9 ms·

A few kilograms weight loss nearly halves the risk of diabetes?

102 points by rustoo 6y ago

kaiju0 6y ago
Have a feeling this is a correlation and not direct causation. You have to eat less / better to lose the weight. That helps with your insulin resistance.
- Zancarius 6y ago
  It's also possible that people who are suddenly interested in losing weight and exercising more have an increased awareness in what they're eating.
- rileymat2 6y ago
  I wonder if you could form a study to disambiguate it by using liposuction patients in some way. edit: https://www.webmd.com/beauty/news/20000825/study-looks-at-whether-liposuction-has-anti-diabetes-bonus#1 https://www.webmd.com/beauty/news/20000825/study-looks-at-wh...
- bird_monster 6y ago
  You do not have to eat better to lose weight. You only have to eat less. edit To correct confusion, I am saying "eat less" to mean "be at a caloric deficit." Weight loss is caused by caloric deficit, nothing else.
  - stkdump 6y ago
    Can confirm, lost 25kg this year.
  - identity0 6y ago
    This mindset is why people find it hard to lose weight. Can't we agree that it's both?
    - recursive 6y ago
      It doesn't have to be either one! You could just exercise more.
      - theonemind 6y ago
        You mostly have to control what you eat. One donut takes like 3 hours to burn off at a good clip on a treadmill. I think that thinking you can make up for eating habits with exercise at all will just get you into trouble. You should exercise for health, but unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management
        recursive 6y ago
        > One donut takes like 3 hours to burn off at a good clip on a treadmill. You're way off. A "Frosted Snowflake Donut" from Dunkin weighs in at 270 calories. [1] A 155-pound person will burn 298 calories in 30 minutes doing 12-minute miles on a treadmill, [2] which is probably less than "a good clip". > You should exercise for health, but unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management My personal experience just does not bear this out. I used to ride bikes a lot. The I stopped because I didn't have as much time for it anymore. I eat noticeably less. I also gained 20 pounds. [1]: https://www.dunkindonuts.com/content/dam/dd/pdf/nutrition.pdf https://www.dunkindonuts.com/content/dam/dd/pdf/nutrition.pd... [2]: https://www.health.harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisure-and-routine-activities https://www.health.harvard.edu/diet-and-weight-loss/calories...
        ketralnis 6y ago
        > One donut takes like 3 hours to burn off at a good clip on a treadmill I don't know where you get this idea but I see this meme really often in defeatist "it's impossible to lose weight" discussions. It's so easy to research, I don't know why it spreads so easily. A Krispy Kreme caramel glazed doughnut is about 220 kcal[0] and a very light treadmill session (30 minute, 5% incline, 3 mph) will probably burn in the 220 range[1]. > unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management Absolutely not. It's true that for somebody that eats/burns ~2000 kcal in a day, about 1500 of that is for just existing (the resting metabolic rate[2]). But even small amounts of exercise are significant: that 30-minute speedwalk is 10% of your calorie intake! Turning it up to a jog can easily be twice that. [0]: https://s3.amazonaws.com/kkd-e1-images.kktestkitchen.com/ecomm/nutrition/11019-nutrition.pdf https://s3.amazonaws.com/kkd-e1-images.kktestkitchen.com/eco... [1]: https://www.sparkpeople.com/resource/calories_burned.asp?exercise=193 https://www.sparkpeople.com/resource/calories_burned.asp?exe... [2]: https://www.verywellfit.com/metabolism-facts-101-3495605 https://www.verywellfit.com/metabolism-facts-101-3495605
  - bityard 6y ago
    Calories in == calories out is probably the worst lie in mainstream medical/nutritional guidance today. In a purely mathematical model is it obviously true but the reality is that our body deals with macro-nutrients (carbs, protein, fat) very differently.
    - dleslie 6y ago
      It does, but over long enough time spans chronic caloric deficiency will result in weight loss, regardless of the form of the calories consumed. Some calories are better than others for short term outcomes, of course.
      - bityard 6y ago
        Calories in/calories out ignores that fact that the _type_ of calorie matters a great deal. It also ignores the fact that the body is capable of moderating its metabolic rate in response to energy requirements and supply. If calories in and out were _really_ all that mattered, I would be able to calculate my energy needs precisely and then eat exactly the right number of cupcakes (and only cupcakes) every day for the rest of my life. And yet we intuitively know that would be extremely unhealthy. Why is that?
        dleslie 6y ago
        I'm not disagreeing with you on the good calories, bad calories concept. Simply that calories in/out is, when applied as a chronic deficiency, effective at reducing weight over long periods of time. No, you should not eat 750 calories of cupcakes and cupcakes alone.
        bird_monster 6y ago
        You're mixing two different arguments together. Calories in/out is the only requirement for weight loss. Calories in/out is a percentage of the overall picture we define as "health". To lose weight, you only have to be at a caloric deficit. You can eat _only_ three cupcakes a day and probably lose weight (unless they're kinda insane cupcakes). If you only eat 3 cupcakes a day and nothing else, you will be malnourished and nutrient deficient, which I would extend to mean "unhealthy", but you will lose weight.
- KineticLensman 6y ago
