A few kilograms weight loss nearly halves the risk of diabetes? | Hacker News Reader

A few kilograms weight loss nearly halves the risk of diabetes?

uea.ac.uk

102 pointsrustoo84 comments

After a blood test 1.5 years ago, I was considered "Prediabetes".

I was just slightly overweight (probably "average" by american standards).

Hearing the doc say "Prediabetes", plus having heart disease in the family and sky high cholesterol, I decided to try losing a few pounds (for me, that meant deleting all food delivery apps from my phone...)

2-3 months later I had lost maybe 10 lbs (more than the few kgs in the article). Got retested, and I was no longer prediabetes and cholesterol dropped to normal levels.

Since then, I've continued to lose another 40 lbs and am no longer considered overweight.

The reason I'm sharing the anecdote is to share my surprise that almost all of the improvement in blood test came from the first 10 lbs (the extra 40 lbs I lost maybe improved numbers a bit more, but 90% improvement came after the first 10 lbs)

Similar here, but allergies instead of diabetes.

Went to a doctor, got a high blood pressure reading plus some cholesterol. Lucky the doc was reasonable and instead of giving me a bunch of pills, she just tested me for typical food allergies. Turns out I was allergic to 2/3 of my daily diet.

Once I've cut those foods out of my system, everything's back to normal. It really seems we can do quite a bit of good by just not harming our body to begin with.

Good on you for getting healthy but I feel compelled to point out that if you had 50 lbs to lose (without becoming severely underweight) you were pretty much by definition not "slightly" overweight.

Yes, you're right, I was clinically obese. (I'm also 6'2 - 50lb lost at that height is very different from someone of average height)

But thanks for that clarification :)

I think you'd be surprised how wide the 'overweight' range is with BMI. For myself: Normal: 117.8-159.2lb Overweight: 159.3-191.20

I'm 5'8. For a 6' person the range is going to be wider.

I recommend reading THE HACKER'S DIET to all my nerdy/hacker friends (like me) who seek to understand and engage in weight loss with some simple truths worded by a deep nerd himself (one of the authors of AutoCAD).

It made sense to me more than what the doctors told me I should blindly do "and it'll work". Things I already knew but just couldn't swallow (<-- nice pun here).

https://www.fourmilab.ch/hackdiet/

That is great book and every engineer should read it, but not because its correct, because it isn't - now I know enough of medicine to know that solution works because it is another way to say lets do IF.

The book is great because you can follow how engineer tries to solve a very hard problem.

What is not correct in the book?

I don't see at all how the book leads to intermittent fasting. He advocates for regular and predictable meal schedule, but does not advocate for meal count restrictions.

"How many meals, and when? Only total calories per day count." https://www.fourmilab.ch/hackdiet/e4/planningmeals.html

He eats once a day. That is IF.

Everything is wrong in the book, including that you can fix the sensor by measuring how much you eat and including that total calories per day count, because all calories are not equal.

Its very interesting book nevertheless.

Where in the book does he say you should only eat once a day? Where does he even day he does that?

> CHAPTER: How many meals, and when?

> I eat basically one meal a day, about 7 or 8 hours after I awake.

Before that he says it doesn't matter, but he based many thing on his own experience which is given above.

This is entirely wrong:

> Only total calories per day count. For the most part it doesn't matter when you eat them or how you spread them around the day, so long as your schedule stays pretty much the same, day in and day out

Lets say I eat every hour. That is going to be enormous stress to the liver for one. If you eat carbs you will basically simulate diabetes entire day... you may be thin depending on how much you starve, but you will still be candidate for insulin resistance. WRONG. We know better now, nutrition science progressed since the book was written.

As far as I know all respected research on the subject shows that for weight loss caloric deficit is indeed all that counts, do you have sources that say otherwise?

Of course many ways to achieve the caloric deficit will have side effects that may be detrimental in other ways, as the example you gave of liver stress, but that's a separate question from whether you lose fat mass or not. The Hacker Diet is focused on losing weight, not on achieving perfect health.

