Where your fat is stored in the body and reducing it is much more important than just losing overall weight to reduce your risk of diabetes, according to a new study published in Nature. In other words, those who have prediabetes, a condition when your blood sugar is elevated but is not high enough to be classified as diabetes, should focus on removing belly fat first because that can be more impactful than losing weight overall through lifestyle corrections.

Halting prediabetes is very important as almost 70 per cent of people in this category eventually develop diabetes in their lifetimes. Reversing prediabetes also protects you from diabetes-related complications like cardiovascular conditions, kidney disease and neuropathy.

What about study findings?
Two groups in the study did not show any marked difference in overall fat levels but differed in the patterns of fat storage. Those who reported a greater reduction in belly fat (visceral adipose tissue) after one year were able to reverse prediabetes than those who did not achieve healthy blood glucose levels.

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Study authors from the University Hospital Tübingen in Germany found that focussed lifestyle intervention can bring prediabetics into remission even without significant weight loss.  This remission, they said, cuts future Type 2 diabetes risk by approximately 70 per cent over up to 10 years.

From the 1,105 participants with prediabetes, researchers focussed on data from 234 participants who did not achieve weight loss. Fifty-one participants from this cohort of 234 individuals, who did not achieve weight loss, showed prediabetes remission after a year of lifestyle interventions, whereas the remaining 183 individuals did not achieve healthy glucose levels.

Does this study hold lessons for Indians?
“Weight loss remains the primary target for individuals who are obese. However, reversal of prediabetes can also occur without significant weight reduction, particularly when lifestyle interventions focus on improving diet quality and enhancing physical activity with the aim of increasing muscle strength, reducing fat mass and increasing lean mass rather than solely losing weight. Unlike the findings from this study conducted in a US population, in Indians, reduction of both abdominal subcutaneous fat and intra-abdominal (visceral) fat is crucial for metabolic improvement. These changes should ideally occur alongside an increase in muscle mass and functional capacity, which together contribute to improved insulin sensitivity and sustained glycaemic control,” says Dr Anoop Misra, chairman, Fortis C-Doc Hospital for Diabetes and Allied Sciences.

Why abdominal obesity is priority
Belly fat, also known as abdominal fat and visceral fat, releases inflammatory substances which impair the hormone insulin from moving sugar out of the bloodstream and into the cells. Given the inflammation, the body compensates by producing more insulin, but this can overwhelm the pancreas and lead to elevated blood sugar levels.  According to Dr Misra, excess sugar is converted into fat and stored in layers around the abdomen. This is the reason why people with normal body weight but protruding stomachs tend to develop diabetes.

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What lifestyle interventions should be done to reduce abdominal fat?
“Diet is always important, especially the ratio of macronutrients. Lower carbs, high protein and high monounsaturated fat, within the same calorie quota, will help in reversing prediabetes, without much weight loss,” says Dr Misra. Sources of healthy carbohydrates include whole grains, fruits, non-starchy vegetables and legumes. Healthy fats include nuts, seeds, olive oil and fatty fish.

Studies have shown that physical exercise reduces visceral fat. Combining resistance training that includes lifting weights at least two times a week in addition to aerobic exercises like walking, running and swimming, should be enough. Of course, a seven-hour sleep is non-negotiable to reduce blood sugar.