Welcome back, health champions!👋

Ever feel like your body's playing by different rules when it comes to weight management? If you've got prediabetes, you're not imagining things—your metabolism really IS working differently. Today, we're diving into the science behind why prediabetes makes weight management such a challenge (spoiler: it's not about willpower!) and what actually works based on recent research.

In This Issue:

• The surprising metabolic roadblocks created by prediabetes

• Three common outcomes after diagnosis (and what predicts success)

• Why your waist measurement matters as much as the scale

• Specific strategies that work better than calorie counting

• What to expect in next week's follow-up issue

Keep reading for strategies that address the real root causes—instead of just treating symptoms.

The Prediabetes-Weight Connection: What You Really Need to Know

If you've ever thought losing weight with prediabetes feels like swimming upstream, you're absolutely right. Your body's insulin resistance creates a perfect storm of metabolic challenges that can make traditional weight loss approaches not just ineffective, but sometimes counterproductive.

We believe understanding what's happening inside your body is the first step to making meaningful changes. No, it's not about eating tiny salads or spending hours on a treadmill—it's about strategically addressing the hormonal imbalances that drive both prediabetes and weight retention.

Prediabetes and BMI stats:

About 8-9 out of 10 adults with prediabetes have a BMI of 25 kg/m² or higher. But here's the good news—losing just 5-7% of your starting weight can dramatically cut your diabetes risk. That's only 10-14 pounds for a 200-pound woman!

Reality Check: Three Typical Prediabetes Trajectories

Studies tracking women with prediabetes from the DPP cohort for a decade or longer after their program show these patterns:

• About one-third (roughly speaking) restore normal blood sugar and maintain it (what you’ve read on the internet as ‘reversing prediabetes’)

• Another third stay in the prediabetes range

• The remaining third eventually develop diabetes

Beyond the Initial Drop: The Maintenance Mystery

Most women are observed to lose their biggest chunk of weight in the first 6 months of several programs. Without structured follow-up? More than half that weight typically returns within two years. This highlights a crucial truth: maintaining weight is just as important as losing it initially—maybe even more so.

Metabolic Memory: Early Efforts Pay Dividends

Here's something encouraging: the weight you lose early in your journey creates lasting "metabolic memory" that protects your insulin-producing beta cells, even if some weight bounces back later. After a remarkable 22 years of follow-up, Diabetes Prevention Program participants who made lifestyle changes still had 25% lower diabetes rates compared to controls—despite modest weight regain!

Not Just a Weight Issue: The "Lean Prediabetes" Phenomenon

While excess weight is definitely a risk factor, about 10-15% of people with prediabetes have a normal BMI. This condition (sometimes called "metabolically obese, normal weight" or MONW) stems from:

• Genetic factors affecting insulin secretion rather than resistance

• "Hidden" fat deposits in liver, pancreas, and muscle

• Altered gut microbiome that affects metabolism

• Hormonal imbalances (particularly with conditions like PCOS)

Ethnic-Specific Risk: Different Thresholds Matter

Women of Asian, Hispanic, and Black heritage can develop dangerous visceral fat and prediabetes at BMIs below what's typically labeled "overweight." The World Health Organization suggests ≥23 kg/m² as the overweight threshold for some Asian populations—considerably lower than the standard 25 kg/m² cutoff.

Waist Wisdom: Better Than The Scale

Your tape measure might tell you more than your scale. For women, aim for a waist circumference below 35 inches (88 cm). This simple measurement reflects visceral fat—the dangerous kind around your organs that's much more strongly linked to insulin resistance than your overall weight.

Quick Waist Measurement Guide

MEASURE UP: YOUR 60-SECOND ASSESSMENT
✓ Stand relaxed in front of a mirror
✓ Find your hip bones and the bottom of your ribs
✓ Place tape measure at midpoint between these landmarks
✓ Exhale naturally (don't suck in!)
✓ Record measurement
✓ Target: Under 35 inches (88 cm) for women. 

Visual learners, check this YouTube video

The Uphill Battle: Why Prediabetes Makes Weight Loss Harder

If losing weight feels like an impossible challenge, it's not your imagination or lack of determination—it's biology.

Insulin Resistance: The Root of the Problem

Prediabetes is fundamentally about insulin resistance—your cells aren't properly responding to insulin signals. This triggers a metabolic cascade:

• Your pancreas pumps out extra insulin to compensate

• Higher insulin levels promote fat storage and block fat burning

• Your body prioritizes carbs for fuel instead of tapping into fat stores

• Energy gets trapped in fat cells, leaving you hungry and tired

Stress Signals: The Cortisol Connection

Prediabetes doesn't just mess with insulin—it disrupts your entire hormone balance:

• Chronically elevated cortisol furthers insulin resistance

• Cortisol promotes belly fat accumulation

• Sleep disruption becomes more common, spiking cortisol further

• Hunger hormones go haywire - ghrelin increases while leptin resistance grows

Hormonal Hurricanes: Women's Additional Challenges

Perimenopause (typically during your 40s-50s) brings fluctuating estrogen that can worsen visceral fat deposition and disrupt sleep, both amplifying insulin resistance. These hormonal shifts make weight management tougher precisely when diabetes prevention becomes most critical.

Gut Reaction: The Microbiome Factor

Emerging research highlights how your gut bacteria influence glucose regulation. A loss of beneficial bacterial diversity (particularly decreases in species like Akkermansia) correlates with higher fasting glucose and may partly explain those frustrating weight loss plateaus.

Medication Effects: Hidden Hurdles

Certain commonly prescribed medications can raise blood glucose and hinder weight loss, including some antidepressants, beta-blockers, and corticosteroids. If you're taking any of these, consider asking your healthcare provider about optimized medication strategies that could support both your blood sugar goals and weight management journey.

Traditional Approaches: Why They Often Backfire

Many conventional weight loss strategies actually worsen insulin resistance:

• Extreme calorie cutting: slows metabolism and raises stress hormones

• Low-fat, high-carb diets: can trigger insulin spikes

• Excessive cardio: can increase cortisol without improving insulin sensitivity

• The tired "eat less, move more" advice: completely ignores the hormonal reality of prediabetes

What Actually Works: Starting Your Success Journey

The key? Address insulin resistance first, which often leads to natural weight loss as a beneficial side effect.

Strategic Carb Control: Quality Over Quantity

Research from clinical trials shows moderating carbohydrates can directly improve insulin sensitivity:

• Focus first on cutting refined carbs and sugars

• Prioritize protein at each meal (aim for 25-30g)

• Include healthy fats for satiety and hormonal balance

• Time carbohydrates strategically around physical activity (or time physical activity around carb intake: check our old issue)

Muscle Matters: Resistance Training Revolution

For prediabetes, exercise type matters significantly:

• Resistance training improves insulin sensitivity for up to 72 hours

• Building muscle creates metabolic tissue that burns calories at rest

• Brief, intense exercise shows better results than long, moderate sessions

• Just 2-3 weekly resistance sessions can dramatically improve glucose control

Learn more about the 7 simple moves that can change your numbers in our previous newsletter issue

Time It Right: Strategic Meal Timing

Emerging research on time-restricted eating shows promising results:

• Extending overnight fasting (12-16 hours) improves insulin sensitivity

• Eating earlier aligns with natural metabolic rhythms

• Front-loading calories earlier improves glucose tolerance all day

• Avoiding late-night eating reduces insulin production during sleep

TRY THIS
"3-2-1" approach to stabilize blood sugar:

• 3 hours minimum between meals (no constant snacking)

• 2 meals with protein eaten before 2pm

• 1 12-hour overnight fast (e.g., 7pm to 7am)