Type 2 Diabetes  is often associated with being overweight or obese, leading to the common perception that weight loss is always beneficial for managing blood sugar levels. However, a minority of people with Type 2 Diabetes  experience unintended weight loss, which can be both perplexing and concerning. This unintended weight loss can make managing Type 2 Diabetes  more difficult and may signal underlying health issues that need to be addressed.

The Problem of Unintended Weight Loss in Type 2 Diabetes

Unintended weight loss in people with Type 2 Diabetes  is less common, but can occur for various reasons. This weight loss can be worrying because it may indicate that the body isn’t processing nutrients properly or that other health issues are at play. Unlike the intentional weight loss many people strive for to manage their Type 2 Diabetes , unintended weight loss can lead to muscle wasting, fatigue, and a general decline in overall health.

Potential Causes of Unintended Weight Loss

• Poor Blood Sugar Control: When blood sugar levels are consistently high (hyperglycaemia), the body struggles to use glucose efficiently. Insulin resistance, a hallmark of Type 2 Diabetes, means that glucose remains in the bloodstream instead of being used for energy. As a result, the body may begin to break down fat and muscle for energy, leading to weight loss.
• Increased Urination: High blood sugar levels cause the kidneys to work harder to remove excess glucose from the blood, leading to increased urination (polyuria). This can result in dehydration and the loss of essential nutrients and calories, contributing to weight loss.
• Malabsorption: In some cases, Type 2 Diabetes can lead to conditions like gastroparesis, where the stomach doesn’t empty properly. This can interfere with nutrient absorption, leading to weight loss even if food intake remains the same.
• Medication Side Effects: Certain Type 2 Diabetes medications, such as SGLT2 inhibitors (e.g., empagliflozin or dapagliflozin), are designed to help the body excrete excess glucose through urine, which can lead to weight loss. While this effect is often intentional, it can sometimes result in more weight loss than desired.
• Underlying Illnesses: Other health issues, such as thyroid disorders, infections, or cancer, can also cause unintended weight loss. These conditions may be more common in people with Type 2 Diabetes due to their weakened immune systems.
• Depression and Anxiety: Mental health conditions, which are more prevalent in individuals with Type 2 Diabetes, can lead to changes in appetite and weight. Depression, in particular, is associated with weight loss due to decreased appetite and interest in food.

Biological Mechanisms Behind Unintended Weight Loss

To understand why unintended weight loss occurs, it’s essential to delve into the biological mechanisms at play in Type 2 Diabetes.

Insulin Resistance and Fat Metabolism

Insulin is a hormone that allows cells to take in glucose from the bloodstream to be used for energy. In people with Type 2 Diabetes, cells become resistant to insulin, meaning they can’t use glucose effectively. As a result, the body turns to other sources of energy, such as fat and muscle tissue, leading to weight loss.

When the body breaks down fat for energy, it releases fatty acids and ketones into the bloodstream. While this can provide energy, it also leads to the loss of body fat and muscle mass, contributing to unintended weight loss.

Gluconeogenesis and Muscle Wasting

Another contributing factor is gluconeogenesis, the process by which the liver produces glucose from non-carbohydrate sources like amino acids. When blood glucose levels are low or when the body cannot use glucose effectively, gluconeogenesis kicks in. This process can lead to muscle wasting, as amino acids from muscle tissue are broken down to produce glucose, further contributing to weight loss.

Hyperglycaemia-Induced Dehydration

High blood sugar levels cause the kidneys to excrete more water in an attempt to eliminate excess glucose. This diuretic effect can lead to dehydration, which not only causes weight loss but also impairs nutrient absorption and utilisation. Over time, this can result in the depletion of essential nutrients, exacerbating weight loss and potentially leading to malnutrition.

Strategies for Safely Gaining Weight in Type 2 Diabetes

For individuals with Type 2 Diabetes experiencing unintended weight loss, regaining weight can be a delicate process. The challenge lies in increasing calorie intake without compromising blood sugar control, which is vital for managing Type 2 Diabetes.

Prioritise Nutrient-Dense Foods

Why It’s Important: Nutrient-dense foods are rich in calories and packed with essential nutrients like vitamins, minerals, and healthy fats, which are crucial for overall health and well-being. For those with Type 2 Diabetes, it’s important to choose foods that provide energy without causing significant spikes in blood sugar levels.

