“It’s pretty clear that when you have a lot of smaller fat cells, your metabolic health is tremendously improved,” Tracey McLaughlin, MD, MS, professor of medicine, endocrinology, gerontology and metabolism at the Stanford University Medical Center, said during her presentation. “As the fat cells get bigger, they predict the development of diabetes.”

In a study assessing the effects of weight loss on cardiovascular risk factors among adults with insulin resistance and overweight, but not obesity, McLaughlin and colleagues found that a modest weight loss of roughly 5 kg significantly improved insulin resistance, and that improvement was associated with adipose cell size.

“Fat cell size appears to be an even stronger predictor of insulin resistance than obesity per se,” McLaughlin said. “[In the study], the more weight you lost, the more [insulin action] improved; but the more your fat cell size shrank, the more your insulin action improved.”

Diet studies that manipulate the macronutrient content of eating plans demonstrate that weight loss depends on calorie restriction, McLaughlin said. Participants who comply with the plan, whether low carbohydrate or low-fat/higher carbohydrate, experience weight loss. However, weight loss alone may not result in improved insulin resistance.

“You can lose weight, but if you’re having a lot of carbs and your insulin is sky high, maybe your fat cells aren’t shrinking as much,” McLaughlin said.

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