I'm still skeptical on meal schedule can have such a big impact on the liver to the point of causing insulin resistance. Is there any study comparing say IF with 8 meals a day with the same overall macronutrient intake?

I feel like the best way to lose weight is to make your own food for your whole diet, keeping processed foods to an absolute minimum. This alongside being aware of drinking mostly water instead of sugary drinks and keeping snacking to a minimum should lead to more gripability on one's diet, since tracking what one eats is much easier to remember when one cooks his own food. If this doesn't quite work, perform a calorie calculation once to be sure it lines with the dietary calculators to actually decrease caloric intake.

It's relatively easy to overeat when cooking your own meals, that's not a panacea, especially if the real problem is one of self-control.

Yeah I should be clear I have never had problems with overeating myself so I am coming at the issue with an outwards viewpoint. I have been 6'7" and 190-200 pounds for all my adult life, and have cooked most all my own meals since I moved for university, so at least for being weight consistent I haven't had much trouble. I moreso have observed that snacking foods + sugary drinks + fast food leads to a partial negligence of the diet, we often eat too fast and eat hard-to-estimate caloric worth quantities to recognize in our gut we are full enough.

Snack foods do tend to be calorie dense.

And preparing meals certainly puts oneself in better control over what goes in.

It's just been my experience that as a bachelor preparing meals for individual consumption, particularly as the ability to make tasty meals improves, weight gain is still a problem. It's challenging to make single servings from scratch without going even a little overboard, and for me at least, it's all getting eaten in one sitting.

Cooking for me has become viewed more as just a DIY form of JIT-processed food. It tends to be healthier than food processed by someone else, for lack of preservatives and less salt/sugars, and higher quality ingredients, but the cooking process still tends to produce something more calorically dense and unnaturally delicious I have difficulty resisting overeating.

The key to eating well is to make healthy eating take less effort than unhealthy eating. I like to cook large portions and save leftovers in the freezer. It takes only 4 mins to prepare a good meal from the freezer. This is a lot less effort than getting dressed, going outside, increasing my covid exposure risk, paying money, and getting unhealthy food.

I've tried a lot of different freezer containers. Nowadays, I use Rubbermaid Take-Along Food Storage Containers in 0.5 cup and 1.2 cup "twist & seal" styles. They're cheap and super durable. I clean them in a dishwasher. They are brittle when frozen so heat them a bit before opening.

A happy discovery: Make brown rice taste amazing by cooking it with some sticky rice. I cook 300g brown rice, 100g sticky rice, and 600mL water in an Instant Pot pressure cooker. This makes about 10 0.5-cup servings. The rice tastes great with Japanese curry, stir-fried veggies & tofu, veggies with chorizo and sausage, etc.

Another happy discovery: Cut meal prep time in half by cooking veggies separately in the microwave. You can ensure each one is cooked just enough. And you'll make less indoor air pollution. Use a large glass bowl with a wide lip to avoid burning your fingers. Use frozen ingredients to eliminate even the washing & cutting work. If you're making food to freeze, undercook the veggies since they will get cooked again during reheating.

I want to buy a squat round 1.2-cup food container, with a hole in the middle, and not brittle when frozen. The non-brittle material lets me eliminate the initial heating before opening the container. The hole in the frozen food block allows even heating in the microwave, letting me eliminate the step of separating the food. Does this product exist?

I have my own experience with weight loss. I used to get sick constantly, had low energy and snored at night. A few years ago got serious, started weight training(was running but weights made a huge difference), also cut out all the junk in my diet(snacking now healthy, more water). I was never obese, but just carried a good amount of weight, The results have been dramatic.

I no longer snore, and have ample energy throughout the day. And I have been getting sick alot less now. Other things that I found to be interesting is I now have a very good sense of smell, I can now smell very faint things my Wife cannot. Also I always had a terrible balance and that has changed dramatically as well for the better.