  > Have a feeling this is a correlation and not direct causation Classic. An HN commenter's gut feel (no pun intended) apparently outweighs a serious piece of work. Here's the results from the actual study [0] referenced in the article: In this study, 1028 participants were randomized (INT, 424 [41.2%] [166 women (39.2%)]; INT-DPM, 426 [41.4%] [147 women (34.5%)]; CON, 178 [17.3%] [70 women (%39.3)]) between January 1, 2011, and February 24, 2017. The mean (SD) age was 65.3 (10.0) years, mean (SD) body mass index 31.2 (5) (calculated as weight in kilograms divided by height in meters squared), and mean (SD) follow-up 24.7 (13.4) months. A total of 156 participants progressed to type 2 diabetes, which comprised 39 of 171 receiving CON (22.8%), 55 of 403 receiving INT (13.7%), and 62 of 414 receiving INT-DPM (15.0%). There was no significant difference between the intervention arms in the primary outcome (odds ratio [OR], 1.14; 95% CI, 0.77-1.7; P = .51), but each intervention arm had significantly lower odds of type 2 diabetes (INT: OR, 0.54; 95% CI, 0.34-0.85; P = .01; INT-DPM: OR, 0.61; 95% CI, 0.39-0.96; P = .033; combined: OR, 0.57; 95% CI, 0.38-0.87; P = .01). The effect size was similar in all glycemic, age, and social deprivation groups, and intervention costs per participant were low at $153 (£122). [0] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2772239 https://jamanetwork.com/journals/jamainternalmedicine/articl...
  - jamil7 6y ago
    HN's medical advice is on par with it's advice on law and economics.
    - roel_v 6y ago
      *its (cause if there's one thing we do well, it's pedantry!)
  - rileymat2 6y ago
    I don't think the OP is denying the results of the study, but trying to understand if it is the acts associated with losing weight or actually weighing less.
  - aplummer 6y ago
    Yeah in this case OP is right though, you can gain muscle mass, be very active, and eat healthy. It is 100% a correlation. Actually I would describe what you posted an example of a limitation of the correlation, since it uses BMI.
- bityard 6y ago
  Yep. Diabetes (type 2 at least) is widely understood to be the result of chronic insulin resistance, which can be remedied with diet. No one has shown a causation between weight and and diabetes but the correlation is definitely there because they have the same root cause. In fact, weight alone cannot be the cause because there are plenty of overweight older individuals who never develop the symptoms of diabetes.
- krooj 6y ago
  This is crap. There are people, myself included, which are simply predisposed to insulin resistance. For reference, I'm 145lbs @ 5'10", exercise daily, and eat relatively well. My last A1C was 5.6. To some extent, yes, diet will help; however, insulin resistance is a complex metabolic process that is absolutely rooted in your genetics, so simply telling people to eat less and/or lose weight is facile at best.
  - bityard 6y ago
    There may be a genetic component to Type 2 diabetes but _most_ people who are diagnosed with it are indeed quite overweight and have decades of poor lifestyle choices behind them. If we can help those people understand that diabetes is not always inevitable, even if it's not helpful for a small percentage, then that sounds like a net win for me.
rootusrootus 6y ago
How many times can this be repeated? I wasn't quite prediabetic, but I lost a few kilograms. And then a few more. So far, over 20 kilograms, in fact. My diabetes risk should now be quite low.
- MichaelZuo 6y ago
  Your diabetes risk should be asymptotically approaching zero given the premise.
  - deleted 6y ago
    [deleted]
  - Accujack 6y ago
    In fact, by losing enough weight it can go negative, so you'll be curing diabetes in other people by sitting next to them on the bus.
- bityard 6y ago
  Was it the weight loss that lowered your risk of diabetes? Or did the changes you made reduce both?
tomjakubowski 6y ago
Type 2 diabetes
victor106 6y ago
My friends mother has always been skinny and almost underweight but she's been diabetic since her late 40's. I know its sample size 1. but I always wonder if there are other reasons other than just weight?
- Bjartr 6y ago
  Of course there are. There are always going to be one-off or few-off cases in medicine (see "idiopathic" anything). Which is why larger scale studies are so important.
- andrewjl 6y ago
  Important to distinguish between Type 1 and Type 2 diabetes, one of which is genetic and the other isn't.
cj 6y ago
After a blood test 1.5 years ago, I was considered "Prediabetes". I was just slightly overweight (probably "average" by american standards). Hearing the doc say "Prediabetes", plus having heart disease in the family and sky high cholesterol, I decided to try losing a few pounds (for me, that meant deleting all food delivery apps from my phone...) 2-3 months later I had lost maybe 10 lbs (more than the few kgs in the article). Got retested, and I was no longer prediabetes and cholesterol dropped to normal levels. Since then, I've continued to lose another 40 lbs and am no longer considered overweight. The reason I'm sharing the anecdote is to share my surprise that almost all of the improvement in blood test came from the first 10 lbs (the extra 40 lbs I lost maybe improved numbers a bit more, but 90% improvement came after the first 10 lbs)
- kec 6y ago
  Good on you for getting healthy but I feel compelled to point out that if you had 50 lbs to lose (without becoming severely underweight) you were pretty much by definition not "slightly" overweight.
  - cj 6y ago
    Yes, you're right, I was clinically obese. (I'm also 6'2 - 50lb lost at that height is very different from someone of average height) But thanks for that clarification :)
  - cannaceo 6y ago
    I think you'd be surprised how wide the 'overweight' range is with BMI. For myself: Normal: 117.8-159.2lb Overweight: 159.3-191.20 I'm 5'8. For a 6' person the range is going to be wider.
- kirillzubovsky 6y ago
