• Posted September 23, 2022

Not Just Obesity: Everyone May Have a 'Fat Threshold' for Type 2 Diabetes

If you are one of the millions of people with type 2 diabetes, losing weight can help reverse the blood sugar disease even if you aren't overweight or obese, new research reveals.

Here's the proof: 70% of people with type 2 diabetes who were a normal weight during the study went into remission after they lost roughly 10% of their body weight.

Type 2 diabetes is the form of the disease most closely tied to obesity, yet around 15% of patients aren't overweight or obese. They may, however, be pushing their personal "fat threshold."

"Everyone has a level at which they can no longer store fat safely inside the body -- that is determined by genes,"said study author Dr. Roy Taylor, a professor of medicine and metabolism at Newcastle University in the United Kingdom.

"If you can't store more fat under your skin, the fat spills over and starts building up inside the liver,"he explained. When this happens, too much fat goes to the rest of the body, including the pancreas. Insulin-producing cells in the pancreas then stop working correctly, triggering diabetes.

"Type 2 diabetes happens to those who are susceptible, but only when they have become too heavy for their own body,"Taylor noted.

No test can say "you have exceeded your personal fat threshold" yet, but some blood markers of stress in fat may one day prove to be a reliable way to measure that threshold, he added.

For the study, 20 people with diabetes who weren't overweight or obese ate 800 calories a day (from low-calorie soups and shakes and non-starchy vegetables) for two to four weeks. They did these three times, with each cycle followed by four to six weeks of weight maintenance.

They lost about 10.7% of their weight overall, and kept it off for six months to a year.

Fourteen people achieved diabetes remission, based on their HbA1c levels. This provides a snapshot of average blood glucose levels over several weeks. Folks in remission no longer needed to take diabetes medication.

This mirrors what is seen among people with type 2 diabetes who are overweight or obese and lose weight, Taylor said.

MRI scans showed declines of fat inside the liver and pancreas that were in line with what is seen in people without diabetes. Specifically, fat in the pancreas fell from an average of 5.8% to 4.3% among people with diabetes, and the activity of the insulin-producing cells returned to normal.

It doesn't take much extra fat to thwart the activity of insulin-producing cells in the pancreas. "You only need an extra half gram of fat in the pancreas to prevent normal insulin production,"Taylor said.

"Regardless of body mass index [BMI], people diagnosed with type 2 diabetes have more fat inside the body than they can cope with,"he said. "There is a good chance of remission if they can lose around 10% of their starting weight."

The study was presented this week at the European Association for the Study of Diabetes meeting in Stockholm. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

The relationship between obesity and diabetes is consistent and strong, said Dr. Scott Kahan, director of the National Center for Weight and Wellness, in Washington, D.C.

"Even exceedingly small amounts of weight gain or excess weight can increase the risk for type 2 diabetes significantly -- even in people who are relatively thin," Kahan noted.

The good news is that small weight losses, often on the order of just a few pounds, can improve blood sugar control and diabetes risk.

"This study further supports the importance of weight management for the prevention and treatment of type 2 diabetes, and strongly suggests that weight management guidance, support and intervention will likely be valuable even in persons with only small amounts of excess weight,"Kahan said.

More information

The American Diabetes Association provides tips on how to lose weight if you have diabetes.

SOURCES: Roy Taylor, MD, professor, medicine and metabolism, Newcastle University, Newcastle, U.K.; Scott Kahan, MD, director, National Center for Weight and Wellness, Washington, D.C.; European Association for the Study of Diabetes meeting, Sept. 19-23, 2022