If there is one thing that was life changing for me, it is losing all the weight, I couldn't recommend it enough for everyone.

I have faced this issue on and off. My wife and kids tell me that I snore. This happens when i get overweight. I have been having difficulty in keeping the weight off. After losing weight, I get it back after few weeks. But yes, i stop snoring when i lose weight. I don’t know what the connection is between weight and snoring is.

Partial airway blockage by fat when you are in a prone position. Snoring is just a narrow air passage in sleep that makes sound by the pressure of air forcing its way through.

If you have the situation where your airway can become completely blocked temporarily, you have sleep apnea. If it's partially blocked, you snore, and you can have either one in different positions.

I think attributing all of the benefits to weight loss seems a bit rushed to me.

At the same time you lost weight you also improved the quality of your diet and started exercising. Any of those can be a factor to any of the improvements, and for some of them the weight loss it self may not even play a role.

Maybe you had sleep apnea? That can cause low energy and poor immune system function. If so, it's likely to come back as you age. Treatments are effective. One of my friends has it and CPAP gave him his life back.

Seconding this. It's been like night-and-day since I started using a CPAP.

Yup, the CPAP is a life-changer.

How many times can this be repeated? I wasn't quite prediabetic, but I lost a few kilograms. And then a few more. So far, over 20 kilograms, in fact. My diabetes risk should now be quite low.

Your diabetes risk should be asymptotically approaching zero given the premise.

In fact, by losing enough weight it can go negative, so you'll be curing diabetes in other people by sitting next to them on the bus.

Was it the weight loss that lowered your risk of diabetes? Or did the changes you made reduce both?

The headline is misleading. The result was from a getting support to make diet and lifestyle changes. That resulted in both losing weight and lowering risk of diabetes.

"Interventions A control arm receiving usual care (CON), a theory-based lifestyle intervention arm of 6 core and up to 15 maintenance sessions (INT), or the same intervention with support from diabetes prevention mentors, trained volunteers with type 2 diabetes (INT-DPM)."

I want to know if I'm reading this wrong because our conclusions were different. It feels like they tested whether additional mentorship worked, it didn't, but their conclusion was that the "interventions" worked on both groups.

From the "Findings" [1]

>> In this randomized clinical trial of 1028 participants with high-risk intermediate glycemic categories, the intervention significantly reduced the 2-year risk of type 2 diabetes by 40% to 47%, although lay volunteer support did not reduce the risk further. For every 11 participants treated, 1 diabetes diagnosis was prevented.

I took it to mean that the support added no additional benefit: both groups benefited from the treatment and the group treated with and volunteers did not outperform the control.

[1] https://jamanetwork.com/journals/jamainternalmedicine/articl...

Yes. In fact, as far as I can tell, the abstract does not even mention weight loss as an outcome (though it seems to me that this kind of intervention might lead to it).

I assume the submitter has read the full paper and can comment on it? Was the effect not significant, was it not preregistered, or was it not included in the abstract for some other reason?

Since the world is turning diabetic and on track to bankrupt the healthcare system in a decade or two, it helps to recognize a few facts about "diabetes". First, realize that "prediabetic"/"diabetic" is just a stupid number in A1c or glucose tolerance where recommended care is to start giving you drugs. It doesn't mean the glucose level in your blood isn't destroying your body before you reach that level. Metabolic syndrome is a range of insulin resistance, and the sooner you reverse it, the better. Don't wait for some doctor to tell you after two or three decades of slowly increasing insulin resistance that, "Now, we will do something." There is growing evidence that Alzheimer's should be renamed Type 3 diabetes, and some questions about Parkinson's being Type 4 diabetes. The brain is specially sensitive to excess glucose, and special sets of cells are more sensitive than other neurons (like in Parkinson's).