How to Implement:

• Avocados: Avocados are an excellent source of monounsaturated fats, which are heart-healthy and provide a concentrated source of calories. They can be added to salads, spread on whole-grain toast, or blended into smoothies for a creamy texture.
• Nuts and Seeds: These are calorie-dense and provide a combination of protein, healthy fats, and fibre, which helps regulate blood sugar levels. Almonds, walnuts, chia seeds, and flaxseeds can be added to yogurt, oatmeal, or salads.
• Whole Grains (in moderation): Foods like quinoa, brown rice, barley, and oats are not only high in calories but also provide fibre, which slows the absorption of glucose and prevents blood sugar spikes. Incorporate these grains into meals as a base for stir-fries, salads, or as a side dish.
• Fatty Fish: Rich in omega-3 fatty acids, salmon, mackerel, and sardines support heart health and provide high-quality protein and fats. These can be grilled, baked, or included in salads.

Increase Healthy Fats

Why It’s Important: Healthy fats are a concentrated source of calories and are less likely to cause sharp increases in blood glucose levels compared to carbohydrates. They also help with the absorption of fat-soluble vitamins, which are important for overall health.

How to Implement:

• Oils: Incorporate oils like extra virgin olive oil, avocado oil, and flaxseed oil into your cooking. Use them in salad dressings, drizzle over vegetables, or add to soups and stews.
• Nut Butters: Almond butter, peanut butter, and tahini are high in calories and healthy fats. Spread them on whole-grain bread, add them to blood-sugar-friendly smoothies, or use them as a dip for fruits like apples.
• Full-Fat Dairy: Choose full-fat versions of dairy products such as milk, yogurt, and cheese. These are richer in calories and also provide calcium and protein. They can be added to meals or snacks to increase overall caloric intake.

Add Protein-Rich Foods

Why It’s Important: Protein is essential for maintaining and rebuilding muscle mass, which is often lost during periods of unintended weight loss. Additionally, protein helps stabilise blood sugar levels by slowing down the absorption of glucose.

How to Implement:

• Lean Meats and Poultry: Chicken breast, turkey, and lean cuts of beef or pork are excellent sources of high-quality protein. Aim to include a portion in each meal. Grilled, baked, or stir-fried meats can be paired with vegetables and whole grains.
• Fish and Seafood: In addition to being a great source of protein, fish like salmon and tuna also provide healthy fats. Try to consume fatty fish at least twice a week.
• Eggs: Eggs are versatile, high in protein, and can be included in various meals throughout the day. Scrambled eggs for breakfast, hard-boiled eggs as a snack, or an omelette with vegetables for dinner are all great options.
• Plant-Based Proteins: If you prefer plant-based options, foods like lentils, chickpeas, black beans, tofu, and tempeh are excellent choices. They can be used in soups, stews, salads, or as a base for vegetarian dishes.

Eat Smaller, More Frequent Meals

Why It’s Important: Eating smaller, more frequent meals can help prevent overeating and ensure a steady supply of calories throughout the day. This approach is particularly beneficial for those with Type 2 Diabetes, as it helps maintain stable blood sugar levels by preventing large spikes or drops.

How to Implement:

• Meal Planning: Plan to eat five to six small meals or snacks daily. This could include three main meals and two to three snacks in between.
• Balanced Meals: Each meal should include a balance of carbohydrates, protein, and healthy fats. For example, a meal might consist of a small portion of whole-grain pasta with olive oil, grilled chicken, and steamed vegetables.
• Portable Snacks: Keep portable, nutrient-dense snacks on hand, such as nuts, cheese sticks, or whole-grain crackers with nut butter. This ensures you have access to healthy calories when you’re on the go.

Consider Nutritional Supplements

Why It’s Important: Nutritional supplements can provide additional calories and nutrients, especially when it’s difficult to meet your energy needs through food alone. They can be particularly useful for individuals who have a reduced appetite or difficulty consuming large quantities of food.

