Weight Loss
While genetics, environment, and social determinants all play a role, one of the strongest drivers of type 2 diabetes is excess body weight. Research over the past two decades has shown that intentional weight loss can not only improve blood glucose control but in some cases even put diabetes into remission. Understanding how weight, metabolism, and culture intersect is key to improving outcomes.
Why Weight Matters in Type 2 Diabetes
Carrying extra weight — particularly around the abdomen and in the liver and pancreas — makes it harder for the body’s insulin to do its job. This insulin resistance means blood glucose levels rise. Over time, the pancreas struggles to keep up with the demand, and type 2 diabetes develops. In New Zealand, rising rates of obesity have paralleled the increase in diabetes prevalence. For Māori and Pacific peoples, these trends are influenced not only by biology but also by structural inequities, food environments, and colonisation-related disruptions to traditional food systems and physical activity.
Evidence That Weight Loss Works
Clinical trials have shown that weight loss can transform the trajectory of type 2 diabetes. The landmark DiRECT trial in the UK found that nearly half of participants who lost more than 10 kg through a structured, low-calorie diet achieved diabetes remission after one year. In New Zealand, lifestyle-focused trials such as the Let’s Beat Diabetes programme in South Auckland and culturally tailored initiatives like Whānau Ora health services have highlighted the importance of community-led, culturally grounded support in achieving meaningful weight loss and better health outcomes.
Even modest weight loss — around 5–10% of body weight — can significantly improve blood sugar control, blood pressure, and cholesterol. Larger losses of 10–15% or more provide the greatest chance of remission. This is encouraging, because it means that remission is not an unrealistic goal, but it does require sustained effort and supportive systems.
Approaches to Weight Loss
There is no single “right” way to lose weight; the best approach is the one that works for the individual and whānau (family).
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Lifestyle approaches: Diet and physical activity remain the foundation. For many people, structured programmes with meal replacements or low-calorie eating plans help kickstart weight loss. Increasing physical activity supports not only weight management but also insulin sensitivity and mental wellbeing.
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Medications: Newer diabetes and weight-loss medicines, such as GLP-1 receptor agonists, are proving powerful tools. In New Zealand, access to these medicines is currently limited and inequitable, raising important questions about fairness – see below for more info
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Surgery: Bariatric (metabolic) surgery can achieve dramatic and long-lasting weight loss, often leading to diabetes remission. However, it is available to only a small fraction of those who might benefit, with barriers including surgical capacity, referral pathways, and funding.
For Māori and Pacific communities, successful programmes go beyond diet and exercise advice. They integrate cultural values, strengthen collective identity, and address barriers such as cost, access to healthy food, and safe spaces for activity.
Weight loss medications
| Medication | Funded for T2D? | Key Eligibility / Restrictions (Special Authority Criteria) | Notes |
|---|---|---|---|
| Liraglutide (Victoza) | Yes, funded for type 2 diabetes for people who meet eligibility criteria. | As of 1 March 2025, new people who meet criteria can start funded liraglutide. Criteria include: • Have T2D, and • Tried other appropriate blood-glucose lowering treatments (e.g. metformin, etc) without achieving target HbA1c, especially in people with high risk of cardiovascular or renal complications. Pharmac+2Pharmac+2 • Also, special authority rules: for example, not combining with certain therapies unless specific conditions are met (e.g. heart failure treatments) Pharmac+1 • There is a maximum subsidised supply (e.g. # of pens per month). Pharmac | While liraglutide is approved for weight management (as Saxenda) in NZ, that obesity-indication is not funded. So people with obesity without diabetes generally must self-fund. The pharmacologically funded use is for glucose lowering in T2D, not directly for obesity. Best Practice Advocacy Centre+2goodfellowunit.org+2 |
| Dulaglutide (Trulicity) | Yes, funded for type 2 diabetes under certain criteria. | • Until recently, there was a restriction due to supply: no new patients could start on funded dulaglutide. Pharmac+3Pharmac+3Pharmac+3 • From 1 July 2025, that restriction is lifted for patients meeting criteria (similar to liraglutide): T2D, failed other glucose-lowering therapies, high cardiovascular / renal risk etc. Pharmac+1 | Same as for liraglutide: the funding is for the diabetes indication. Even though dulaglutide often causes weight loss, its funded use is for glycaemic management. Using it solely for weight loss (in someone without diabetes) is not funded. |
