook of oxycontin maker, Purdue Pharma.
One of the greatest problems I see with the coming recommendation that weight loss is more important than blood sugar control is that it completely overlooks evidence-based research and practice, and diverts both medical professionals and their patients from bona-fide treatments. Research already exists that fatness may have a protective effect, and is not clearly correlated with increased risk for cardiovascular issues. In fact, in some overweight people, forcing them to lose weight can increase their risk for cardiovascular events.
Drugs like Ozempic, which may soon be prioritized as front line for T2 treatment are being favored because they may lead to temporary weight loss (ie weight loss that lasts only as long as you are on the medication), but often to the exclusion of quality of life as a significant number of patients report severe nausea and other unpleasant side effects. Additionally, GLP-1 agonists such as Ozempic may confer no other benefits--unlike metformin which can quite effectively control blood sugar, is much cheaper, is often more readily tolerated, and has protective benefits for the cardiovascular and renal (kidney) systems, as well as offering protection benefits against age-related macular degeneration, dementia, and some types of cancer. GLP-1 agonists may lower blood sugar A1C by .66%, while metformin has been shown to lower blood sugar up to 1.5%. (A1C is often expressed with numbers like 5.4, 6.7 etc. so the difference between .66% and 1.5% is pretty important.)
The low side per unit cost of metformin is $.16, while the low side per unit cost of Ozempic is $632. Yes, Ozempic is $631.84 more than metformin, on a per dose basis.
Just like Purdue Pharma created the medical "conditions" that would require oxycontin, it's very hard for me to imagine a world where NovoNordisk is not similarly creating a "need", which will drive a new treatment direction, which will drive sales of Ozempic--all the while lacking sufficient research which would justify such a switch in treatment protocols.
I'm not against anyone who uses GLP-1 agonists because it improves their quality of life and health--but since I have directly been negatively impacted by doctors who were misguided by the over focus on weight to exclusion of all else, I hate to see anything else that might further compromise evidence-based diagnostics and treatments when it comes to T2. If your treatment for T2 begins and ends with, "You're too fat," the need for additional diagnostic work, along with improved treatment protocols becomes irrelevant. This is sloppy medicine at best, and could be deadly at worst.
If you are [in Oregon and] in need of an evidence-based treatment-minded, non-weight-obsessed endocrinologist, please let me know, I would be happy to share the name of my doctor. I had to go to Corvallis to find her, but she is 100% worth the drive. I also have a new PCP who is likewise a breath of fresh air to work with. Finally, the surgeon who removed my gallbladder? He was the first person to order the actual diagnostic work for me, and I would recommend him as well. I will always be grateful that he did not simply tell me my issue was my weight."
Your experience with your previous PCP sounds eerily like mine: unsuccessful diet and weight-loss plans, followed by accusations and threats when the weight loss didn't work. It felt like I wasn't allowed to think about anything other than my weight, and I would be punished if I relaxed or showed any sign of happiness. I didn't realize how damaging the relationship was until I switched to a more supportive PCP.
I think I trust my current PCP to treat me well, but these recommendations make me nervous. My current treatment works really well. I don't want to be pressured into something less effective, especially if it encourages the kind of abuse we experienced with our old PCPs.
I read the article before I read your breakdown and without even finishing it I though "this article was paid for by Novo Nordisk." Maybe not directly but as you broke down, very much indirectly. I'm on one of the diabetes medications that "promotes" weight loss. It has been insanely effective for my blood sugars but honestly the weight loss tends to come from the fact that if I eat too much at once, I lose all of it. I've been able to successfully navigate this and become more of a grazer/snacker as a way to eat. As a result I've been able to maintain my weight on this drug. I swear most people who are on it lose weight because they either can't hold anything down or become too fearful to eat. We have to treat type 2 diabetics better than that! That is NOT a way to live.
Hyperglycemia and improper glucose, protein, and lipid metabolism are hallmarks of diabetes mellitus (DM). Type-2 DM is called insulin resistance and insulin shortage. Also, the interplay of genetic, environmental, and behavioral risk factors also contributes to DM. It affects adults and the elderly, with an ever-increasing global prevalence. Furthermore, diabetic patients are particularly sensitive to microvascular and macrovascular problems, which can lead to early death. Despite specific anti-diabetic treatment existing, the rising prevalence of the disease necessitates the development of newer anti-hyperglycemic medications. Diabetes mellitus is difficult to control; however, early diagnosis and treatment, along with lifestyle changes, aid in the long-term management of the disease. Furthermore, even if you have a family history of diabetes, living a healthy lifestyle can help you avoid the disease.