  Similar here, but allergies instead of diabetes. Went to a doctor, got a high blood pressure reading plus some cholesterol. Lucky the doc was reasonable and instead of giving me a bunch of pills, she just tested me for typical food allergies. Turns out I was allergic to 2/3 of my daily diet. Once I've cut those foods out of my system, everything's back to normal. It really seems we can do quite a bit of good by just not harming our body to begin with.
wins32767 6y ago
The headline is misleading. The result was from a getting support to make diet and lifestyle changes. That resulted in both losing weight and lowering risk of diabetes. "Interventions A control arm receiving usual care (CON), a theory-based lifestyle intervention arm of 6 core and up to 15 maintenance sessions (INT), or the same intervention with support from diabetes prevention mentors, trained volunteers with type 2 diabetes (INT-DPM)."
- everythingswan 6y ago
  I want to know if I'm reading this wrong because our conclusions were different. It feels like they tested whether additional mentorship worked, it didn't, but their conclusion was that the "interventions" worked on both groups. From the "Findings" [1] >> In this randomized clinical trial of 1028 participants with high-risk intermediate glycemic categories, the intervention significantly reduced the 2-year risk of type 2 diabetes by 40% to 47%, although lay volunteer support did not reduce the risk further. For every 11 participants treated, 1 diabetes diagnosis was prevented. I took it to mean that the support added no additional benefit: both groups benefited from the treatment and the group treated with and volunteers did not outperform the control. [1] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2772239 https://jamanetwork.com/journals/jamainternalmedicine/articl...
- microtherion 6y ago
  Yes. In fact, as far as I can tell, the abstract does not even mention weight loss as an outcome (though it seems to me that this kind of intervention might lead to it). I assume the submitter has read the full paper and can comment on it? Was the effect not significant, was it not preregistered, or was it not included in the abstract for some other reason?
fb03 6y ago
I recommend reading THE HACKER'S DIET to all my nerdy/hacker friends (like me) who seek to understand and engage in weight loss with some simple truths worded by a deep nerd himself (one of the authors of AutoCAD). It made sense to me more than what the doctors told me I should blindly do "and it'll work". Things I already knew but just couldn't swallow (<-- nice pun here). https://www.fourmilab.ch/hackdiet/ https://www.fourmilab.ch/hackdiet/
- majkinetor 6y ago
  That is great book and every engineer should read it, but not because its correct, because it isn't - now I know enough of medicine to know that solution works because it is another way to say lets do IF. The book is great because you can follow how engineer tries to solve a very hard problem.
  - tjader 6y ago
    What is not correct in the book? I don't see at all how the book leads to intermittent fasting. He advocates for regular and predictable meal schedule, but does not advocate for meal count restrictions. "How many meals, and when? Only total calories per day count." https://www.fourmilab.ch/hackdiet/e4/planningmeals.html https://www.fourmilab.ch/hackdiet/e4/planningmeals.html
    - majkinetor 6y ago
      He eats once a day. That is IF. Everything is wrong in the book, including that you can fix the sensor by measuring how much you eat and including that total calories per day count, because all calories are not equal. Its very interesting book nevertheless.
      - tjader 6y ago
        Where in the book does he say you should only eat once a day? Where does he even day he does that?
kirillzubovsky 6y ago
A more accurate title would be "healthy lifestyle improvements leads to improved odds in type2 diabetes prevention in obese older women." That's what the results section of that paper is saying. Unfortunately we can't really see more without paying $30 to read it.
drilldrive 6y ago
I feel like the best way to lose weight is to make your own food for your whole diet, keeping processed foods to an absolute minimum. This alongside being aware of drinking mostly water instead of sugary drinks and keeping snacking to a minimum should lead to more gripability on one's diet, since tracking what one eats is much easier to remember when one cooks his own food. If this doesn't quite work, perform a calorie calculation once to be sure it lines with the dietary calculators to actually decrease caloric intake.
- pengaru 6y ago
  It's relatively easy to overeat when cooking your own meals, that's not a panacea, especially if the real problem is one of self-control.
  - drilldrive 6y ago
    Yeah I should be clear I have never had problems with overeating myself so I am coming at the issue with an outwards viewpoint. I have been 6'7" and 190-200 pounds for all my adult life, and have cooked most all my own meals since I moved for university, so at least for being weight consistent I haven't had much trouble. I moreso have observed that snacking foods + sugary drinks + fast food leads to a partial negligence of the diet, we often eat too fast and eat hard-to-estimate caloric worth quantities to recognize in our gut we are full enough.
    - pengaru 6y ago
      Snack foods do tend to be calorie dense. And preparing meals certainly puts oneself in better control over what goes in. It's just been my experience that as a bachelor preparing meals for individual consumption, particularly as the ability to make tasty meals improves, weight gain is still a problem. It's challenging to make single servings from scratch without going even a little overboard, and for me at least, it's all getting eaten in one sitting. Cooking for me has become viewed more as just a DIY form of JIT-processed food. It tends to be healthier than food processed by someone else, for lack of preservatives and less salt/sugars, and higher quality ingredients, but the cooking process still tends to produce something more calorically dense and unnaturally delicious I have difficulty resisting overeating.