How to Implement:

• Protein Powders: Protein powders can be added to smoothies, oatmeal, or yogurt to boost protein intake. Choose a product that is low in sugar and high in protein.
• Meal Replacement Shakes: These shakes are designed to provide a balanced mix of carbohydrates, protein, and fats, along with essential vitamins and minerals. Opt for diabetes-specific formulas that are designed to avoid blood sugar spikes.
• Caloric Supplements: There are specialized high-calorie drinks available that are fortified with vitamins and minerals. These can be used as a snack or to complement meals.

Monitor Blood Sugar Levels Closely

Why It’s Important: As you work to increase your calorie intake, it’s essential to keep a close eye on your blood sugar levels. Gaining weight typically involves consuming more calories, which can affect your glucose control. Frequent monitoring will help you and your healthcare provider make necessary adjustments to your diabetes management plan.

How to Implement:

• Frequent Testing: Test your blood sugar levels before and after meals to understand how different foods and portion sizes affect your glucose levels. This information can help you make informed decisions about your diet.
• Adjusting Medications: Work with your healthcare provider to adjust your medication if necessary. For instance, if your blood sugar levels are rising due to increased food intake, your provider may suggest changes in your medication regimen.
• Keep a Food and Glucose Diary: Maintaining a diary that records your meals, snacks, and corresponding blood glucose levels can help you identify patterns and make adjustments as needed.

Stay Hydrated

Why It’s Important: Proper hydration is crucial for overall health, especially for those with Type 2 Diabetes, as dehydration can exacerbate blood sugar imbalances. Additionally, staying hydrated ensures that your body functions optimally and can aid in nutrient absorption.

How to Implement:

• Water: Drink water regularly throughout the day. Aim for at least 6-8 glasses per day, but this may vary depending on individual needs and activity levels.
• Electrolyte Drinks: If you experience frequent urination or sweat a lot due to exercise, consider electrolyte-rich drinks that are low in sugar. These help replenish lost electrolytes without causing blood sugar spikes.
• Limit Caffeinated and Sugary Drinks: While it’s important to stay hydrated, be mindful of the types of drinks you consume. Avoid sugary drinks that can lead to blood sugar spikes and limit caffeinated drinks, which can have a diuretic effect.

Incorporate Strength Training

Why It’s Important: Strength training helps build and maintain muscle mass, which is often lost during unintended weight loss. Increased muscle mass not only helps with weight gain but also improves insulin sensitivity, which can aid in better blood sugar control.

How to Implement:

• Start Slowly: If you’re new to strength training, begin with light weights or resistance bands, and gradually increase the intensity as you build strength. Focus on major muscle groups like the legs, back, chest, and arms.
• Consistency is Key: Aim to include strength training exercises at least two to three times per week. This could include activities like weight lifting, resistance band exercises, or body-weight exercises such as squats and push-ups.
• Seek Professional Guidance: Consider working with a fitness trainer who has experience with Type 2 Diabetes management. They can help design a safe and effective workout plan tailored to your needs and capabilities.

Address Underlying Health Issues

Why It’s Important: If your weight loss is due to an underlying health condition, such as gastroparesis, thyroid disorders, or depression, addressing these issues is critical. Proper management of these conditions can help stabilise your weight and improve your overall health.

How to Implement:

• Regular Medical Check-Ups: Ensure that you have regular check-ups with your healthcare provider to monitor for any underlying conditions that might be contributing to weight loss.
• Medications and Treatments: Work with your healthcare provider to manage any underlying conditions effectively. This might involve adjusting medications, seeking therapy for mental health conditions, or managing gastrointestinal symptoms.
• Symptom Monitoring: Keep track of any new or worsening symptoms and report them to your healthcare provider promptly. Early detection and management of underlying issues can prevent further weight loss.

Consult a Nutritionist

Why It’s Important: A nutritionist who specialises in Type 2 Diabetes can provide personalized advice and support, helping you create a meal plan that meets your specific needs while supporting weight gain and blood sugar control.

How to Implement:

• Personalised Meal Plans: A dietitian can create meal plans that account for your calorie needs, food preferences, and blood sugar targets. These plans can include specific recommendations for portion sizes, meal timing, and snack choices.
• Nutritional Counselling: Regular counselling sessions can help you stay on track with your weight gain goals, adjust your diet as needed, and address any challenges you encounter along the way.
• Ongoing Support: A nutritionist can provide ongoing support and guidance, helping you navigate any dietary changes or adjustments in response to changes in your health status or blood sugar levels.