So how to measure insulin resistance? The gold standards is a continuous glucose monitor ($500). Then the glucose tolerance test (not the overnight fast), which takes hours and involves ingesting slugs of glucose and sampling blood over time. Ideally we would directly measure insulin in the blood, not glucose, but that is much harder so far.

One new test that holds out the hope of predicting diabetes years or even decades down the road is the LabCorp NMR LipoProfile with Graph[0][1]. Not yet FDA approved for diagnosis, this cheap test ($40 Medicare reimbursement) calculates an insulin resistance score that can be tracked year by year. I first learned of this test in an article in Managed Care Magazine, which seems to have gone out of business, leaving only a PubMed blurb pointing to it[2]. I was interested enough in my numbers that I paid for my own test, about $90 after Black Friday discount, in November 2018 at WalkInLab[3].

[0] https://www.labcorp.com/tests/123810/nmr-lipoprofile-with-li...

[1] https://www.labcorp.com/tests/related-documents/L15035

[2] https://pubmed.ncbi.nlm.nih.gov/29701589/

[3] https://www.walkinlab.com/products/view/nmr-lipoprofile-bloo...

Do you have any links on the connections between glucose and brain chemistry?

Sorry, just noticed your question. Dr. Georgia Eades is a psychiatrist specializing in nutrition and brain health. Here is an article where she summarizes various research on insulin resistance and neurodegenerative diseases[0].

Dr. Eades seems to enjoy poking holes in current nutrition recommendations, but she is able to back her statements up with lots of facts. For example, I first learned of her work when someone here on Hacker News linked to this video[1] about the dangers of eating plants. Say what? It was eye opening to realize, for example, that the difference between fruits and vegetables is that plants want us to eat fruit, and very much do not want us to eat the vegetables. Plants go so far as to evolve defenses that our bodies have to mitigate when we eat a lot of plants.

[0] https://www.psychologytoday.com/us/blog/diagnosis-diet/20190...

[1] https://www.youtube.com/watch?v=YdRBFiBWQZQ

Bankrupt the health care system, where? In the States it is covered by insurance (or bankrupts uncovered people), and all other countries have different configurations for health care, some from non existant universal coverage, to full coverage. I can only imagine a poor country with full universal coverage having a risk of bankruptcy due to one axis of disease along these lines (diabetes).

This is like saying water makes trees grow. Yes, loosing weight means consuming less calories. The body moves calories around as glucose. High glucose = weight gain (and above a certain limit you can't gain weight faster and then you look like type 2 diabetes). Keeping your glucose near floor (there's a lot of biological controls that keep glucose above 80) = weight loss.

I think this is actually easy to explain.

To lose weight you need to be in energy deficit.

When one is in deficit, the body starts to use stored fat.

Body prefers certain types of stores to others.

One of the first and most dangerous stores is fat in the liver, which is common for high fructose eating humans.

This fat is the primary reason for being in metabolic disease aka pre diabetes state.

So once body burns off fat from liver, your pre diabetes vanishes.

A more accurate title would be "healthy lifestyle improvements leads to improved odds in type2 diabetes prevention in obese older women."

That's what the results section of that paper is saying. Unfortunately we can't really see more without paying $30 to read it.

There's a great bit on Anatomy Life And Death where they show 2 arteries. One is ever so slightly thinner, in diameter. The speed fluid flows through them is vastly different...

My friends mother has always been skinny and almost underweight but she's been diabetic since her late 40's. I know its sample size 1. but I always wonder if there are other reasons other than just weight?

Of course there are. There are always going to be one-off or few-off cases in medicine (see "idiopathic" anything). Which is why larger scale studies are so important.

Important to distinguish between Type 1 and Type 2 diabetes, one of which is genetic and the other isn't.

Type 2 diabetes

Have a feeling this is a correlation and not direct causation. You have to eat less / better to lose the weight. That helps with your insulin resistance.

It's also possible that people who are suddenly interested in losing weight and exercising more have an increased awareness in what they're eating.