killjoywashere 6y ago
This is like saying water makes trees grow. Yes, loosing weight means consuming less calories. The body moves calories around as glucose. High glucose = weight gain (and above a certain limit you can't gain weight faster and then you look like type 2 diabetes). Keeping your glucose near floor (there's a lot of biological controls that keep glucose above 80) = weight loss.
subsubzero 6y ago
I have my own experience with weight loss. I used to get sick constantly, had low energy and snored at night. A few years ago got serious, started weight training(was running but weights made a huge difference), also cut out all the junk in my diet(snacking now healthy, more water). I was never obese, but just carried a good amount of weight, The results have been dramatic. I no longer snore, and have ample energy throughout the day. And I have been getting sick alot less now. Other things that I found to be interesting is I now have a very good sense of smell, I can now smell very faint things my Wife cannot. Also I always had a terrible balance and that has changed dramatically as well for the better. If there is one thing that was life changing for me, it is losing all the weight, I couldn't recommend it enough for everyone.
- hi41 6y ago
  I have faced this issue on and off. My wife and kids tell me that I snore. This happens when i get overweight. I have been having difficulty in keeping the weight off. After losing weight, I get it back after few weeks. But yes, i stop snoring when i lose weight. I don’t know what the connection is between weight and snoring is.
  - Accujack 6y ago
    Partial airway blockage by fat when you are in a prone position. Snoring is just a narrow air passage in sleep that makes sound by the pressure of air forcing its way through. If you have the situation where your airway can become completely blocked temporarily, you have sleep apnea. If it's partially blocked, you snore, and you can have either one in different positions.
- tjader 6y ago
  I think attributing all of the benefits to weight loss seems a bit rushed to me. At the same time you lost weight you also improved the quality of your diet and started exercising. Any of those can be a factor to any of the improvements, and for some of them the weight loss it self may not even play a role.
- mleonhard 6y ago
tacon 6y ago
Since the world is turning diabetic and on track to bankrupt the healthcare system in a decade or two, it helps to recognize a few facts about "diabetes". First, realize that "prediabetic"/"diabetic" is just a stupid number in A1c or glucose tolerance where recommended care is to start giving you drugs. It doesn't mean the glucose level in your blood isn't destroying your body before you reach that level. Metabolic syndrome is a range of insulin resistance, and the sooner you reverse it, the better. Don't wait for some doctor to tell you after two or three decades of slowly increasing insulin resistance that, "Now, we will do something." There is growing evidence that Alzheimer's should be renamed Type 3 diabetes, and some questions about Parkinson's being Type 4 diabetes. The brain is specially sensitive to excess glucose, and special sets of cells are more sensitive than other neurons (like in Parkinson's). So how to measure insulin resistance? The gold standards is a continuous glucose monitor ($500). Then the glucose tolerance test (not the overnight fast), which takes hours and involves ingesting slugs of glucose and sampling blood over time. Ideally we would directly measure insulin in the blood, not glucose, but that is much harder so far. One new test that holds out the hope of predicting diabetes years or even decades down the road is the LabCorp NMR LipoProfile with Graph[0][1]. Not yet FDA approved for diagnosis, this cheap test ($40 Medicare reimbursement) calculates an insulin resistance score that can be tracked year by year. I first learned of this test in an article in Managed Care Magazine, which seems to have gone out of business, leaving only a PubMed blurb pointing to it[2]. I was interested enough in my numbers that I paid for my own test, about $90 after Black Friday discount, in November 2018 at WalkInLab[3]. [0] https://www.labcorp.com/tests/123810/nmr-lipoprofile-with-lipids-with-graph https://www.labcorp.com/tests/123810/nmr-lipoprofile-with-li... [1] https://www.labcorp.com/tests/related-documents/L15035 https://www.labcorp.com/tests/related-documents/L15035 [2] https://pubmed.ncbi.nlm.nih.gov/29701589/ https://pubmed.ncbi.nlm.nih.gov/29701589/ [3] https://www.walkinlab.com/products/view/nmr-lipoprofile-blood-test https://www.walkinlab.com/products/view/nmr-lipoprofile-bloo...
- andrewjl 6y ago
  Do you have any links on the connections between glucose and brain chemistry?
  - 6y ago
LatteLazy 6y ago
There's a great bit on Anatomy Life And Death where they show 2 arteries. One is ever so slightly thinner, in diameter. The speed fluid flows through them is vastly different...
moltar 6y ago
I think this is actually easy to explain. To lose weight you need to be in energy deficit. When one is in deficit, the body starts to use stored fat. Body prefers certain types of stores to others. One of the first and most dangerous stores is fat in the liver, which is common for high fructose eating humans. This fat is the primary reason for being in metabolic disease aka pre diabetes state. So once body burns off fat from liver, your pre diabetes vanishes.