| Semaglutide (Wegovy / Ozempic) | Part-funded (for diabetes) but with complications | • Ozempic (semaglutide) is approved to treat type 2 diabetes. Pharmac | Because it is not funded, many people who might benefit must pay themselves. Cost is a major barrier. Its weight loss effects are strong, but the lack of subsidy for many means inequity in access. |
| Other drugs (Orlistat, Naltrexone + Bupropion, Phentermine / Duromine) | • But Pharmac does not currently fund semaglutide for either weight loss (Wegovy) or the diabetes brand (Ozempic). There has been no successful application yet. Pharmac | These would typically need to be self-funded. There is no indication from recent Pharmac decisions that they are subsidised for weight loss or T2D overall beyond their usual prescribing if any. | Because these are not subsidised, their cost can be prohibitive. Also their effectiveness is generally less than GLP-1s in terms of sustained weight loss + glycaemic benefit. |
| ** Please think twice about trying to buy weight loss drugs over the internet! There are many scammers out there and it really is best to involve your health care team. |
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The Challenge of Sustaining Weight Loss
Losing weight is difficult; keeping it off is harder. The body resists long-term weight loss by slowing metabolism and increasing appetite signals. This biological “push back” helps explain why many people regain weight. In New Zealand, food environments dominated by cheap, calorie-dense foods and limited availability of fresh, affordable produce in some communities make it even tougher.
Ongoing monitoring and support are crucial. Long-term success often comes from a combination of regular health checks, whānau support, community programmes, and when available, medical or surgical options. Importantly, sustainable weight loss strategies recognise that obesity and diabetes are not simply about individual choices but are shaped by social, cultural, and economic contexts.
A Message of Hope and Equity
Weight loss is not a cure-all for type 2 diabetes, and remission is not always permanent. But for many people, achieving even modest weight reduction can bring significant improvements in health and quality of life. In Aotearoa, tackling weight and diabetes together requires not just clinical solutions but also systemic change: affordable healthy food, walkable communities, culturally appropriate care, and equitable access to new treatments.
For Māori and Pacific peoples in particular, solutions must be co-designed with communities, drawing on cultural strengths, traditional food knowledge, and collective approaches to health. When these elements are combined with scientific advances, the pathway to better diabetes outcomes becomes much stronger.
Conclusion
The science is clear: weight loss can prevent, manage, and even reverse type 2 diabetes. But sustaining these benefits requires long-term support at every level — individual, whānau, community, and health system. In Aotearoa New Zealand, the challenge and opportunity lie in weaving together biomedical evidence with cultural and systemic approaches, ensuring that all people, regardless of background, can access the benefits of healthier weight and improved diabetes care.
| Language Matters: Talking About Weight and Diabetes |
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| How we talk about weight can shape how people feel, whether they seek support, and how effective that support is. Words can heal or harm. |
| Avoid blame: Weight gain and type 2 diabetes are influenced by biology, environment, and systemic factors — not just personal choices. Blaming individuals is unhelpful and inaccurate. |
| Use person-first language: Say “a person living with obesity” rather than “an obese person”. This puts the person, not the condition, first. |
| Respect cultural values: For Māori and Pacific peoples, health and body image are understood in collective and cultural contexts. Language should reflect whānau (family) and community strengths, not just individual responsibility. |
| Focus on health, not appearance: Frame weight loss in terms of improving wellbeing, energy, and managing diabetes, rather than appearance or thinness. |
| Empower, rather than stigmatise: Use supportive, non-judgemental language that encourages people to set their own goals. |
| Why it matters: Stigmatising language can discourage people from accessing care, while respectful, strengths-based language can build trust and motivation. In Aotearoa, aligning health messages with values of manaakitanga (care) and whanaungatanga (connection) supports more effective and equitable outcomes. |
Page updated September 2025
