A medical expert weighs in with practical, proven tips to help you achieve and maintain successful weight loss.

Losing weight with type 2 diabetes can present unique challenges, but with the right support, it can be a journey that leads to meaningful improvements in health and well-being.

Dr. Jennah Siwak, a board certified obesity specialist known to many in the GLP-1 medication community on TikTok as @WeightDoc, approaches this challenge with a blend of evidence-based medicine, compassion, and realism.

In this guide, Dr. Siwak shares how she helps patients navigate weight loss for better health outcomes, not just for the number on the scale but to prevent complications like kidney disease, heart disease, and neuropathy.

“There is no research-proven ‘best’ diet or ‘best’ macronutrient pattern for people with diabetes,” Dr. Siwak explains.

Instead of chasing trends, she emphasizes improving the quality of the diet. That means building meals around:

  • non-starchy vegetables
  • fruits
  • legumes
  • whole grains
  • nuts
  • seeds

It also means cutting back on:

Diets like the Mediterranean and DASH diets are often recommended because of their heart-health benefits. “Diabetes and obesity are risk factors for heart disease,” Dr. Siwak says, “so I often recommend a heart-healthy diet.” These patterns help lower blood pressure, cholesterol, and overall cardiovascular risk.

But sustainability is key. “The most effective dietary pattern for weight loss is the pattern that is sustainable,” she says. A restrictive plan, even one that promises fast results, is not worthwhile if a patient can’t stick to it long-term.

To make nutrition truly personal, Dr. Siwak refers many patients to registered dietitians. “Meal plans should be individualized and are best provided by a registered dietician with experience in diabetes and obesity care.”

People often overlook the impact of sleep on weight and high blood sugar. “Sleep has been linked to weight,” Dr. Siwak notes. Poor sleep or untreated sleep disorders, like obstructive sleep apnea (OSA), can disrupt hormones involved in appetite, such as leptin and ghrelin.

“Not getting enough sleep is associated with low leptin (decreased satiety) and high ghrelin (increased hunger),” she says.

Fatigue from chronic sleep deprivation can reduce motivation to be active, creating a feedback loop that worsens both weight and glucose control. Addressing sleep issues, including testing for OSA, can become a crucial part of a successful weight loss plan.

GLP-1 receptor agonists like Ozempic, Wegovy, and Mounjaro can be powerful allies for patients managing both type 2 diabetes and obesity.

“GLP1s can be a great tool,” Dr. Siwak says, noting that they lower appetite by slowing gastric emptying (the rate at which food leaves the stomach and enters the intestines) and signaling satiety (fullness) to the brain.

“They also provide glycemic control (helping to keep blood sugar levels stable) through effects on the pancreas to help our bodies process glucose more efficiently.”

Still, medications are not magic. Lifestyle and behavioral changes remain critical, and medications should be considered part of a comprehensive treatment plan rather than a substitute for them.

Navigating a new diagnosis like type 2 diabetes or facing a major physical transformation through weight loss can come with a wide range of emotional responses. While some people experience a boost in confidence from weight loss, others feel let down when weight loss doesn’t fix everything they hoped it would.

“Often the expectation is ‘If I can JUST lose the weight, EVERYTHING will be better,’ and it turns out that weight loss does not make everything else better,” Dr. Siwak says. This emotional gap can even lead to worsening mood or lingering body image issues.

Stress is another important factor that can interfere with healthy behavior change. It can affect sleep, eating patterns, and overall motivation, making it harder to stay consistent with healthy routines.

Addressing stress through mental health support, self-care practices, and realistic goal-setting can make a meaningful difference.

She emphasizes the importance of processing these emotions with support. “I commonly refer to our therapist and counselor friends working in behavioral health,” she says. A strong support system, whether through friends, family, or local groups, can also help people stick with lifestyle changes.

Managing expectations is one of the most powerful things Dr. Siwak does with her patients. “Don’t compare yourself to people sharing their weight loss journeys online,” she warns.

Rapid weight loss is unsustainable and can have side effects like muscle loss, fatigue, and hair loss.

“Ideally we do not want people losing more than 1% of their body weight per week,” she says. That’s usually no more than 1 to 2 pounds per week. And slow progress often leads to better long-term outcomes.

She encourages patients to focus on non-scale victories: improvements in lab values like A1C, glucose, cholesterol, and even normalized liver enzymes. These are signs that health is improving, even if the scale isn’t moving quickly.

Early interventions can be more effective for newly diagnosed patients because their insulin resistance may not be as severe. But for those with long-standing type 2 diabetes, Dr. Siwak emphasizes setting realistic goals.

“In type 2 diabetes, there is a progressive decline in the function of the beta cells of the pancreas,” she explains. That means weight loss may not eliminate the need for medication, especially if the disease has been present for many years. “Losing weight won’t necessarily negate the need for diabetes medications.”

This reality can be disappointing, but it doesn’t mean efforts are wasted. Even modest weight loss can improve blood sugar levels, reduce cardiovascular risk, and enhance quality of life.

One of the most common misconceptions Dr. Siwak encounters is the idea that type 2 diabetes is purely a result of poor lifestyle choices. “Most people with type 2 diabetes have a family history,” she says. “There is a strong genetic component to diabetes.”

She explains that genetics is like the “lock,” and lifestyle is the “key.” Healthy habits can delay or reduce the severity of diabetes, but they can’t always prevent it entirely. Blaming yourself for a diagnosis is not only emotionally painful, but also often based on misunderstandings about the true causes of type 2 diabetes.

Managing type 2 diabetes through weight loss, if that is medically recommended to you, is not about finding the perfect diet or medication. As Dr. Jennah Siwak puts it, “Show yourself grace! Losing weight is really hard, and we know it can be even more difficult for people with metabolic disease, such as type 2 diabetes.”

A sustainable, compassionate approach that combines nutrition, mental health support, medical tools, and lifestyle changes is the best path forward, and it’s one that should be personalized every step of the way.