102 points by rustoo 6y ago

Have a feeling this is a correlation and not direct causation. You have to eat less / better to lose the weight. That helps with your insulin resistance.

Zancarius 6y ago
It's also possible that people who are suddenly interested in losing weight and exercising more have an increased awareness in what they're eating.
rileymat2 6y ago
I wonder if you could form a study to disambiguate it by using liposuction patients in some way. edit: https://www.webmd.com/beauty/news/20000825/study-looks-at-whether-liposuction-has-anti-diabetes-bonus#1 https://www.webmd.com/beauty/news/20000825/study-looks-at-wh...
bird_monster 6y ago
You do not have to eat better to lose weight. You only have to eat less. edit To correct confusion, I am saying "eat less" to mean "be at a caloric deficit." Weight loss is caused by caloric deficit, nothing else.
- stkdump 6y ago
  Can confirm, lost 25kg this year.
- identity0 6y ago
  This mindset is why people find it hard to lose weight. Can't we agree that it's both?
  - recursive 6y ago
    It doesn't have to be either one! You could just exercise more.
    - theonemind 6y ago
      You mostly have to control what you eat. One donut takes like 3 hours to burn off at a good clip on a treadmill. I think that thinking you can make up for eating habits with exercise at all will just get you into trouble. You should exercise for health, but unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management
      - recursive 6y ago
        > One donut takes like 3 hours to burn off at a good clip on a treadmill. You're way off. A "Frosted Snowflake Donut" from Dunkin weighs in at 270 calories. [1] A 155-pound person will burn 298 calories in 30 minutes doing 12-minute miles on a treadmill, [2] which is probably less than "a good clip". > You should exercise for health, but unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management My personal experience just does not bear this out. I used to ride bikes a lot. The I stopped because I didn't have as much time for it anymore. I eat noticeably less. I also gained 20 pounds. [1]: https://www.dunkindonuts.com/content/dam/dd/pdf/nutrition.pdf https://www.dunkindonuts.com/content/dam/dd/pdf/nutrition.pd... [2]: https://www.health.harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisure-and-routine-activities https://www.health.harvard.edu/diet-and-weight-loss/calories...
      - ketralnis 6y ago
        > One donut takes like 3 hours to burn off at a good clip on a treadmill I don't know where you get this idea but I see this meme really often in defeatist "it's impossible to lose weight" discussions. It's so easy to research, I don't know why it spreads so easily. A Krispy Kreme caramel glazed doughnut is about 220 kcal[0] and a very light treadmill session (30 minute, 5% incline, 3 mph) will probably burn in the 220 range[1]. > unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management Absolutely not. It's true that for somebody that eats/burns ~2000 kcal in a day, about 1500 of that is for just existing (the resting metabolic rate[2]). But even small amounts of exercise are significant: that 30-minute speedwalk is 10% of your calorie intake! Turning it up to a jog can easily be twice that. [0]: https://s3.amazonaws.com/kkd-e1-images.kktestkitchen.com/ecomm/nutrition/11019-nutrition.pdf https://s3.amazonaws.com/kkd-e1-images.kktestkitchen.com/eco... [1]: https://www.sparkpeople.com/resource/calories_burned.asp?exercise=193 https://www.sparkpeople.com/resource/calories_burned.asp?exe... [2]: https://www.verywellfit.com/metabolism-facts-101-3495605 https://www.verywellfit.com/metabolism-facts-101-3495605
- bityard 6y ago
  Calories in == calories out is probably the worst lie in mainstream medical/nutritional guidance today. In a purely mathematical model is it obviously true but the reality is that our body deals with macro-nutrients (carbs, protein, fat) very differently.
  - dleslie 6y ago
    It does, but over long enough time spans chronic caloric deficiency will result in weight loss, regardless of the form of the calories consumed. Some calories are better than others for short term outcomes, of course.
    - bityard 6y ago
      Calories in/calories out ignores that fact that the _type_ of calorie matters a great deal. It also ignores the fact that the body is capable of moderating its metabolic rate in response to energy requirements and supply. If calories in and out were _really_ all that mattered, I would be able to calculate my energy needs precisely and then eat exactly the right number of cupcakes (and only cupcakes) every day for the rest of my life. And yet we intuitively know that would be extremely unhealthy. Why is that?
      - dleslie 6y ago
        I'm not disagreeing with you on the good calories, bad calories concept. Simply that calories in/out is, when applied as a chronic deficiency, effective at reducing weight over long periods of time. No, you should not eat 750 calories of cupcakes and cupcakes alone.
      - bird_monster 6y ago
        You're mixing two different arguments together. Calories in/out is the only requirement for weight loss. Calories in/out is a percentage of the overall picture we define as "health". To lose weight, you only have to be at a caloric deficit. You can eat _only_ three cupcakes a day and probably lose weight (unless they're kinda insane cupcakes). If you only eat 3 cupcakes a day and nothing else, you will be malnourished and nutrient deficient, which I would extend to mean "unhealthy", but you will lose weight.
KineticLensman 6y ago
> Have a feeling this is a correlation and not direct causation Classic. An HN commenter's gut feel (no pun intended) apparently outweighs a serious piece of work. Here's the results from the actual study [0] referenced in the article: In this study, 1028 participants were randomized (INT, 424 [41.2%] [166 women (39.2%)]; INT-DPM, 426 [41.4%] [147 women (34.5%)]; CON, 178 [17.3%] [70 women (%39.3)]) between January 1, 2011, and February 24, 2017. The mean (SD) age was 65.3 (10.0) years, mean (SD) body mass index 31.2 (5) (calculated as weight in kilograms divided by height in meters squared), and mean (SD) follow-up 24.7 (13.4) months. A total of 156 participants progressed to type 2 diabetes, which comprised 39 of 171 receiving CON (22.8%), 55 of 403 receiving INT (13.7%), and 62 of 414 receiving INT-DPM (15.0%). There was no significant difference between the intervention arms in the primary outcome (odds ratio [OR], 1.14; 95% CI, 0.77-1.7; P = .51), but each intervention arm had significantly lower odds of type 2 diabetes (INT: OR, 0.54; 95% CI, 0.34-0.85; P = .01; INT-DPM: OR, 0.61; 95% CI, 0.39-0.96; P = .033; combined: OR, 0.57; 95% CI, 0.38-0.87; P = .01). The effect size was similar in all glycemic, age, and social deprivation groups, and intervention costs per participant were low at $153 (£122). [0] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2772239 https://jamanetwork.com/journals/jamainternalmedicine/articl...
- jamil7 6y ago
  HN's medical advice is on par with it's advice on law and economics.
  - roel_v 6y ago
    *its (cause if there's one thing we do well, it's pedantry!)
- rileymat2 6y ago
  I don't think the OP is denying the results of the study, but trying to understand if it is the acts associated with losing weight or actually weighing less.
- aplummer 6y ago
  Yeah in this case OP is right though, you can gain muscle mass, be very active, and eat healthy. It is 100% a correlation. Actually I would describe what you posted an example of a limitation of the correlation, since it uses BMI.
bityard 6y ago
Yep. Diabetes (type 2 at least) is widely understood to be the result of chronic insulin resistance, which can be remedied with diet. No one has shown a causation between weight and and diabetes but the correlation is definitely there because they have the same root cause. In fact, weight alone cannot be the cause because there are plenty of overweight older individuals who never develop the symptoms of diabetes.
krooj 6y ago
This is crap. There are people, myself included, which are simply predisposed to insulin resistance. For reference, I'm 145lbs @ 5'10", exercise daily, and eat relatively well. My last A1C was 5.6. To some extent, yes, diet will help; however, insulin resistance is a complex metabolic process that is absolutely rooted in your genetics, so simply telling people to eat less and/or lose weight is facile at best.
- bityard 6y ago
  There may be a genetic component to Type 2 diabetes but _most_ people who are diagnosed with it are indeed quite overweight and have decades of poor lifestyle choices behind them. If we can help those people understand that diabetes is not always inevitable, even if it's not helpful for a small percentage, then that sounds like a net win for me.

