Ideally, weight management recommendations for overweight patients with type 2 diabetes should lower BMI. Thus, the purpose of this investigation was to describe intentional weight loss strategies occurring in a diverse sample of overweight individuals with type 2 diabetes and identify strategies associated with lower BMI in the general sample.
When taken as a whole, in this study we found rates of intentional weight loss strategies similar to those in previous investigations examining participants without type 2 diabetes. For example, in this study, as with previous research, prior intentional weight loss was very common, particularly in non-Hispanic white women (12
). However, less than half of participants weighed themselves weekly or more often, a rate described previously (4
). Although a regular eating pattern was reported (five meals/snacks consumed per day), breakfast was skipped ~1 day/week. Fast food intake was fairly high, two meals per week, which is similar to what has been shown in adult women (21
). However, when examined by race/ethnicity, it becomes clear that Native American participants, particularly women, appeared to have the least healthy profile for weight loss strategies (they monitored their weight less frequently, skipped breakfast more often, and consumed more fast food meals).
The top three weight control practices reported consistently by participants of all race/ethnicity and both sexes focused on dietary changes and were practiced persistently, similar to previous reports (11
). Although these practices were not related to lower BMI in the adjusted model, they could reflect an attempt to influence carbohydrate consumption. Contrary to this result, prior studies examining the prevalence of specific weight control practices in adults without type 2 diabetes using similar measures showed that the most prevalent diet-related practice targets reducing energy consumed or decreasing fat intake (11
). This study suggests that patients with type 2 diabetes use weight control practices that help meet dietary recommendations for type 2 diabetes (13
). Indeed, similar to findings from this study, in a national representative sample of adults with type 2 diabetes, making healthy food choices was a health-related behavior reported by almost 80% of the participants (22
Most importantly, this study identified a few strategies related to lower BMI in overweight individuals with type 2 diabetes. As predicted, weekly self-weighing, regularly consuming breakfast, and eating less fast food were related to lower BMI.
Randomized trials that have promoted regular self-weighing have also shown better weight control (5
) than conditions with less emphasis on self-weighing. Although frequent self-weighing itself most likely does not reduce weight, it may play an important role in self-regulation, providing objective feedback on energy balance (4
This study supports previous findings that consuming less fast food (8
) and regular breakfast consumption (7
) are related to lower BMI. Greater consumption of fast food may contribute to increased BMI through excessive energy intake via passive overconsumption because of the high energy density of fast food, large portion sizes, and greater palatability (24
). Eating breakfast may improve weight control by preventing excessive consumption that might occur with irregular eating patterns (25
This study showed that duration of the most commonly used weight control practice, increasing fruit and vegetable intake, was not related to BMI in the adjusted model. Supporting this finding, a randomized trial in which fruit and vegetable intake was increased with no prescription to reduce energy intake produced an initial small weight loss that was not maintained (26
), suggesting that this strategy alone may be an ineffective method for weight control.
The strengths of this study include a large, ethnically and socioeconomically diverse sample with objectively measured height and weight. Limitations include the inability to conduct multivariate analyses for BMI specific to sex and race/ethnicity because of the smaller sample size in some of the different subgroups, the retrospective nature of self-reported measures, a potential bias associated with self-report of eating patterns and weight control practices, the limited range of BMI in participants (to be eligible to participate in the trial, a BMI ≥25 kg/m2 was required), and the observational, cross-sectional study design, which precludes any conclusions regarding the temporal ordering of relationships.
In summary, several weight loss strategies (weekly self-weighing, regular consumption of breakfast, and reduced intake of fast food) were associated with lower BMI in overweight individuals with type 2 diabetes. These strategies are specific and may be easier to implement, monitor, and adhere to than global weight loss strategies (reducing calories consumed). Future research should test interventions that encourage the persistent use of these specific strategies to help with weight control in adults with type 2 diabetes.