The advice by the "experts" in the article you're critiquing is so infuriating! I am a type 2 diabetic and have absolutely contrary experience to all of this. #1: I took "Wegovy" in the form of Ozempic (same drug) to treat my type 2 diabetes, and it made me so horribly sick that I missed a ton of work, couldn't get out of bed because I felt so weak, and couldn't digest anything "healthy." In short, it gave me gastroparesis, and I basically threw up everything I ate, and was weak from starvation. And after all that, I didn't even lose any weight and my blood sugars didn't even go down. It was a totally useless drug for me that resulted in me not being able to take care of myself and do the things that would make a difference like eating a balanced diet and exercising. I could only digest shakes (and sometimes not even that), and I was too weak to get out of a chair/bed much less exercise.
#2: I have lost (and regained) "significant" amounts of weight (as much as 50 pounds at a time) in my four decades of being a large-bodied person. (I was born into a larger body, so I've dealt with the medical community telling me my body is "wrong" my whole life.) And guess what? None of the weight loss ever shifted my blood glucose numbers. (I've been a type 2 diabetic for 15 years.) And at one point, after all that focus on weight loss, I ended up being on as many as three diabetes medications. Now I only take a single medication. Why? Because I stopped focusing on weight loss and now focus on my health instead.
I realize reducing medications isn't possible for everyone. (There's research to support that.) But what worked for me was to get off the weight loss path and put my focus on health. The two are absolutely not the same thing, since the drug Ozempic made me unable to engage in healthy lifestyle factors like eating vegetables (I couldn't digest them) and exercising (I was too weak). Drug-free calorie restriction diets are also not healthy, since they put too much stress on the body and are doomed to fail. (I always regained what I lost plus some, despite my best efforts. Until I eventually became weightloss resistant due to a lifetime of chronic dieting. Hence, losing nothing when I was taking Ozempic despite not being able to digest food.)
There's also, btw research from the ADA (wish I still had the link) that found focusing on lifestyle significantly improves type 2 diabetics' A1c over focusing on weight loss. As you can imagine, that's because research shows things like following a Mediterranean way of eating (for example - because there are lots of ways to eat with type 2 diabetes) and exercising improve blood sugar completely irrespective of weight loss. But focusing on calorie restriction is counter-productive because it causes a huge amount of stress on the body. And when the body is stressed it releases cortisol. Cortisol is proven to raise blood sugar.
So I realize I'm a one-person case study, but weight loss has NOTHING to do with improving glucose control. In fact, there's also research out there that shows that if both of your parents have type 2 diabetes, you have a 70% chance you'll get it too (because the condition is largely GENETIC, not a result of being "fat." FYI: I know more thin and normal weight people with type 2 than "overweight" ones.) But there's also research that says if you have a lifetime history of chronic dieting, you have a 78% chance of getting type 2 diabetes! (I am a recovering lifelong dieter.) So it's entirely possible the correlation of obesity to type 2 (of course, correlation does not equal causation) is because those of us labeled "obese" are more likely to diet.
Btw, I'm also pretty sure the "correlation" is also a sham, anyway. As there are plenty of demographic studies of people around the world that show type 2 diabetes is just as prevalent for so-called normal-weight individuals as for those of us in larger bodies. So these so-called "experts" need to go back to the research, since there's absolutely no research that supports their position and a ton of research that shows dieting is a horrible way to manage type 2. This is completely irresponsible medical advice being peddled by these "experts."
OK, done ranting now . . . Apologies for the super long comment, but this stuff is so upsetting because it's just SO wrong.
This is my wheelhouse, as close as I can get without actual medical/nutrition degrees. I've been reading studies about diabetes and body weight for over 25 years now, because when I was diagnosed with diabetes I was told that "insulin is only for bad diabetics" and that I "had to be lying" about what I ate because my blood sugars were so high and I was very sick. I got a better doctor, and then started reading research papers and studies. I started a mailing list for diabetics who didn't want to diet-for-weight loss because pop culture insisted you had to lose weight or you would DIE! (People actually called me selfish for refusing to go on a severely restrictive weight loss diet.)