rootusrootus 6y ago

How many times can this be repeated? I wasn't quite prediabetic, but I lost a few kilograms. And then a few more. So far, over 20 kilograms, in fact. My diabetes risk should now be quite low.

MichaelZuo 6y ago
Your diabetes risk should be asymptotically approaching zero given the premise.
- deleted 6y ago
  [deleted]
- Accujack 6y ago
  In fact, by losing enough weight it can go negative, so you'll be curing diabetes in other people by sitting next to them on the bus.
bityard 6y ago
Was it the weight loss that lowered your risk of diabetes? Or did the changes you made reduce both?

tomjakubowski 6y ago

Type 2 diabetes

victor106 6y ago

My friends mother has always been skinny and almost underweight but she's been diabetic since her late 40's. I know its sample size 1. but I always wonder if there are other reasons other than just weight?

Bjartr 6y ago
Of course there are. There are always going to be one-off or few-off cases in medicine (see "idiopathic" anything). Which is why larger scale studies are so important.
andrewjl 6y ago
Important to distinguish between Type 1 and Type 2 diabetes, one of which is genetic and the other isn't.

cj 6y ago

After a blood test 1.5 years ago, I was considered "Prediabetes". I was just slightly overweight (probably "average" by american standards). Hearing the doc say "Prediabetes", plus having heart disease in the family and sky high cholesterol, I decided to try losing a few pounds (for me, that meant deleting all food delivery apps from my phone...) 2-3 months later I had lost maybe 10 lbs (more than the few kgs in the article). Got retested, and I was no longer prediabetes and cholesterol dropped to normal levels. Since then, I've continued to lose another 40 lbs and am no longer considered overweight. The reason I'm sharing the anecdote is to share my surprise that almost all of the improvement in blood test came from the first 10 lbs (the extra 40 lbs I lost maybe improved numbers a bit more, but 90% improvement came after the first 10 lbs)