Strategies for Safely Gaining Weight in Type 2 Diabetes

Start Your Day with a High-Calorie Breakfast

Why It’s Important: Breakfast sets the tone for your day and replenishes energy after the overnight fast. For weight gain, a calorie-dense, nutrient-rich breakfast is crucial.

How to Implement:

• Balanced Breakfast: Create a meal that includes protein, healthy fats, and low-GI carbohydrates. For example, a smoothie made with full-fat Greek yogurt, a handful of oats, a banana, some berries, and a spoonful of almond butter offers a balanced start.
• Overnight Oats: Prepare overnight oats with full-fat milk, chia seeds, and a topping of nuts and berries. This ensures a slow release of energy and helps maintain stable blood sugar levels.
• Egg-based Dishes: Include eggs in your breakfast, such as an omelette with spinach and cheese, served with whole-grain toast and avocado.

Snack on Nuts and Seeds

Why It’s Important: Nuts and seeds are dense in calories, healthy fats, and protein, making them perfect for in-between meals without impacting blood sugar levels.

How to Implement:

• Portion Control: While nuts and seeds are healthy, they are also calorie-dense, so keep portions reasonable (a handful per serving).
• Variety: Mix different types of nuts (almonds, walnuts, pistachios) and seeds (chia, flax, pumpkin) to get a variety of nutrients.
• Nut Butter: Incorporate nut butters into snacks like apple slices with almond butter or whole-grain crackers with peanut butter.

Use Full-Fat Dairy Products

Why It’s Important: Full-fat dairy provides more calories than its low-fat counterparts and is rich in nutrients like calcium and vitamin D.

How to Implement:

• Choose Unsweetened Varieties: Opt for plain, unsweetened full-fat yogurt or milk to avoid added sugars that could spike blood sugar.
• Cheese: Include cheese in salads, sandwiches, and as snacks, but be mindful of portion sizes to avoid excessive saturated fat intake.
• Cooking with Dairy: Use full-fat cream in soups, sauces, and casseroles to increase caloric content.

Add Extra Olive Oil to Your Meals

Why It’s Important: Olive oil is a healthy fat source with anti-inflammatory properties and no impact on blood sugar levels.

How to Implement:

• Salads: Drizzle olive oil over salads and roasted vegetables for added flavour and calories.
• Cooking: Use olive oil as your primary cooking oil for sautéing, roasting, or grilling.
• Dipping: Serve whole-grain bread with olive oil mixed with herbs as a starter or snack.

Incorporate Smoothies

Why It’s Important: Smoothies can pack a lot of nutrition and calories into a single, easy-to-consume drink, which is especially helpful if you have a reduced appetite.

How to Implement:

• Low-GI Ingredients: Use low-GI fruits like berries, along with protein powder, full-fat yogurt, and a handful of spinach or kale to create balanced smoothies.
• Healthy Fats: Add a tablespoon of chia seeds, flaxseeds, or a scoop of avocado to boost calorie content without increasing the glycaemic load.
• Avoid Sugary Additives: Steer clear of added sugars or syrups, and instead use natural sweetness from fruits or a small amount of honey.

Choose Whole-Grain Carbohydrates

Why It’s Important: Whole grains are high in fibre, which helps to slow the absorption of glucose, leading to more stable blood sugar levels. However, to avoid blood sugar spikes, whole grains should be consumed in moderation.

How to Implement:

• Whole-Grain Staples: Incorporate brown rice, quinoa, barley, and oats into your diet. For example, use quinoa as a base for a stir-fry or add barley to soups.
• Portion Control: Be mindful of portion sizes, as even whole grains can raise blood sugar if consumed in large amounts. Balance your plate with proteins and fats.
• Breads and Pastas: Choose whole-grain bread and pasta over refined versions. Add lean protein and vegetables to these dishes to create balanced meals.

Add Protein to Every Meal

Why It’s Important: Protein not only supports muscle maintenance and growth but also helps to stabilise blood sugar levels by slowing the digestion of carbohydrates.