There's been a lot of work since then to find real causes of diabetes, both type 1 and type 2, that don't rely on the lazy "Because you're fat." Until the late '90s, when there was a huge push for weight loss drugs and using BMI as the standard of "weight" and "health," you'd find in a list of symptoms of type 2 diabetes as "unwanted weight gain." They've known for decades that insulin resistance often causes weight gain in people with glucose intolerance. And if you go to the diabetes forum on reddit, you'll see the same story over and over again: "I gained weight, my doctor said I was 'pre-diabetic' and had to lose weight, I lost weight, six months later I was diagnosed with diabetes. How could this happen when I did everything right?" (Because body weight and insulin resistance are a complicated loop, but once you have IR you're on the track to type 2 diabetes no matter how much you weigh.)
They're pretty sure that the plasma C14:0 ceramide (a type of lipid) is one of the root causes of insulin resistance. Exercise independent of weight change can reduce the C14:0 ceramide which in turn can reduce insulin resistance. (There are also believed to be types of insulin resistance caused by antibodies and autoimmune disorders.) Note that the C14:0 ceramine is also indicated in non-alcoholic fatty liver disease.
Saying that even "people who aren't ob*se can benefit from weight loss" is horrific. That's like saying that people with no sign of cardiovascular disease can benefit from shunts (which we now know don't work, either).
The latest "sure cure for fat people" that's really a diabetes drug which is being handed out like candy off-label is terrifying. I'm fully expecting for it to go down like Phen-Fen and Rezulin as drugs promising diabetes cures, health, and thinness and instead causing too early death and disease.
I could blather on for pages but I've hijacked your comment section enough. :)
Do you still do your emails? I would love to be on the mailing list. Thanks for sharing this information!
Thank you for taking time to write this, when I shared it to others, I led with this intro post about my personal experience with 2 practitioners who were both obsessed with weight loss as a front line T2 treatment:
"If you have pre-diabetes or T2, please read this: Some of you know that I've been on a long journey attempting to balance my blood sugar and to limit the progression of T2 diabetes (my mother's side of the family has a history of T2). After years of this, it finally became clear to me that I was dealing with medical fatphobia to the exclusion of actual good medical diagnostic work. I had 2 separate practitioners outline their recommended treatment protocols for me, which I followed obsessively. In both cases, I even lost 10% of my then body weight, which is reputed to create statistically significant improved health markers. Both practitioners treated medication such as metformin as a "failure" of some sort.
Here's the painful truth: those recommended measures, including 3 years eating strict keto, did not produce the promised results, in spite of my weight loss. In one case, this led to a practitioner yelling at me and trying to shame me as she believed I couldn't possibly have followed her directions if I wasn't getting the improved markers she expected.
In the other case, I suffered through medical misdiagnosis as my weight was perceived as the front line cause of all problems--this led to me going years with a worsening gall bladder condition, which resulted in a near emergency surgery to finally remove my gall bladder in May of this year. I cannot even describe to you how much this has improved not just my quality of life, but a sweeping swath of my health markers! (C-Reactive protein dropped from 14.3 to 1.4 within 3 months of the surgery, for instance. It had been high for years.)
At any point when I had what were gall bladder symptoms, my PCP assumed it was weight related and would send me out for things like heart stress tests--and these tests all came back with good results. At that point, because my PCP assumed weight must somehow still be the source of the issue, he would simply stop there, and not pursue any other evidence-based diagnostic work because clearly any symptoms I was having that couldn't be related to weight must be outlier experiences that didn't indicate I had other problems to be pursued. (I had gallbladder symptoms going back to 2017.)
Why does this matter? If you are a person who is pre-diabetic or already has T2, it's critical to know that diet and exercise can only impact 30% of what is behind the tipping point into T2. In fact, genetics makes up a larger proportion of impact, along with social determinants of health. Even stress and insomnia dramatically skew blood sugar levels, which anyone who tests their blood sugar regularly can easily confirm. People who have a trauma background (which can include things like trauma related to growing up in a racist society, for instance) are effectively steeped in stress hormones which can rather permanently alter blood sugar levels skewing toward pre-diabetes and T2. So no, I didn't "eat yourself into T2."
My own PCP, while blinded by his over focus on my weight, even conceded that science doesn't actually know if the endocrine disruption happens first and then causes weight gain, or if it's the other way around. But the public assumption is simply that people eat themselves into T2 and caused this particular health issue themselves--which is not substantiated.
