On one level, that's bad news, given how tough losing weight (and keeping it off) can be for most people. But there's good news too: In many cases, you need to lose only 5 to 7% of total body weight to reduce your risks, according to the Diabetes Prevention Program, a clinical research study of 3,234 people. Translation: If you weigh 200 pounds, dropping just 10 to 14 of them will drastically cut your odds of developing type 2 diabetes. "You don't need to squeeze back into your prom dress," says David Marrero, MD, a professor of medicine at Indiana University. But you do need to make healthy diet changes you can stick with for life.
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The problem with excess body fat is that it kicks off insulin resistance (also known as metabolic syndrome), a condition that prevents the body's cells from opening their doors to let blood sugar in when insulin (a hormone made by the pancreas) knocks. As a result, cells require more and more insulin before they respond. Eventually, the pancreas can't make enough insulin to do the job, causing chronically high levels of circulating blood sugar and increasing the risk of heart disease, blindness, amputations, and kidney damage requiring dialysis.
Unfortunately, many patients don't take the risks seriously and miss the opportunity to intervene when diet changes are most effective. "The dividing line between prediabetes and diabetes is an arbitrary blood sugar measurement," says Mark Hyman, MD, the author of The Blood Sugar Solution, noting that the two conditions are just varying degrees of the same problem. But losing weight can stop the disease in its tracks. The Diabetes Prevention Program study put people with prediabetes on a diet-and-exercise routine. After nearly 3 years, the participants who followed the plan reduced their chances of progressing to full-blown disease by 58%, versus just 31% for a group that took the diabetes drug metformin. Other studies have shown that the same measures can benefit those who already have been diagnosed with type 2.
"It's absolutely possible to manage diabetes with lifestyle changes if you're willing to put in the work," says Dr. Marrero.
So just what kind of diet is best? (Search: What's the best diet for diabetes prevention?) Most experts agree that there's no magic diabetes meal plan and recommend commonsense measures, such as eating plenty of vegetables and practicing portion control. Many doctors advocate the so-called plate method: Your plate should contain one-half nonstarchy vegetables such as broccoli or kale; one-quarter lean protein, such as fish, beans, or soy; and one-quarter slow-digesting carbs, such as brown rice or sweet potatoes. Vegetables are crucial. One analysis found that eating leafy greens--just 1.35 servings a day--can cut risk by 14%. Another found that people who eat the most beans and soy reduce risk by almost half. Better yet, this type of diet also promotes heart health. "What kills people with diabetes is heart disease," says Neal Barnard, MD, the author of Dr. Neal Barnard's Program for Reversing Diabetes.
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Equally important is what you leave off your plate. While no food group has been shown definitively to cause type 2 diabetes, a diet laden with trans fats, saturated fats, and refined carbohydrates appears to increase the odds. Studies suggest that drinking sugar-sweetened beverages can raise the risk by 26%, and eating bacon can ratchet it up by 50%. The American diet is so reliant on these types of foods that cutting them out can be hard, but it's worth it. "If you eliminate high fructose corn syrup and trans fat, that alone can improve your health, because you avoid calorie-dense packaged foods," says Dr. Hyman. Just cutting out sugary drinks can improve your blood sugar in a matter of days.
What about the treats you love? Most experts no longer strictly forbid refined carbs but urge moderation. "Occasionally, a little splurge is not out of order," says Geralyn Spollett, president of health care and education for the American Diabetes Association (ADA). But, she cautions, be smart about it. If you want to have ice cream, indulge on an afternoon when you're going for a bike ride, which will help you use the glucose. She also recommends compensating on splurge days by eating less of something else that contains sugar or saturated fat. Even Risor, who reversed her diabetes, still enjoys her former favorite food (pizza) from time to time.
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Whatever its specifics, your food plan must help you maintain a healthy weight and must be something you can stick with. Some people get good results with a reduced-carb diet, while others find that a vegan one works for them. Many people manage their diabetes with the calorie-controlled balanced diet recommended by the ADA.
Regardless of your strategy, you'll increase your odds of success by emphasizing the positive. Choose fitness activities that are fun, and embrace healthy eating. "Be inspired by the foods you should eat more of--leafy greens, nuts and seeds, and colorful vegetables," says Dr. Jampolis. Most of all, be empowered. This is one disease for which the healing can be in your hands.
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Additional reporting by Anne Underwood
What About Diabetes Drugs?
When you're diagnosed with type 2 diabetes, your doctor should advise you about how to eat well and exercise to control your blood sugar, but she may also put you on medication.
The most widely prescribed diabetes drug is also one of the oldest: metformin (brand names: Glucophage, Riomet, and others), which usually comes as a pill taken once or twice a day. It not only reduces the amount of glucose produced by the liver but also lowers LDL cholesterol and makes you more sensitive to insulin. The most common side effect--gastric upset--usually subsides quickly, and the risk of hypoglycemia (low blood sugar) is small. A month's supply of the generic costs $28 to $33 without insurance.
One of the newest drugs, Victoza, is an injectable, noninsulin medication that you take daily. It mimics a natural hormone in the body to stimulate insulin production and reduces the amount of glucose made by the liver. The most common side effects of Victoza are headaches, nausea, and diarrhea, which often decrease within weeks, and hypoglycemia risk is low. Victoza's packaging includes an FDA warning that it caused thyroid tumors in some rodents. Studies haven't determined yet if it would do the same in humans, but the drug isn't recommended for those with a personal or family history of thyroid cancer.