How to Implement:

• Lean Meats: Include lean meats like chicken, turkey, or lean cuts of beef in your meals. Pair these with whole grains and vegetables.
• Fish: Fatty fish like salmon, mackerel, or tuna are rich in omega-3 fatty acids and protein. Aim to include fish in your diet at least twice a week.
• Plant-Based Proteins: Beans, lentils, tofu, and tempeh are excellent plant-based protein options that can be added to salads, stews, and stir-fries.

Enjoy Nut Butters

Why It’s Important: Nut butters are a concentrated source of calories, healthy fats, and protein, making them ideal for adding to meals or snacks.

How to Implement:

• Spreads: Spread nut butter on soughdough or whole grain toast, apple slices, or celery sticks for a balanced snack.
• Smoothies: Add a spoonful of nut butter to your smoothie for extra calories and a creamy texture.
• Baking: Use nut butter in baking to create calorie-dense treats like protein balls or energy bars.

Opt for Fatty Fish

Why It’s Important: Fatty fish are not only rich in protein but also provide essential omega-3 fatty acids, which are beneficial for heart health and have anti-inflammatory effects.

How to Implement:

• Grilled or Baked: Prepare fish by grilling or baking, and serve with a side of whole grains and vegetables.
• Fish Tacos: Use fatty fish as a filling for tacos with avocado, salsa, and whole-grain tortillas for a balanced meal.
• Fish Salads: Flake grilled fish over a salad for a nutrient-dense meal that’s also high in calories.

Use Avocado as a Spread

Why It’s Important: Avocados are high in healthy fats and provide a good source of calories without spiking blood sugar levels.

How to Implement:

• On Toast: Spread mashed avocado on whole-grain toast and top with a poached egg for a balanced, calorie-dense breakfast.
• In Salads: Add diced avocado to salads for extra creaminess and calories.
• Sandwiches and Wraps: Use avocado as a spread instead of mayonnaise for a healthier, nutrient-rich alternative.

Cook with Coconut Oil

Why It’s Important: Coconut oil contains medium-chain triglycerides (MCTs), which are quickly absorbed and used for energy, providing a calorie boost without negatively impacting blood sugar levels.

How to Implement:

• Cooking: Use coconut oil for sautéing vegetables, cooking eggs, or adding to curries and soups.
• Baking: Substitute butter or other oils with coconut oil in baking recipes for an added calorie boost.
• Smoothies: Add a spoonful of coconut oil to smoothies for a richer texture and increased caloric content.

Include Legumes

Why It’s Important: Legumes are rich in protein, fibre, and complex carbohydrates, which help maintain energy levels and support blood sugar regulation.

How to Implement:

• Soups and Stews: Add beans, lentils, or chickpeas to soups and stews for a hearty, calorie-dense meal.
• Salads: Use legumes as a base for salads, mixing them with vegetables, olive oil, and spices for a filling meal.
• Side Dishes: Prepare legume-based dishes like hummus, refried beans, or lentil curry as sides to accompany your main meals.

Incorporate Cheese

Why It’s Important: Cheese is high in calories, fat, and protein, making it an excellent food for weight gain. It can add flavour and richness to a variety of dishes.

How to Implement:

• Snacks: Enjoy cheese as a snack with whole-grain crackers, fruits, or nuts. Pairing cheese with fibre-rich foods helps mitigate blood sugar spikes.
• Meals: Add cheese to sandwiches, salads, soups, and casseroles to increase the calorie content.
• Grated Cheese: Sprinkle grated cheese over meals for added flavour and calories.

Drink Calorie-Rich Drinks

Why It’s Important: Drinks can be an easy way to increase your calorie intake, especially if you struggle with eating large portions of food. However, it’s important to avoid sugary drinks that can spike blood sugar levels.

How to Implement:

• Milk: Drink full-fat milk or use it as a base for smoothies and hot drinks. Ensure the milk is unsweetened.
• Protein Shakes: Prepare protein shakes with milk, protein powder, fruits, and nut butter for a high-calorie drink. Choose unsweetened or Type 2 Diabetes-friendly protein powders.
• Meal Replacement Shakes: Use meal replacement shakes that are specifically formulated for diabetes, ensuring they are low in sugar but high in calories and nutrients.

Incorporate Eggs

Why It’s Important: Eggs are a versatile and inexpensive source of high-quality protein and healthy fats, making them ideal for weight gain without affecting blood sugar levels.

