While type 2 diabetes and being overweight have long been linked, it was not until 2015 that researchers from the UK’s Newcastle University demonstrated that individuals have a personal fat threshold. Normal weight, skinny fat or overweight, if we have more fat inside the body than we are individually able to cope with, we are at risk of diabetes. Some people have a higher, others a lower, personal fat threshold.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to any supporting studies or resources are at the end of page.
In 2008, led by Professor Roy Taylor, the research team revealed that type 2 diabetes is triggered the accumulation of fat in the liver and pancreas - the 'twin cycle hypothesis'.
For those with a high BMI, over 27, Taylor’s team showed in the DIRECT trial (2018) that diabetes could be reversed with diet-induced weight loss. The trial participants were placed on a 3 month low-calorie ”soup and shake” diet. After that time they were supported by a team to reintroduce healthy food and maintain weight loss. After 12 months, almost 50% of participants had achieved remission.
The research team revealed that type 2 diabetes is triggered by the same factors in individuals with normal weight as it is in those with obesity.
Most recently in the ReTUNE study (2023), Taylor’s team produced similar results on people with a lower BMI of 21 to 27, many of these people having a 'normal' BMI. 20 participants with type 2 diabetes, despite having an average BMI of 24.8, underwent a structured weight loss program involving an 800-calorie daily intake, followed by weight maintenance phases. Astonishingly, 70% of these participants achieved remission, defined by an average blood sugar level (HbA1c) of less than 48mmol/mol for at least six months, with no medication needed. Their weight loss averaged 10.7% of their initial body weight.
Crucially, the study's MRI scans demonstrated significant reductions in liver and pancreatic fat levels, indicating improved organ function. Notably, the fat content in the liver dropped from 4.1% to 1.4%, aligning with healthy control levels, while pancreas fat reduced from 5.8% to 4.3%. These results underline the pivotal role of managing body fat composition in treating type 2 diabetes, regardless of body weight.
These studies have challenged the way we understand and approach type 2 diabetes on an individual level. They emphasise the importance of recognising individual thresholds and encouraging treatments to lose and subsequently manage weight. To implement eating practices to support weight loss and - vitally - in providing support, so that people can successful reach their goals and continue to live healthily thereafter. Taylor's findings showed that familial support are a vital part of the health equation.
Patients could achieve substantial weight loss in a short period of time, to bring their weight below their personal fat threshold and put diabetes into remission.
As part of their weight loss protocol, Taylor's team created a dietary protocol, including a formulated shake-drink, for study participants. There are other effective diets that can be used for weight loss as well. Diabetes remission is not only affected by weight loss, many other factors (the pillars of health) have a role to play. Exercise, sleep, work-life balance are all issues that can be addressed as part of a whole person approach to health.
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To learn more about Dr Taylor and the work of the team at Newcastle University, click here.
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Related Studies
Taylor R, Barnes AC, Hollingsworth KG, Irvine KM, Solovyova AS, Clark L, Kelly T, Martin-Ruiz C, Romeres D, Koulman A, Meek CM, Jenkins B, Cobelli C, Holman RR. Aetiology of Type 2 diabetes in people with a 'normal' body mass index: testing the personal fat threshold hypothesis. Clin Sci (Lond). 2023 Aug 31;137(16):1333-1346. doi: 10.1042/CS20230586. PMID: 37593846; PMCID: PMC10472166.
Unwin D, Delon C, Unwin J, Tobin S, Taylor R. What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss. BMJ Nutr Prev Health. 2023 Jan 2;6(1):46-55. doi: 10.1136/bmjnph-2022-000544. PMID: 37559961; PMCID: PMC10407412.
Dambha-Miller H, Day AJ, Strelitz J, Irving G, Griffin SJ. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med. 2020 Apr;37(4):681-688. doi: 10.1111/dme.14122. Epub 2019 Sep 26. PMID: 31479535; PMCID: PMC7155116.
Taylor R, Holman RR. Normal weight individuals who develop type 2 diabetes: the personal fat threshold. Clin Sci (Lond). 2015 Apr;128(7):405-10. doi: 10.1042/CS20140553. PMID: 25515001.
Leslie WS, Ford I, Sattar N, Hollingsworth KG, Adamson A, Sniehotta FF, McCombie L, Brosnahan N, Ross H, Mathers JC, Peters C, Thom G, Barnes A, Kean S, McIlvenna Y, Rodrigues A, Rehackova L, Zhyzhneuskaya S, Taylor R, Lean ME. The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial. BMC Fam Pract. 2016 Feb 16;17:20. doi: 10.1186/s12875-016-0406-2. PMID: 26879684; PMCID: PMC4754868.
Taylor R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause. Diabetologia. 2008 Oct;51(10):1781-9. doi: 10.1007/s00125-008-1116-7. Epub 2008 Aug 26. PMID: 18726585.
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