The article suggesting new treatment protocols prioritizing weight loss over blood sugar control that is about to come out or has just been released features a "debate" between doctors and a doctor moderator who are all paid by weight loss industry and NovoNordisk. If you watched "Dope Sick" on Hulu, many of the marketing tactics NovoNordisk has used for GLP-1 agonist drugs are a direct lift from the playbook of oxycontin maker, Purdue Pharma.
One of the greatest problems I see with the coming recommendation that weight loss is more important than blood sugar control is that it completely overlooks evidence-based research and practice, and diverts both medical professionals and their patients from bona-fide treatments. Research already exists that fatness may have a protective effect, and is not clearly correlated with increased risk for cardiovascular issues. In fact, in some overweight people, forcing them to lose weight can increase their risk for cardiovascular events.
Drugs like Ozempic, which may soon be prioritized as front line for T2 treatment are being favored because they may lead to temporary weight loss (ie weight loss that lasts only as long as you are on the medication), but often to the exclusion of quality of life as a significant number of patients report severe nausea and other unpleasant side effects. Additionally, GLP-1 agonists such as Ozempic may confer no other benefits--unlike metformin which can quite effectively control blood sugar, is much cheaper, is often more readily tolerated, and has protective benefits for the cardiovascular and renal (kidney) systems, as well as offering protection benefits against age-related macular degeneration, dementia, and some types of cancer. GLP-1 agonists may lower blood sugar A1C by .66%, while metformin has been shown to lower blood sugar up to 1.5%. (A1C is often expressed with numbers like 5.4, 6.7 etc. so the difference between .66% and 1.5% is pretty important.)
The low side per unit cost of metformin is $.16, while the low side per unit cost of Ozempic is $632. Yes, Ozempic is $631.84 more than metformin, on a per dose basis.
Just like Purdue Pharma created the medical "conditions" that would require oxycontin, it's very hard for me to imagine a world where NovoNordisk is not similarly creating a "need", which will drive a new treatment direction, which will drive sales of Ozempic--all the while lacking sufficient research which would justify such a switch in treatment protocols.
I'm not against anyone who uses GLP-1 agonists because it improves their quality of life and health--but since I have directly been negatively impacted by doctors who were misguided by the over focus on weight to exclusion of all else, I hate to see anything else that might further compromise evidence-based diagnostics and treatments when it comes to T2. If your treatment for T2 begins and ends with, "You're too fat," the need for additional diagnostic work, along with improved treatment protocols becomes irrelevant. This is sloppy medicine at best, and could be deadly at worst.
If you are [in Oregon and] in need of an evidence-based treatment-minded, non-weight-obsessed endocrinologist, please let me know, I would be happy to share the name of my doctor. I had to go to Corvallis to find her, but she is 100% worth the drive. I also have a new PCP who is likewise a breath of fresh air to work with. Finally, the surgeon who removed my gallbladder? He was the first person to order the actual diagnostic work for me, and I would recommend him as well. I will always be grateful that he did not simply tell me my issue was my weight."
Your experience with your previous PCP sounds eerily like mine: unsuccessful diet and weight-loss plans, followed by accusations and threats when the weight loss didn't work. It felt like I wasn't allowed to think about anything other than my weight, and I would be punished if I relaxed or showed any sign of happiness. I didn't realize how damaging the relationship was until I switched to a more supportive PCP.
I think I trust my current PCP to treat me well, but these recommendations make me nervous. My current treatment works really well. I don't want to be pressured into something less effective, especially if it encourages the kind of abuse we experienced with our old PCPs.
I read the article before I read your breakdown and without even finishing it I though "this article was paid for by Novo Nordisk." Maybe not directly but as you broke down, very much indirectly. I'm on one of the diabetes medications that "promotes" weight loss. It has been insanely effective for my blood sugars but honestly the weight loss tends to come from the fact that if I eat too much at once, I lose all of it. I've been able to successfully navigate this and become more of a grazer/snacker as a way to eat. As a result I've been able to maintain my weight on this drug. I swear most people who are on it lose weight because they either can't hold anything down or become too fearful to eat. We have to treat type 2 diabetics better than that! That is NOT a way to live.
Holy cow, this is SOOOO infuriating!!! What can I do about it? It's so completely horrifying, all the collusion and winks/nods!
Dear God.
This is horrifying. I'm speechless. Thank you for bringing this sort of quackery out into public and following the money to show who is funding this.
