How do people with type 2 diabetes experience the behaviour change processes involved in weight loss and maintenance?

A recent UK study in Diabetic Medicine uses qualitative interviews to explore behaviour change processes

By Shaira Baptista


Losing weight improves health outcomes among people with type 2 diabetes. A recent landmark study (the Diabetes Remission Clinical Trial: DiRECT) has shown that a structured weight management programme can, in some cases, achieve and sustain ‘remission’ of type 2 diabetes (i.e. blood glucose levels in the non-diabetes range without medical intervention). However, achieving and maintaining significant weight loss can be very difficult, so it is important to understand what contributes to long-term outcomes.

To understand more about behaviour change processes underlying weight loss, Dr Lucia Rehackova and colleagues interviewed eleven people with type 2 diabetes who took part in the Counterbalance Study three times: at the start and end of the 8-week weight-loss program, and then again at month 8, the end of the weight maintenance phase. Four themes were identified in the participants’ interviews:

  1. ‘Building behavioural autonomy’ – participants describe how having their food limited to meal replacement shakes and soups during the weight loss phase of the program required them to find new ways to incorporate these new eating habits into social situations. Many realised that because they had different food needs from other people, it was important for them to learn how to eat differently in front of other people, thereby developing a sense of independence from other people.
  2. ‘Behavioural contagion’ – some described how the changes they were making resulted in similar behaviour changes in their friends and family members. Mutual participation made behaviour change easier and also improved the quality of relationships with friends and family members.
  3. ‘From rigid to flexible restraint’ – sticking to a regimented meal replacement diet during the weight loss phase was described as being easier than forming new eating habits. While the maintenance period offered more flexibility with food choices, it also required more effort, and readjusting to ‘normal’ food had less predictable consequences (e.g. weight gain) than meal replacements alone.
  4. ‘Shift in identity’ – when participants reflected on their past behaviours prior to participation, they described an increased awareness and more confidence in their abilities to make healthy food choices. Many participants described how they felt like they had a new identity as a ‘non-fat’ person and wanted the change they saw in themselves to be permanent.

Weight loss can be beneficial to many people with type 2 diabetes but it is difficult to achieve. The findings from this qualitative study offer new insights into how people with type 2 diabetes experience this conscious behaviour change. The findings have important applications to weight loss interventions for people with type 2 diabetes. For example, helping people to cope with social situations and increasing the involvement of significant others may enable initial behaviour change and long-term maintenance of weight loss.

Rehackova L, Araújo-Soares V, Steven S, Adamson AJ, Taylor R, & Sniehotta FF. Behaviour change during dietary Type 2 diabetes remission: a longitudinal qualitative evaluation of an intervention using a very low energy diet. Diabetic Medicine, 2020; 37(6), 953-962.