Breaking the cycle between these two health conditions requires addressing underlying hormonal and metabolic changes, often through a combination of lifestyle changes, medications, and, for some people, weight loss surgery.
Lifestyle Changes: Beyond Cutting Calories
Dietary restrictions can only take weight loss so far. According to Dr. Neumiller, people with diabetes should take a multipronged approach to weight loss.
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- Pair your carbs. Pairing carbs like fruit, bread, or pasta with protein or healthy fats — think an apple with peanut butter or pasta with chicken — slows down how quickly sugar enters your bloodstream. This helps prevent the sharp spikes and crashes that leave you feeling hungry and tired.
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- Get enough sleep. For better blood sugar control, aim for six to eight hours of sleep every night. Too little or even too much shut-eye can trigger cortisol, a stress hormone that causes insulin resistance.
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- Focus on resistance training. “Resistance training increases lean muscle mass, improving insulin sensitivity and glucose uptake,” says Mirza.
- Walk more often. Make it a habit to add more steps throughout your day. A simple 10- to 15-minute walk right after a meal, for example, can meaningfully reduce post-meal hyperglycemia, says Mirza. It signals your muscles to burn off the sugar you just ate before it can be stored as fat.
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Medications That Address the Root Causes
Diabetes practitioners often prescribe newer medications, like GLP-1s, to address the root causes of diabesity.
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Drugs like semaglutide and tirzepatide do more than just lower blood sugar, they help correct the hormonal imbalances that can make weight loss so difficult, help your body recognize when it’s full, and manage insulin more naturally.
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Because they target weight and blood sugar at the same time, Neumiller says these medications are an excellent option for people who need to improve both their A1C test results and their weight to stay healthy.
Beyond the scale, they also offer long-term protection for the heart and kidneys, adds Mirza.
Another family of diabetes drugs, SGLT2 inhibitors, also help protect heart and kidney health while reducing weight. These daily pills help the kidneys remove sugar from the bloodstream, which has the secondary effect of flushing calories out of your system through urine. Though they do not provoke the dramatic weight loss that GLP-1 drugs do, they’re associated with a loss of about 2 kilograms, which is roughly 4.5 pounds.
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One older diabetes drug also deserves special mention: Metformin, though available as an inexpensive generic, is still considered fundamental to the diabetes treatment in most adults, and can be used in combination with the newer generation of diabetes drugs. Metformin helps control high blood sugar by improving insulin resistance and also contributes to weight loss.
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Weight Loss Surgery
Metabolic surgery can be a powerful option for some people, since it can help reset the body’s internal chemistry — not just weight on the scale. According to Mirza, these procedures lead to rapid, positive changes in gut hormones like GLP-1 and peptide YY, reduce fat in the liver, and help the body respond to insulin more effectively.
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“For patients with obesity and difficult-to-control diabetes, metabolic surgery is a disease-modifying therapeutic intervention rather than a cosmetic procedure,” says Mirza.
Many people see major improvements in blood sugar, and some are able to reach diabetes remission, meaning their levels stay in a healthy range without glucose-lowering medications. This is more likely when surgery happens earlier in the course of the disease.
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The American Diabetes Association notes that surgery may be considered for people with type 2 diabetes and a body mass index (BMI) of 30.0 or higher, says Neumiller.
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But surgery isn’t a cure for anything if you don’t permanently adopt healthier habits.
“These benefits can reverse if people regain weight lost, so long-term support and lifestyle changes remain important to maintain benefits,” says Neumiller.