Hyperglycemia and improper glucose, protein, and lipid metabolism are hallmarks of diabetes mellitus (DM). Type-2 DM is called insulin resistance and insulin shortage. Also, the interplay of genetic, environmental, and behavioral risk factors also contributes to DM. It affects adults and the elderly, with an ever-increasing global prevalence. Furthermore, diabetic patients are particularly sensitive to microvascular and macrovascular problems, which can lead to early death. Despite specific anti-diabetic treatment existing, the rising prevalence of the disease necessitates the development of newer anti-hyperglycemic medications. Diabetes mellitus is difficult to control; however, early diagnosis and treatment, along with lifestyle changes, aid in the long-term management of the disease. Furthermore, even if you have a family history of diabetes, living a healthy lifestyle can help you avoid the disease.
https://centralbiohub.de/biospecimens/metabolic-disorders/diabetes-ii
The advice by the "experts" in the article you're critiquing is so infuriating! I am a type 2 diabetic and have absolutely contrary experience to all of this. #1: I took "Wegovy" in the form of Ozempic (same drug) to treat my type 2 diabetes, and it made me so horribly sick that I missed a ton of work, couldn't get out of bed because I felt so weak, and couldn't digest anything "healthy." In short, it gave me gastroparesis, and I basically threw up everything I ate, and was weak from starvation. And after all that, I didn't even lose any weight and my blood sugars didn't even go down. It was a totally useless drug for me that resulted in me not being able to take care of myself and do the things that would make a difference like eating a balanced diet and exercising. I could only digest shakes (and sometimes not even that), and I was too weak to get out of a chair/bed much less exercise.
#2: I have lost (and regained) "significant" amounts of weight (as much as 50 pounds at a time) in my four decades of being a large-bodied person. (I was born into a larger body, so I've dealt with the medical community telling me my body is "wrong" my whole life.) And guess what? None of the weight loss ever shifted my blood glucose numbers. (I've been a type 2 diabetic for 15 years.) And at one point, after all that focus on weight loss, I ended up being on as many as three diabetes medications. Now I only take a single medication. Why? Because I stopped focusing on weight loss and now focus on my health instead.
I realize reducing medications isn't possible for everyone. (There's research to support that.) But what worked for me was to get off the weight loss path and put my focus on health. The two are absolutely not the same thing, since the drug Ozempic made me unable to engage in healthy lifestyle factors like eating vegetables (I couldn't digest them) and exercising (I was too weak). Drug-free calorie restriction diets are also not healthy, since they put too much stress on the body and are doomed to fail. (I always regained what I lost plus some, despite my best efforts. Until I eventually became weightloss resistant due to a lifetime of chronic dieting. Hence, losing nothing when I was taking Ozempic despite not being able to digest food.)
There's also, btw research from the ADA (wish I still had the link) that found focusing on lifestyle significantly improves type 2 diabetics' A1c over focusing on weight loss. As you can imagine, that's because research shows things like following a Mediterranean way of eating (for example - because there are lots of ways to eat with type 2 diabetes) and exercising improve blood sugar completely irrespective of weight loss. But focusing on calorie restriction is counter-productive because it causes a huge amount of stress on the body. And when the body is stressed it releases cortisol. Cortisol is proven to raise blood sugar.
So I realize I'm a one-person case study, but weight loss has NOTHING to do with improving glucose control. In fact, there's also research out there that shows that if both of your parents have type 2 diabetes, you have a 70% chance you'll get it too (because the condition is largely GENETIC, not a result of being "fat." FYI: I know more thin and normal weight people with type 2 than "overweight" ones.) But there's also research that says if you have a lifetime history of chronic dieting, you have a 78% chance of getting type 2 diabetes! (I am a recovering lifelong dieter.) So it's entirely possible the correlation of obesity to type 2 (of course, correlation does not equal causation) is because those of us labeled "obese" are more likely to diet.
Btw, I'm also pretty sure the "correlation" is also a sham, anyway. As there are plenty of demographic studies of people around the world that show type 2 diabetes is just as prevalent for so-called normal-weight individuals as for those of us in larger bodies. So these so-called "experts" need to go back to the research, since there's absolutely no research that supports their position and a ton of research that shows dieting is a horrible way to manage type 2. This is completely irresponsible medical advice being peddled by these "experts."
OK, done ranting now . . . Apologies for the super long comment, but this stuff is so upsetting because it's just SO wrong.