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Most people with prediabetes hear the same advice: lose weight and your numbers will improve.

But that raises a more important follow-up question—one that rarely gets discussed: What kind of weight loss actually fixes the metabolic problem behind prediabetes?

Because as many of you have experienced, weight loss alone doesn't always deliver the results you were promised. Today's Health Guide explains why—and what to watch for instead.

Inside today's issue

• Why weight loss alone can fall short in prediabetes

• What "good" vs "bad" weight loss means biologically

• How common weight-loss strategies differ metabolically

• A practical Q&A addressing the most common confusions

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BEST FINDS
Complex Carbs, Done Right: These recipes focus on fiber-rich carbs paired with protein and healthy fats—the combination that helps slow digestion and support better glucose control. Roasted Sweet Potato Black Bean Bowl - A meal-prep staple with sweet potatoes, beans, and grains for high fiber and lasting fullness. Spring Farro Bowls with Lemon Tahini Dressing - Chewy farro plus vegetables and tahini—complex carbs done right. The Best Savory Steel-Cut Oatmeal - Oats reimagined: savory, hearty, and balanced with protein instead of sugar. Cauliflower and Chickpea Coconut Curry - Comforting and filling, with chickpeas and healthy fats to slow digestion. Butternut Squash Quinoa Salad - Naturally sweet squash balanced by quinoa’s protein and fiber. Roasted Chickpeas - A crunchy, fiber-rich snack that helps keep blood sugar steady.

Good vs Bad Weight Loss in Prediabetes: Why the Scale Can Mislead You

In a previous issue, we discussed that even modest weight loss can meaningfully lower A1c and reduce diabetes risk. If you missed that one, it's worth a read: Can Losing 20 Pounds Actually Lower Your A1C?

Let's dig deeper now: Prediabetes is not about the number on the scale. It's about what's happening inside your cells.

Here's how the scale can mislead you: You might lose 15 pounds thinking your prediabetes is improving—but if you're following strategies that sacrifice muscle and don't address insulin resistance, you could be undermining long-term metabolic health. The initial progress often isn't sustainable.

On the other hand, you might beat yourself up for losing little to no weight—only to discover at your follow-up appointment that your A1c has dropped significantly. Why? Because your approach addressed the underlying drivers: you built muscle, reduced visceral fat, and improved insulin sensitivity.

If you've lost weight but your A1c barely moved, your fasting glucose crept up, or your progress unraveled the moment you stopped dieting, it's usually a biology mismatch.

Prediabetes weight loss: why losing weight the wrong way makes it worse

From a physiological standpoint, weight loss is not a single process. The body can lose weight from several compartments:

• water

• glycogen

• lean mass (muscle)

• fat (both subcutaneous and visceral)

The scale adds all of this together—and tells you nothing about which tissue was lost.

Bad weight loss (for prediabetes):

• Scale ↓

• Muscle ↓

• Resting metabolic rate ↓

• Insulin resistance ↔ or ↑

• Glucose improvements are fragile

Good weight loss (for prediabetes):

• Scale ↓ (often more slowly - 1-2 lbs/week vs 3-5 lbs/week with extreme restriction)

• Insulin sensitivity ↑

• Visceral fat ↓

• Muscle preserved

• Glucose control becomes more stable

Same pounds lost. Very different metabolic outcomes.

Tracking what matters: The scale alone won't tell you if you're losing the right tissue. Track waist circumference (visceral fat indicator), body composition with impedance scales or DEXA scans, strength in the gym (reps, load progression), and how your body handles meals. These reveal whether your metabolism is actually improving.

Recommended reading: The Prediabetes Weight Secret

Why weight loss alone often fails to fix prediabetes

Prediabetes is driven primarily by insulin resistance, not by body weight itself.

Long before blood sugar rises, muscle and liver cells become less responsive to insulin. The pancreas compensates by producing more insulin to keep glucose in range—sometimes for years.

Recommended reading: Insulin resistance red flags

This leads to a critical misunderstanding:

Lower blood sugar does not automatically mean insulin resistance has improved. Aggressive calorie restriction can temporarily improve glucose simply by reducing intake. But if insulin sensitivity hasn't improved—and muscle mass has been lost in the process—the system becomes less resilient.