I wonder if you could form a study to disambiguate it by using liposuction patients in some way.

edit: https://www.webmd.com/beauty/news/20000825/study-looks-at-wh...

You do not have to eat better to lose weight. You only have to eat less.

edit To correct confusion, I am saying "eat less" to mean "be at a caloric deficit." Weight loss is caused by caloric deficit, nothing else.

Can confirm, lost 25kg this year.

This mindset is why people find it hard to lose weight. Can't we agree that it's both?

It doesn't have to be either one! You could just exercise more.

You mostly have to control what you eat. One donut takes like 3 hours to burn off at a good clip on a treadmill.

I think that thinking you can make up for eating habits with exercise at all will just get you into trouble. You should exercise for health, but unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management

> One donut takes like 3 hours to burn off at a good clip on a treadmill.

You're way off. A "Frosted Snowflake Donut" from Dunkin weighs in at 270 calories. [1]

A 155-pound person will burn 298 calories in 30 minutes doing 12-minute miles on a treadmill, [2] which is probably less than "a good clip".

> You should exercise for health, but unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management

My personal experience just does not bear this out.

I used to ride bikes a lot. The I stopped because I didn't have as much time for it anymore. I eat noticeably less. I also gained 20 pounds.

[1]: https://www.dunkindonuts.com/content/dam/dd/pdf/nutrition.pd...

[2]: https://www.health.harvard.edu/diet-and-weight-loss/calories...

> One donut takes like 3 hours to burn off at a good clip on a treadmill

I don't know where you get this idea but I see this meme really often in defeatist "it's impossible to lose weight" discussions. It's so easy to research, I don't know why it spreads so easily.

A Krispy Kreme caramel glazed doughnut is about 220 kcal[0] and a very light treadmill session (30 minute, 5% incline, 3 mph) will probably burn in the 220 range[1].

> unless you’re a professional athlete, your voluntary physical activity is a rounding error in terms of weight management

Absolutely not. It's true that for somebody that eats/burns ~2000 kcal in a day, about 1500 of that is for just existing (the resting metabolic rate[2]). But even small amounts of exercise are significant: that 30-minute speedwalk is 10% of your calorie intake! Turning it up to a jog can easily be twice that.

[0]: https://s3.amazonaws.com/kkd-e1-images.kktestkitchen.com/eco...

[1]: https://www.sparkpeople.com/resource/calories_burned.asp?exe...

[2]: https://www.verywellfit.com/metabolism-facts-101-3495605

and to add on an important extra data point, 1lb of fat is roughly 3500 calories. So that one 220 calorie treadmill walk is 0.06lb or about 1lb lost per 16 walks, changing nothing else.

Or put another way, if your office is a 30 minute walk away then you can lose just over 2.5 lb/mo by just changing your routine to walking instead of driving (5×2×4×220÷3500 = ~2.5) and not changing your diet at all.

Exercise helps you eat less. It really does have to be all 3.

No, and in fact, most people report an increased level of hunger when starting an exercise regime because of their increased energy expenditure.

Sure, I was abstracting "Eat less" to mean "Be at a caloric deficit", which is the only requirement for weight loss. Exercising more obviously meets that criteria as well.

But how true is that for weight loss specifically?

Sure the food that's phrased as 'unhealthy' might not be what's best for you, but we shouldn't spread falsehoods.

https://www.npr.org/2010/11/12/131286626/professor-s-weight-...

That professor is stupid. Obviously he lost weight, it's thermodynamics. Energy in, energy out, or whatever. But he is no doubt less healthy after the experiment and probably more susceptible to things like diabetes.

This thread all started as a result of talking about weight loss, not health. Also, you're ignoring all of the health improvements weight loss brings even without any other change in behavior (diet, exercise, sleep).

How can it be both though? If you eat a little healthy food or a little garbage you'll lose weight, and if you eat a lot of healthy food or a lot of garbage you'll gain weight.

