Treating Prediabetes with Obesity Management

Have you been diagnosed with prediabetes or higher-than-normal blood sugar? That could be one of the luckiest things that ever happen to you! Of course you do not want prediabetes, but your awareness gives you an edge over millions of Americans. Consider this: [1]

  • More than 84 million other Americans have prediabetes.

  • Only 1 in 9 of them are aware of it and are getting care for it.

  • The other 8 in 9 are likely to develop type 2 diabetes within a few years without treatment.

You are among the few adults who know about their prediabetes and are ready to treat it. Not only that, but the most effective treatment for most people with prediabetes is simple. It usually involves no medications. For most people, obesity management is a highly effective way to treat prediabetes.


Obesity and Prediabetes

Supplied by BMI Calculator USA

Obesity is all-too-familiar. It is having a weight that is disproportionately high compared to your height. It is defined as having a body mass index (BMI) over 30. You can check your BMI here if you know your height and weight. [2]

Obesity is a health risk because can change the way your body functions. People who are obese have a higher risk for heart disease, hypertension, stroke, kidney disease, certain types of cancer, arthritis, and Alzheimer’s disease. Oh – and it is a top risk factor for prediabetes and diabetes.


Prediabetes is a condition with abnormally high blood sugar, but not as high as in diabetes. Your doctor may have told you that you have prediabetes if you got one of the following results on a blood test. [3]

Fasting blood sugar 100 to 124 mg/dl

  • Glycated hemoglobin (A1C) 5.7to 6.4%

  • Oral glucose tolerance test (OGTT) 140 to 199 mg/dl

Be sure to ask your doctor for a prediabetes test if you have not had one recently. They are inexpensive, easy, and potentially life-saving.


Insulin Resistance and the Link between Obesity and Prediabetes

Obesity and prediabetes are linked because of a condition called insulin resistance, or reduced sensitivity. Obesity is a common cause of insulin resistance. Insulin resistance leads to higher blood sugar and prediabetes.[4]

The key factor here is insulin. Insulin is a hormone that is produced by beta cells in your pancreas. It has a few roles in lowering blood sugar or blood glucose.

  1. Helps get glucose or sugar get from your bloodstream into your muscle and fat cells after a meal.

  2. Prevents your liver from releasing sugar into your bloodstream when you already have enough.

  3. Helps your liver store extra glucose after a meal for use later when your muscles need it for energy.

Being obese can interrupt this process of glucose regulation. It can lead to insulin resistance, or reduced insulin sensitivity. That means the sugar in your blood is less able to get out of your bloodstream and into the cells that depend on insulin. The result is higher blood sugar, or prediabetes. 

With prediabetes comes a high risk for developing type 2 diabetes. With diabetes comes:

  • The likelihood of measuring blood sugar at home one or more times daily.

  • The likelihood of needing oral or injectable medications.

  • A high risk of complications, including neuropathy, blurry vision, and heart and kidney disease.

That is heavy stuff. Are you ready for the good news? Weight loss has been shown to lower risk for type 2 diabetes. [5] In a famous clinical trial among patients with prediabetes, weight loss lowered risk of diabetes by over 50% in:

  • Men and women 25 years and older.

  • Patients with BMI of 22 (a “normal” weight) through a BMI over 35.

  • White, African American, Hispanic, American Indian, and Asian participants.

Losing weight worked for those groups of people. It may work for you!

You do not even need to lose that much weight to get benefits. A couple of pounds can lead to a lower risk. If you can hit a loss of 5 to 7% of your body weight, your risk can drop by over 50%. That works out to a loss of:

  • 8 to 11 lb. if you weigh 150 lb. 

  • 9 to 12 lb. if you weigh 170 lb.

  • 10 to 14 lb. if you weigh 200 lb.

Oh, there is a catch: it is most effective if you can not only lose the weight, but also keep it off. So, here are some tips for realistic, long-term weight loss.


A Few Calories at a Time

The most effective way to lose weight is to reduce the number of calories you consume. You get calories from food and some beverages. You do not need to cut back by too much to lose weight. If you can build up a deficit of 100 or more calories a day, you will lose weight gradually and eventually hit your goals. 


Good and Bad Foods for Obesity Management

The best foods for obesity management tend to:

  • Be filling. Big foods with small amounts of calories (low calorie-density) let your stomach feel full when your meal or snack is over. Think about a big bowl of broth-based, chunky soup, salad, fruit salad, or egg white omelet, for example.

  • Slow down your eating. High-fiber foods tend to require a lot of effort to chew and that can help you feel more satisfied on less food. Think about broccoli and other vegetables, beans and other legumes, and apples and other fruit.

  • Take a long time to digest. Protein and healthy fats are slower to metabolize than most types of carbohydrates, so you can stay full for longer after a meal if you include protein or fat. Think about lean proteins such as fish, tofu, egg whites, skinless chicken or turkey, and non-fat cottage cheese, and small servings of healthy fats such as avocados and nuts. 

  • Be less processed. Less-processed foods are usually higher in nutrients and lower in extra calories from sugars and other additives. Think about fresh fruit and vegetables, whole grains, and fresh poultry.

The worst foods for obesity management tend to:

  • Be calorie-dense. High calorie density means a food or beverage has a lot of calories and a small serving size. Think about a piece of cake, a few slices of bacon, or a scoop of potato salad, for example.

  • Be quick to eat. Melt-in-your-mouth foods give you a lot of calories quickly and are not good at filling you up. Think about shakes and smoothies, candy, ice cream, creamy soups, fatty dips and spreads, and pasta primavera, for example.