Muscle matters here. It's one of the body's largest glucose-disposal tissues. When weight loss comes at the expense of muscle, glucose-handling capacity shrinks. That's one reason repeated dieting often leads to faster rebounds and worsening control over time.

Read more about Spike Control Strategies 

How different weight loss methods affect prediabetes: what the science shows

Most people with prediabetes aren't choosing "bad" strategies. They're choosing what's recommended, available, or heavily marketed. The difference lies in how these approaches affect insulin sensitivity and lean mass.

Severe calorie restriction

The science: Produces fast weight loss but often accelerates muscle loss and metabolic adaptation. Short-term glucose improvements are common as you're simply eating less carbohydrate.

What to watch for: Declining strength, constant hunger, fatigue, and glucose rebounds when you return to normal eating. These signal metabolic adaptation, not metabolic repair.

Low-carb or ketogenic diets

The science: Lower glucose exposure by reducing carbohydrate intake, which can meaningfully improve postprandial (after-meal) glucose levels. This can be useful for symptom control. However, lower glucose alone doesn't automatically restore insulin sensitivity at the cellular level—it reduces the workload, but doesn't necessarily fix the underlying machinery.

What to watch for: Without adequate protein (0.8-2.0g per kg body weight) and resistance training, lean mass loss is common. For long-term reversal, the goal is restoring your body's ability to handle carbohydrates efficiently again—not just avoiding them forever.

Also read: Diet Matchmaker: Which Approach Fits Your Life? 

Intermittent fasting

The science: Can improve insulin sensitivity in some people, especially when paired with sufficient protein, strength training, and good sleep.

What to watch for: Layered on top of chronic stress, inadequate sleep, or under-fueling, it can backfire—worsening cortisol patterns and accelerating muscle loss.

GLP-1 medications

The science: Powerful appetite regulators that meaningfully support weight loss and can improve insulin sensitivity independent of weight loss.

What to watch for: Muscle preservation is not automatic. Studies show that without resistance training and adequate protein, 25-40% of weight lost can be lean mass. Medication supports weight loss; behavior determines its quality.

Community corner:

Prediabetes Weight Loss FAQs: Your Questions Answered

1. If I'm losing weight, doesn't that automatically mean my prediabetes is improving?

Not necessarily. Weight loss helps prediabetes only when it improves insulin sensitivity and preserves metabolic capacity. Losing muscle or relying on extreme restriction can lower the scale without fixing the underlying problem. It's also critical that your approach doesn't cause or worsen lipid abnormalities or micronutrient deficiencies —which can worsen metabolic dysfunction or create new problems.

2. My blood sugar improved at first, then stalled or worsened. Did I do something wrong?

Early improvements often reflect reduced glucose intake rather than true metabolic repair. If insulin resistance persists—or muscle mass declines—numbers can plateau or rebound.

3. Is faster weight loss better if my numbers are high?

Fast weight loss feels productive, but biologically it increases the risk of lean mass loss and metabolic adaptation. In prediabetes, weight loss that protects muscle—albeit slower—is far more likely to last.

4. Can I improve blood sugar without losing much weight?

Yes. Many people—especially those with normal or near-normal BMI—see improvements through muscle gain, reduced visceral fat, and better insulin sensitivity, even if the scale barely changes.

5. How can I tell if I'm losing muscle instead of fat?

Common clues include declining strength, increased fatigue, feeling cold, or worse glucose responses to meals that were previously well tolerated. These suggest reduced metabolic capacity, not improved insulin sensitivity. You want to see loss of visceral fat—waist circumference shrinking, pants fitting looser around the midsection—even if total weight changes slowly.

6. Do GLP-1 medications guarantee "good" weight loss?

No. They support appetite control, but muscle preservation depends on protein intake and resistance training. Without those, lean mass loss is common.

7. What's the biggest mistake people make when losing weight for prediabetes?

Chasing speed instead of durability. In prediabetes, the goal isn't just fewer pounds—it's a metabolism that handles glucose better during weight loss and after it. Another major mistake: putting arbitrary time limits on progress. Self-imposed deadlines create stress that can worsen cortisol and insulin resistance. Focus on improving trends, not meeting artificial deadlines.

Have questions? We got answers. Email [email protected]