As far as weight loss is concerned, "healthy" food helps insofar as it makes it easier to eat less and exercise more, which is a property that some (not all) healthy foods accidentally happen to have, and which they share with a variety of less healthy calorie sources.

Think about why you want to lose weight. Is it to be healthier, or is to reach an arbitrary number? If it's the latter then maybe you can just pound down 1500 calories of cake a day. If not, then you actually do need to eat healthy. The health benefits don't come from weighing less, they come from having a healthier body composition and less visceral (internal) fat.

This attitude strikes me as harmful.

1. Why exercise if you never plan on engaging in vigorous hobbies or professions?

2. Why seek physio therapy for a stiff joint if you spend your days on the couch or in a chair?

3. Why see a dentist if you only receive calories from drinking soylent?

4. Why bathe if you never leave your house?

There's some philosophy of morals argument to be made here similar to the concept of whether it is good or bad to eat arsenic.

Not sure what your point is.

1. Because it's healthy and feels good

2. Because it's healthy and may stop future problems

3. Because it may stop future problems

4. Because it feels good

So why lose weight for the sake of losing weight? It's neither healthy nor fun if you do it the wrong way.

> So why lose weight for the sake of losing weight?

Because chronic obesity is associated with numerous morbidities.

The same answer you gave for (3) applies to avoiding obesity.

> Think about why you want to lose weight. Is it to be healthier, or is to reach an arbitrary number?

Many possible reasons. You would be surprised at the number of people doing it mainly to be able to fit into pretty clothes.

It's difficult to find motivation to lose weight to be healthier when you don't actually have any health problems yet.

From my point of view (currently mid 40s and undergoing my very first attempt at losing weight in my life), losing weight of course means consuming fewer calories than you burn. However, eating healthy foods is what makes that a less miserable experience. Eating foods that take a while to digest and sit in your stomach for a while making you feel full like whole grains, nuts, fresh fruit and vegetables, and enough protein to keep your muscle mass, will make it a lot more likely to lead to success than simply "eating less."

Hmm. Worked fine for me. Calorie counting but no other dietary modification let me drop 30kg. Better (and less processed) food choices came about naturally as an effect of caloric restriction and understanding of the makeup of food I was consuming, not as the driver.

The notion that one has to pound salads and give up enjoyed foods is also a mindset that causes people to struggle in maintaining a healthy weight.

30kgs! Good on you ( assuming that is a healthy amount to lose). From my own point of view, I have grown to like a quality salad, and they are very easy to make quickly. Some fresh variety of greens from the store, half an avocado sliced, cubes of roasted golden beet, add roasted/salted pistachio nuts or sunflower seeds, layer a few chunks of roasted chicken on top, add olive oil and your choice of tasty vinegar (e.g., balsamic), and a dash of salt and mix. 5 minutes to prep if you have all the ingredients. Divine!

No, because that's not how calories work.

Calories in == calories out is probably the worst lie in mainstream medical/nutritional guidance today. In a purely mathematical model is it obviously true but the reality is that our body deals with macro-nutrients (carbs, protein, fat) very differently.

It does, but over long enough time spans chronic caloric deficiency will result in weight loss, regardless of the form of the calories consumed.

Some calories are better than others for short term outcomes, of course.

Calories in/calories out ignores that fact that the _type_ of calorie matters a great deal. It also ignores the fact that the body is capable of moderating its metabolic rate in response to energy requirements and supply.

If calories in and out were _really_ all that mattered, I would be able to calculate my energy needs precisely and then eat exactly the right number of cupcakes (and only cupcakes) every day for the rest of my life. And yet we intuitively know that would be extremely unhealthy. Why is that?

I'm not disagreeing with you on the good calories, bad calories concept. Simply that calories in/out is, when applied as a chronic deficiency, effective at reducing weight over long periods of time. No, you should not eat 750 calories of cupcakes and cupcakes alone.