kec 6y ago
Good on you for getting healthy but I feel compelled to point out that if you had 50 lbs to lose (without becoming severely underweight) you were pretty much by definition not "slightly" overweight.
- cj 6y ago
  Yes, you're right, I was clinically obese. (I'm also 6'2 - 50lb lost at that height is very different from someone of average height) But thanks for that clarification :)
- cannaceo 6y ago
  I think you'd be surprised how wide the 'overweight' range is with BMI. For myself: Normal: 117.8-159.2lb Overweight: 159.3-191.20 I'm 5'8. For a 6' person the range is going to be wider.
kirillzubovsky 6y ago
Similar here, but allergies instead of diabetes. Went to a doctor, got a high blood pressure reading plus some cholesterol. Lucky the doc was reasonable and instead of giving me a bunch of pills, she just tested me for typical food allergies. Turns out I was allergic to 2/3 of my daily diet. Once I've cut those foods out of my system, everything's back to normal. It really seems we can do quite a bit of good by just not harming our body to begin with.

wins32767 6y ago

The headline is misleading. The result was from a getting support to make diet and lifestyle changes. That resulted in both losing weight and lowering risk of diabetes. "Interventions A control arm receiving usual care (CON), a theory-based lifestyle intervention arm of 6 core and up to 15 maintenance sessions (INT), or the same intervention with support from diabetes prevention mentors, trained volunteers with type 2 diabetes (INT-DPM)."

everythingswan 6y ago
I want to know if I'm reading this wrong because our conclusions were different. It feels like they tested whether additional mentorship worked, it didn't, but their conclusion was that the "interventions" worked on both groups. From the "Findings" [1] >> In this randomized clinical trial of 1028 participants with high-risk intermediate glycemic categories, the intervention significantly reduced the 2-year risk of type 2 diabetes by 40% to 47%, although lay volunteer support did not reduce the risk further. For every 11 participants treated, 1 diabetes diagnosis was prevented. I took it to mean that the support added no additional benefit: both groups benefited from the treatment and the group treated with and volunteers did not outperform the control. [1] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2772239 https://jamanetwork.com/journals/jamainternalmedicine/articl...
microtherion 6y ago
Yes. In fact, as far as I can tell, the abstract does not even mention weight loss as an outcome (though it seems to me that this kind of intervention might lead to it). I assume the submitter has read the full paper and can comment on it? Was the effect not significant, was it not preregistered, or was it not included in the abstract for some other reason?

fb03 6y ago

I recommend reading THE HACKER'S DIET to all my nerdy/hacker friends (like me) who seek to understand and engage in weight loss with some simple truths worded by a deep nerd himself (one of the authors of AutoCAD). It made sense to me more than what the doctors told me I should blindly do "and it'll work". Things I already knew but just couldn't swallow (<-- nice pun here). https://www.fourmilab.ch/hackdiet/ https://www.fourmilab.ch/hackdiet/

majkinetor 6y ago
That is great book and every engineer should read it, but not because its correct, because it isn't - now I know enough of medicine to know that solution works because it is another way to say lets do IF. The book is great because you can follow how engineer tries to solve a very hard problem.
- tjader 6y ago
  What is not correct in the book? I don't see at all how the book leads to intermittent fasting. He advocates for regular and predictable meal schedule, but does not advocate for meal count restrictions. "How many meals, and when? Only total calories per day count." https://www.fourmilab.ch/hackdiet/e4/planningmeals.html https://www.fourmilab.ch/hackdiet/e4/planningmeals.html
  - majkinetor 6y ago
    He eats once a day. That is IF. Everything is wrong in the book, including that you can fix the sensor by measuring how much you eat and including that total calories per day count, because all calories are not equal. Its very interesting book nevertheless.
    - tjader 6y ago
      Where in the book does he say you should only eat once a day? Where does he even day he does that?

kirillzubovsky 6y ago

A more accurate title would be "healthy lifestyle improvements leads to improved odds in type2 diabetes prevention in obese older women." That's what the results section of that paper is saying. Unfortunately we can't really see more without paying $30 to read it.

drilldrive 6y ago

I feel like the best way to lose weight is to make your own food for your whole diet, keeping processed foods to an absolute minimum. This alongside being aware of drinking mostly water instead of sugary drinks and keeping snacking to a minimum should lead to more gripability on one's diet, since tracking what one eats is much easier to remember when one cooks his own food. If this doesn't quite work, perform a calorie calculation once to be sure it lines with the dietary calculators to actually decrease caloric intake.

pengaru 6y ago
It's relatively easy to overeat when cooking your own meals, that's not a panacea, especially if the real problem is one of self-control.
- drilldrive 6y ago
  Yeah I should be clear I have never had problems with overeating myself so I am coming at the issue with an outwards viewpoint. I have been 6'7" and 190-200 pounds for all my adult life, and have cooked most all my own meals since I moved for university, so at least for being weight consistent I haven't had much trouble. I moreso have observed that snacking foods + sugary drinks + fast food leads to a partial negligence of the diet, we often eat too fast and eat hard-to-estimate caloric worth quantities to recognize in our gut we are full enough.
  - pengaru 6y ago
    Snack foods do tend to be calorie dense. And preparing meals certainly puts oneself in better control over what goes in. It's just been my experience that as a bachelor preparing meals for individual consumption, particularly as the ability to make tasty meals improves, weight gain is still a problem. It's challenging to make single servings from scratch without going even a little overboard, and for me at least, it's all getting eaten in one sitting. Cooking for me has become viewed more as just a DIY form of JIT-processed food. It tends to be healthier than food processed by someone else, for lack of preservatives and less salt/sugars, and higher quality ingredients, but the cooking process still tends to produce something more calorically dense and unnaturally delicious I have difficulty resisting overeating.

