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There is a long-held perception in diabetes prevention that weight reduction is the primary method to decrease illness threat. Our new research challenges this.
For many years, individuals identified with prediabetes—a situation affecting as much as one in three adults relying on age—have been advised the identical factor by their medical doctors: eat healthily and drop pounds to keep away from growing diabetes.
This strategy hasn’t been working for all. Regardless of unchanged medical suggestions for greater than 20 years, diabetes prevalence continues rising globally. Most individuals with prediabetes discover weight-loss targets onerous to achieve, leaving them discouraged and nonetheless at excessive threat of diabetes.
Our newest analysis, revealed in Nature Medication, reveals a special strategy completely. We discovered that prediabetes can go into remission—with blood sugar returning to regular—even with out weight reduction.
About one in 4 individuals in life-style intervention applications convey their blood sugar again to regular with out shedding any weight. Remarkably, this weight-stable remission protects in opposition to future diabetes simply as successfully as remission achieved via weight reduction.
This represents a major shift in how medical doctors would possibly deal with obese or overweight sufferers at excessive threat for diabetes. However how is it potential to scale back blood glucose ranges with out losing a few pounds, and even whereas gaining weight?
The reply lies in how fats is distributed all through the physique. Not all physique fats behaves the identical means.
The visceral fats deep in our stomach, surrounding our inside organs, acts as a metabolic troublemaker. This stomach fats drives power irritation that interferes with insulin—the hormone answerable for controlling blood sugar ranges. When insulin cannot perform correctly, blood glucose rises.
In distinction, subcutaneous fats—the fats immediately underneath our pores and skin—will be helpful. Such a fats tissue produces hormones that assist insulin work extra successfully. Our research exhibits that individuals who reverse prediabetes with out weight reduction shift fats from deep inside their stomach to beneath their pores and skin, even when their whole weight stays the identical.
We have additionally uncovered one other piece of the puzzle. Pure hormones which might be mimicked by new weight-loss medicines like Wegovy and Mounjaro seem to play an important function on this course of. These hormones, significantly GLP-1, assist pancreatic beta cells secrete insulin when blood sugar ranges rise.
Individuals who reverse their prediabetes with out losing a few pounds appear to naturally improve this hormone system, whereas concurrently suppressing different hormones that usually drive glucose ranges increased.
Focusing on fats redistribution, not simply weight reduction
The sensible implications are encouraging. As a substitute of focusing solely on the scales, individuals with prediabetes can goal to shift physique fats with weight loss plan and train.
Analysis exhibits that polyunsaturated fatty acids, considerable in Mediterranean diets wealthy in fish oil, olives and nuts, could assist scale back visceral stomach fats. Equally, endurance coaching can lower stomach fats even with out general weight reduction.
This doesn’t suggest weight reduction ought to be deserted as a objective—it stays helpful for general well being and diabetes prevention. Nevertheless, our findings counsel that attaining regular blood glucose ranges, no matter weight modifications, ought to turn into a main goal for prediabetes therapy.
This strategy might assist tens of millions of people that have struggled with conventional weight-loss applications however would possibly nonetheless obtain significant well being enhancements via metabolic modifications.
For well being care suppliers, this analysis suggests a have to broaden therapy approaches past weight-focused interventions. Monitoring blood glucose enhancements and inspiring fats redistribution via focused vitamin and train might present different pathways to diabetes prevention for sufferers who discover weight reduction significantly tough.
The implications lengthen globally, the place diabetes represents one of many fastest-growing well being issues. By recognizing that prediabetes can enhance with out weight reduction, we open new prospects for stopping a illness that impacts a whole lot of tens of millions worldwide and continues quickly increasing.
This analysis basically reframes diabetes prevention, suggesting that metabolic well being enhancements—not simply weight discount—ought to be central to scientific observe. For the many individuals dwelling with prediabetes who’ve felt discouraged by unsuccessful weight-loss makes an attempt, this gives renewed hope and sensible different methods for decreasing their diabetes threat.
Extra data:
Prevention of sort 2 diabetes via prediabetes remission with out weight reduction, Nature Medication (2025). DOI: 10.1038/s41591-025-03944-9.
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