You're mixing two different arguments together. Calories in/out is the only requirement for weight loss. Calories in/out is a percentage of the overall picture we define as "health".

To lose weight, you only have to be at a caloric deficit. You can eat _only_ three cupcakes a day and probably lose weight (unless they're kinda insane cupcakes). If you only eat 3 cupcakes a day and nothing else, you will be malnourished and nutrient deficient, which I would extend to mean "unhealthy", but you will lose weight.

> Have a feeling this is a correlation and not direct causation

Classic. An HN commenter's gut feel (no pun intended) apparently outweighs a serious piece of work. Here's the results from the actual study [0] referenced in the article:

In this study, 1028 participants were randomized (INT, 424 [41.2%] [166 women (39.2%)]; INT-DPM, 426 [41.4%] [147 women (34.5%)]; CON, 178 [17.3%] [70 women (%39.3)]) between January 1, 2011, and February 24, 2017. The mean (SD) age was 65.3 (10.0) years, mean (SD) body mass index 31.2 (5) (calculated as weight in kilograms divided by height in meters squared), and mean (SD) follow-up 24.7 (13.4) months. A total of 156 participants progressed to type 2 diabetes, which comprised 39 of 171 receiving CON (22.8%), 55 of 403 receiving INT (13.7%), and 62 of 414 receiving INT-DPM (15.0%). There was no significant difference between the intervention arms in the primary outcome (odds ratio [OR], 1.14; 95% CI, 0.77-1.7; P = .51), but each intervention arm had significantly lower odds of type 2 diabetes (INT: OR, 0.54; 95% CI, 0.34-0.85; P = .01; INT-DPM: OR, 0.61; 95% CI, 0.39-0.96; P = .033; combined: OR, 0.57; 95% CI, 0.38-0.87; P = .01). The effect size was similar in all glycemic, age, and social deprivation groups, and intervention costs per participant were low at $153 (£122).

[0] https://jamanetwork.com/journals/jamainternalmedicine/articl...

HN's medical advice is on par with it's advice on law and economics.

*its (cause if there's one thing we do well, it's pedantry!)

I don't think the OP is denying the results of the study, but trying to understand if it is the acts associated with losing weight or actually weighing less.

Yeah in this case OP is right though, you can gain muscle mass, be very active, and eat healthy. It is 100% a correlation.

Actually I would describe what you posted an example of a limitation of the correlation, since it uses BMI.

I don't fully blame OP, the HN title is simply wrong.

The paper does not say that weight loss lowers the risk of diabetes. Which would imply a causal relationship. The paper says that "lifestyle intervention" lowers the risk of diabetes. This intervention could also explain the weight loss, hence a corollary relationship.

That said, there is such a thing as bad science and there is literally decades of it when it comes to nutrition and chronic diseases. And more keeps coming out all the time. I don't blame the OP for being skeptical, but he/she was skeptical of the wrong thing in this case.

Yep. Diabetes (type 2 at least) is widely understood to be the result of chronic insulin resistance, which can be remedied with diet. No one has shown a causation between weight and and diabetes but the correlation is definitely there because they have the same root cause.

In fact, weight alone cannot be the cause because there are plenty of overweight older individuals who never develop the symptoms of diabetes.

This is crap. There are people, myself included, which are simply predisposed to insulin resistance. For reference, I'm 145lbs @ 5'10", exercise daily, and eat relatively well. My last A1C was 5.6. To some extent, yes, diet will help; however, insulin resistance is a complex metabolic process that is absolutely rooted in your genetics, so simply telling people to eat less and/or lose weight is facile at best.

There may be a genetic component to Type 2 diabetes but _most_ people who are diagnosed with it are indeed quite overweight and have decades of poor lifestyle choices behind them. If we can help those people understand that diabetes is not always inevitable, even if it's not helpful for a small percentage, then that sounds like a net win for me.

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