  • Have extra fats, sugars, or starches. These additions often come during processing of packaged foods or during fast food preparation. Think about French fries, breaded fried chicken, and other fried foods and sugar-sweetened flavored cereal, oatmeal, and yogurt, for example.

  • Be more processed. Processed foods tend to be less filling and often higher in calories. Think about pizza, macaroni and cheese, potato chips, frozen dinners, baked goods, and fruit juices. 

Focus on These Weight Loss Foods

  • Raw or cooked non-starchy vegetables or salad
  • Fresh and frozen fruit
  • Lean proteins, such as eggs, chicken breast, tofu, beans, seafood
  • Low-fat dairy, such as cottage cheese, cheese, plain yogurt
  • Whole grains, such as oatmeal, bran cereal, whole-grain bread, unsweetened cereal, and pasta, brown rice, quinoa, unpearled barley, bulgur, whole-wheat couscous
  • Healthy fats, such as avocados, nuts, peanuts
  • Water, green tea, black coffee

Limit These Foods

  • Baked goods and desserts, such as cake, cookies, ice cream, pie, croissants, custard
  • Fried foods, such as French fries, hash browns, fried chicken and fish, onion rings, doughnuts
  • Processed snack foods, such as potato, tortilla, and corn chips, white crackers
  • Processed and fatty meat, such as ribs, bologna, sausage, hot dogs
  • Extra fats, such as buttery and creamy sauces, cream and cheese-based soup, butter or cream on pancakes
  • Refined grains, such as refined cereal, white bread, pasta, and rice
  • Sugary beverages, such as soft, energy, and sports drinks, flavored coffee, sweet tea, fruit drinks

Find Your Personality-Based Plan for Obesity Management and Prediabetes Treatment

Let’s make obesity management easier by building your weight loss plan base on your weight loss personality. See which of these three strategies is the best match for you and see if you can adapt it for your lifestyle.

  1. “I like freedom.”

  2. “I don’t want to be hungry.”

  3. “I want to eat my foods.”

Personality 1: “I like freedom.”

This is a simple one. The basic rule is to fill half of your plate with vegetables at most meals and snacks. The rest of your plate (or bowl) can contain what you would normally eat. The guidelines are:

  • Eat the vegetables first (when you can) so you fill up on them before eating higher-calorie foods.

  • Choose lettuce, greens, or other non-starchy vegetables.

  • Serve them raw or cooked without fat (steamed, grilled, or roasted, for example).

Examples of Dishes

  • Egg tofu chicken or fish with vegetables

  • Spaghetti with saucewith vegetbles

  • Soup

  • Salad

Personality 2: “I don’t want to be hungry.”

Okay, then eat more! Choose lower-calorie-dense foods instead of higher-calorie-dense ones, and you will fill up on fewer calories. In general, higher-fiber, higher-water, lower-sugar, lower-fat foods tend to be bigger. Here are some examples of making your food bigger.

Calories Smaller Food to Limit Bigger Weight Loss Food
1 chocolate peanut butter cup
½ cup non-fat cottage cheese with 1 cup cucumber sticks
1/3 cup of raisins
1 container plain yogurt with 1 cup fresh fruit
1 piece of sausage pizza
Portobello mushroom pizza with pizza sauce, low-fat mozzarella cheese, and veggie toppings, plus 1 side salad and an apple
Bakery muffin
1 cup of oatmeal with 1 cup of blueberries and 2 tablespoons almonds, and 2 hard-boiled egg whites

Personality 3: “I want to eat my foods.” 

That works! Just cut back a bit on the higher-calorie ones, and balance it out by adding some lower calorie ones. For example…

  • Take fewer chips and more celery to dip as a snack.

  • Serve less cereal and add more fresh fruit for breakfast.

  • Have less starch (potato, rice, or pasta) as a side, and add an extra serving of vegetables.

  • Cut your slice of cake or pie in half, and eat it with fresh fruit or cottage cheese.

  • Have 1 instead of 2 slices of pizza, and add a side salad or steamed vegetables to round out your meal.


Type of Diet – Low-Carb, Low-Fat, or What??

Actually, whatever works for you is okay. The best diet is one that you can enjoy and maintain for a long time. It should include a variety of foods and nutrients. The research shows that the type of diet is not really all that important as long as you stick to whatever plan you choose. 

That said, choose something sensible. Diets that do not work or are unhealthy generally include:

  • Meal replacement – eating cookies or shakes instead of meals.

  • Food groups/items – depending on, for example, “special foods” such as cabbage soup or grapefruit for most meals.

  • Detox/cleanse – Fasting, often while taking a possibly dangerous detox blend or sugary juice, without building long-term healthy habits.

  • Timed diets (15-day, 30-day) – they will probably work for 15 or 30 days…then what?


Exercise and Weight Loss

Exercise burns calories and has a wealth of health benefits, including being extremely effective at improving insulin sensitivity and lowering blood sugar in diabetes and prediabetes. Research shows that exercise is best as part of a weight maintenance strategy to prevent regaining your weight. Exercise itself does not tend to lead to weight loss.

The general recommendation for prediabetes and other conditions is to aim for 150 minutes per week of moderate-intensity exercise. You can get more health and weight control benefits from doing more. Research shows that people who are able to keep off the weight they lost sometimes hit 60 minutes on most days.

Obesity management is an important part of prediabetes treatment for most patients. It can lower blood sugar and dramatically reduce the risk of type 2 diabetes. You can lose weight with small daily changes, healthy foods and portion sizes, and help from a smartphone coach such as Lark DPP.


Natalie Stein

Exercise, Fitness & Nutrition Expert | Assistant Professor of Public Health