New research shows that losing weight does not lower the risk of developing type 2 diabetes equally for everyone. A study published in the journal Diabetes found that some people who lost a significant amount of weight and kept it off for years still developed the condition.
The study, known as the Tübingen Lifestyle Intervention Program (TULIP), followed 190 adults at risk for type 2 diabetes through a two-year lifestyle program. Researchers then tracked their health for about nine years. Before the program began, the participants were divided into six groups based on how their bodies processed blood sugar. This included measuring how well their cells responded to insulin and how effectively their pancreas produced it.
Two groups were identified as high-risk. One group had weaker insulin production, labeled cluster 3. Another group, labeled cluster 5, included older participants with higher body weight whose cells did not respond well to insulin. The analysis focused on 60 people who lost at least 3% of their body weight, with an average loss of 8%, and kept the weight off.
Weight loss did not protect everyone
Among those who maintained their weight loss, the results varied by metabolic group. People in cluster 5, those with an insulin-resistant profile, saw their fasting blood sugar and post-meal glucose levels rise more than other groups over time. Their bodies also became less effective at producing insulin.
Despite losing weight and keeping it off for nearly a decade, 41% of participants in cluster 5 developed type 2 diabetes. In comparison, 0% of people in the lower-risk groups developed the disease, and only 10% of those in cluster 3, who had weaker insulin production, did. The researchers concluded that people with this specific metabolic profile may need more targeted approaches beyond standard diet and exercise advice.
The study highlights that weight is only one part of the equation. Two people can follow the same diet, exercise the same amount, and lose the same percentage of body weight, yet have completely different health outcomes. For some, the body’s blood sugar regulation system is already struggling in ways that weight loss alone cannot fully fix. Factors such as how well the pancreas produces insulin, how cells respond to it, and where the body stores fat all play a role.
This does not mean lifestyle changes are useless for high-risk individuals. However, relying only on the scale to measure metabolic health may miss important warning signs. Other interventions and habit changes are also needed. For example, knowing your metabolic markers such as fasting glucose, fasting insulin, HbA1c, and a lipid panel can give a fuller picture of metabolic health than weight alone. Strength training helps regulate blood sugar by improving how cells respond to insulin, independent of weight loss. Building meals around protein and fiber helps keep blood sugar steady. Poor sleep and chronic stress can also throw off blood sugar regulation and make cells less responsive to insulin. Genetics also play a significant role, so knowing family history and getting earlier metabolic screening may be a good idea.