killjoywashere 6y ago

This is like saying water makes trees grow. Yes, loosing weight means consuming less calories. The body moves calories around as glucose. High glucose = weight gain (and above a certain limit you can't gain weight faster and then you look like type 2 diabetes). Keeping your glucose near floor (there's a lot of biological controls that keep glucose above 80) = weight loss.

subsubzero 6y ago

I have my own experience with weight loss. I used to get sick constantly, had low energy and snored at night. A few years ago got serious, started weight training(was running but weights made a huge difference), also cut out all the junk in my diet(snacking now healthy, more water). I was never obese, but just carried a good amount of weight, The results have been dramatic. I no longer snore, and have ample energy throughout the day. And I have been getting sick alot less now. Other things that I found to be interesting is I now have a very good sense of smell, I can now smell very faint things my Wife cannot. Also I always had a terrible balance and that has changed dramatically as well for the better. If there is one thing that was life changing for me, it is losing all the weight, I couldn't recommend it enough for everyone.

hi41 6y ago
I have faced this issue on and off. My wife and kids tell me that I snore. This happens when i get overweight. I have been having difficulty in keeping the weight off. After losing weight, I get it back after few weeks. But yes, i stop snoring when i lose weight. I don’t know what the connection is between weight and snoring is.
- Accujack 6y ago
  Partial airway blockage by fat when you are in a prone position. Snoring is just a narrow air passage in sleep that makes sound by the pressure of air forcing its way through. If you have the situation where your airway can become completely blocked temporarily, you have sleep apnea. If it's partially blocked, you snore, and you can have either one in different positions.
tjader 6y ago
I think attributing all of the benefits to weight loss seems a bit rushed to me. At the same time you lost weight you also improved the quality of your diet and started exercising. Any of those can be a factor to any of the improvements, and for some of them the weight loss it self may not even play a role.
mleonhard 6y ago

tacon 6y ago

Since the world is turning diabetic and on track to bankrupt the healthcare system in a decade or two, it helps to recognize a few facts about "diabetes". First, realize that "prediabetic"/"diabetic" is just a stupid number in A1c or glucose tolerance where recommended care is to start giving you drugs. It doesn't mean the glucose level in your blood isn't destroying your body before you reach that level. Metabolic syndrome is a range of insulin resistance, and the sooner you reverse it, the better. Don't wait for some doctor to tell you after two or three decades of slowly increasing insulin resistance that, "Now, we will do something." There is growing evidence that Alzheimer's should be renamed Type 3 diabetes, and some questions about Parkinson's being Type 4 diabetes. The brain is specially sensitive to excess glucose, and special sets of cells are more sensitive than other neurons (like in Parkinson's). So how to measure insulin resistance? The gold standards is a continuous glucose monitor ($500). Then the glucose tolerance test (not the overnight fast), which takes hours and involves ingesting slugs of glucose and sampling blood over time. Ideally we would directly measure insulin in the blood, not glucose, but that is much harder so far. One new test that holds out the hope of predicting diabetes years or even decades down the road is the LabCorp NMR LipoProfile with Graph[0][1]. Not yet FDA approved for diagnosis, this cheap test ($40 Medicare reimbursement) calculates an insulin resistance score that can be tracked year by year. I first learned of this test in an article in Managed Care Magazine, which seems to have gone out of business, leaving only a PubMed blurb pointing to it[2]. I was interested enough in my numbers that I paid for my own test, about $90 after Black Friday discount, in November 2018 at WalkInLab[3]. [0] https://www.labcorp.com/tests/123810/nmr-lipoprofile-with-lipids-with-graph https://www.labcorp.com/tests/123810/nmr-lipoprofile-with-li... [1] https://www.labcorp.com/tests/related-documents/L15035 https://www.labcorp.com/tests/related-documents/L15035 [2] https://pubmed.ncbi.nlm.nih.gov/29701589/ https://pubmed.ncbi.nlm.nih.gov/29701589/ [3] https://www.walkinlab.com/products/view/nmr-lipoprofile-blood-test https://www.walkinlab.com/products/view/nmr-lipoprofile-bloo...

andrewjl 6y ago
Do you have any links on the connections between glucose and brain chemistry?
- 6y ago

LatteLazy 6y ago

There's a great bit on Anatomy Life And Death where they show 2 arteries. One is ever so slightly thinner, in diameter. The speed fluid flows through them is vastly different...

moltar 6y ago

I think this is actually easy to explain. To lose weight you need to be in energy deficit. When one is in deficit, the body starts to use stored fat. Body prefers certain types of stores to others. One of the first and most dangerous stores is fat in the liver, which is common for high fructose eating humans. This fat is the primary reason for being in metabolic disease aka pre diabetes state. So once body burns off fat from liver, your pre diabetes vanishes.