How to Implement:

• Breakfast: Prepare scrambled eggs, omelettes, or frittatas with vegetables and cheese for a hearty breakfast.
• Lunch and Dinner: Add boiled eggs to salads, sandwiches, or rice bowls for extra protein.
• Snacks: Keep hard-boiled eggs on hand as a quick, protein-rich snack.

Add Extra Ingredients to Meals

Why It’s Important: Adding extra ingredients to meals is an easy way to boost the calorie content without significantly increasing portion sizes. This can help you consume more calories without feeling overly full.

How to Implement:

• Butter and Oils: Stir in extra butter, olive oil, or coconut oil into your cooked dishes for additional calories.
• Cream and Cheese: Add cream or cheese to soups, casseroles, or sauces to increase their richness and caloric content.
• Nut Butters and Seeds: Stir in nut butters or seeds into oatmeal, yogurt, or smoothies for added nutrition and calories.

Avoid Low-Calorie and Diet Foods

Why It’s Important: Low-calorie and diet foods often contain artificial sweeteners or fillers that may not provide the necessary nutrients for weight gain. They can also be less satisfying, leading to under-consumption of calories.

How to Implement:

• Choose Full-Fat Versions: Opt for full-fat versions of dairy products, dressings, and spreads rather than low-fat or fat-free options.
• Avoid Diet Drinks: Instead of diet or low-calorie drinks, choose calorie-rich options like milk, or homemade healthy smoothies.
• Focus on Whole Foods: Emphasise whole, unprocessed foods that are naturally rich in calories and nutrients rather than packaged diet foods.

Use Whole Eggs Instead of Egg Whites

Why It’s Important: Egg yolks are rich in nutrients, including vitamins A, D, E, and K, as well as healthy fats that contribute to increased caloric intake. Whole eggs are more nutrient-dense compared to egg whites alone.

How to Implement:

• Cooking: Use whole eggs in cooking and baking rather than just egg whites. They add richness and flavour to dishes while providing more calories.
• Breakfast: Prepare omelettes, scrambled eggs, or frittatas using whole eggs for a balanced and calorie-rich breakfast.

Increase Portion Sizes Gradually

Why It’s Important: Gradually increasing portion sizes can help you consume more calories without feeling overwhelmed or overly full. This method helps your body adjust to the increased intake slowly.

How to Implement:

• Start Small: Begin by adding small increments to your usual portion sizes. For example, add an extra spoonful of rice, an additional slice of bread, or a few more nuts to your meals.
• Listen to Your Body: Pay attention to how your body responds to the increased portions and adjust accordingly. If you feel uncomfortable or overly full, reduce the portion size slightly.
• Consistent Incremental Increases: Gradually continue increasing portions over time until you reach your desired caloric intake.

Plan Ahead for Meals and Snacks

Why It’s Important: Planning ahead ensures that you have access to high-calorie, nutrient-dense foods throughout the day, reducing the likelihood of skipping meals or opting for unhealthy options.

How to Implement:

• Meal Prep: Prepare meals and snacks in advance, especially if you have a busy schedule. Having ready-to-eat meals will help you stay on track with your weight gain goals.
• Shopping Lists: Create a shopping list with nutrient-dense, high-calorie foods to ensure you have everything you need on hand.
• Portable Snacks: Keep portable snacks like nuts, trail mix, protein bars, or fruit with nut butter in your bag or car, so you always have a healthy option available when you’re on the go.

Safely gaining weight while managing Type 2 Diabetes requires a careful balance of increasing caloric intake without compromising blood sugar control. By focusing on nutrient-dense, low-GI foods (refer to pages 143 to 148 of my book, The KISSS Plan for more details), incorporating healthy fats and proteins, and avoiding high-sugar and processed foods, you can effectively support weight gain and improve overall health.

Remember, it’s essential to monitor your blood sugar levels regularly and make adjustments as needed, working closely with your doctor to tailor these strategies to your individual needs. With the right approach, you can achieve a healthy weight while maintaining optimal Type 2 Diabetes management, leading to better health outcomes and an improved quality of life.

This article is dedicated to Paul Dinsdale.

I hope it helps other Type 2 Diabetics in a similar position of struggling to gain weight too – Neil