Prediabetes, a condition in which markers of blood sugar regulation are higher than normal but not yet in the diabetic range, is typically treated by focusing on weight loss. However, many people struggle to lose weight or keep it off. A new study examined whether people with prediabetes could return to normal blood sugar levels without losing weight, and whether this change affected their future risk of type 2 diabetes.

The researchers analyzed data from a previous large German lifestyle intervention study, focusing on 234 adults with overweight or obesity (BMI around 30) who maintained or even gained a small amount of weight over one year. Participants underwent detailed metabolic testing, including oral glucose tolerance tests (OGTT, which tracks blood sugar and insulin levels over two hours after consuming a glucose drink) and MRI scans to track fat distribution, and were followed for up to 10 years to monitor whether they developed type 2 diabetes.

• About 22% of the participants who did not lose weight still returned to normal blood sugar levels after one year, showing that remission can occur without weight loss.
• Within this group, those who returned to normal blood sugar regulation had a 71% lower risk of developing type 2 diabetes over up to 10 years of follow-up.
• Participants who improved their blood sugar regulation showed better insulin sensitivity, meaning their bodies responded more effectively to insulin. Measures of how much insulin the body releases and how well the insulin-producing cells (called beta cells) work also moved in a healthier direction, but these changes were not strong enough to draw firm conclusions.
• Body weight, total body fat, muscle mass, fitness, diet adherence, physical activity, and circulating inflammatory markers showed similar patterns over time in participants who returned to normal blood sugar regulation and those who did not, suggesting that these factors alone did not explain the difference.
• Participants who improved their blood sugar regulation tended to store fat in a healthier way, with a higher proportion of subcutaneous fat (fat under the skin) compared to visceral fat (fat stored around internal organs), rather than clear differences in individual fat depots.

These results point to a weight-independent effect related to how fat is distributed in the body. Visceral fat is closely linked to metabolic dysfunction because it is more biologically active and releases fatty acids and inflammatory signals to key metabolic organs such as the liver. This can promote insulin resistance, increase blood sugar production, and strain the pancreas over time. In contrast, subcutaneous fat is better at safely storing excess energy and releases fewer harmful signals, making it less likely to interfere with normal blood sugar control.

The study was a post hoc analysis, meaning the subgroup was defined after the trial, which limits how confidently cause and effect can be established. In addition, key measures of insulin function were based on indirect calculations rather than gold-standard methods such as the hyperinsulinemic-euglycemic clamp. Overall, the findings suggest that strategies to prevent type 2 diabetes may need to focus not only on weight loss, but also on how the body stores fat. In episode #96, I explain how HIIT, circadian-timed eating, and quality sleep improve metabolic health and reduce chronic disease risk.

A growing body of research suggests that obesity may be associated with accelerated brain aging, but where fat is stored may be even more important than how much you have. To explore this, researchers followed people for several years to see whether reducing visceral fat, the deep abdominal fat around organs, was tied to better brain health later in life.

The study included 533 adults, most of them men with an average age of about 61, who had previously participated in clinical trials testing how different diets and lifestyle strategies affect body weight and fat distribution. Those trials lasted about 18 to 24 months. Between 5 and 16 years later, the participants underwent detailed testing, including brain and abdominal MRI scans to assess brain structure and fat distribution, along with standard tests of memory and thinking.

• Participants with more visceral fat generally had lower scores on a test of overall thinking ability, particularly among those with higher brain volume measures.
• When the researchers looked at participants with fat measurements taken at three time points (at the start and end of the original trials, and later during this new study), lower long-term exposure to visceral fat was linked to better cognitive and memory scores later in life.
• Participants who lost more visceral fat during the original intervention period tended to have larger total brain volume and gray matter volume (gray matter contains most of the brain's nerve cells and is essential for processing information). In a smaller group with repeated brain scans, those with lower visceral fat showed a slower decline in gray matter and hippocampal measures (the hippocampus is a key memory center in the brain) over time.

The researchers also looked at how visceral fat might affect the brain. Measures of blood sugar control were most strongly linked to later brain changes. In particular, fasting glucose and HbA1c stood out more than cholesterol or common markers of inflammation. This suggests glucose regulation may be an important pathway linking visceral fat to brain health. Visceral fat is strongly associated with insulin resistance, a condition in which the body's cells respond poorly to insulin, leading to higher blood sugar levels over time. Over the long term, these changes can damage blood vessels and reduce blood flow to the brain. Other processes, such as inflammation and weakening of the blood-brain barrier (the system that controls what enters the brain) may also play a role.

Because participants were not randomly assigned after the original trials ended, the study cannot prove that visceral fat loss directly caused the brain benefits. Even so, these findings suggest that where fat is stored may matter more for brain health than body weight alone. In this clip, Dr. Ben Bikman explains the primary causes of insulin resistance and how to reverse it in as little as 90 days.

Patterns of unresolved emotion can quietly shape mood, relationships, and even a person's sense of purpose. In a new study, researchers examined whether people who tend to forgive others more often experience better overall well-being over time.

The study followed 207,919 adults from 23 countries. Participants reported how often they forgave others, and researchers compared those who forgave often or always with those who rarely or never did. They then examined how this tendency related to 56 different outcomes one year later, including mental health, relationships, physical health, behavior, and financial well-being.

• About three-quarters of participants said they often or always forgave others, while roughly one quarter reported doing so rarely or never.
• People who were more forgiving showed slightly higher overall well-being one year later.
• The strongest links appeared in mental, social, and personal character areas, including greater optimism, a stronger sense of purpose, better relationships, and a stronger feeling of belonging.
• More forgiving individuals also reported higher levels of positive personal traits and behaviors, such as gratitude, hope, the ability to delay rewards, and showing care for others.
• Associations with physical health, exercise, and financial or material outcomes were weaker and often close to zero.

These findings can be interpreted in light of psychological theories. One is the stress-and-coping model, which suggests that forgiving others can help reduce ongoing negative feelings like anger, resentment, or the urge to get back at someone. Another is the broaden-and-build theory, which proposes that positive emotions linked to forgiveness can help people think more openly and build emotional and social resources over time.

This study was observational, meaning it cannot determine whether forgiveness leads to better well-being or vice versa. Most measures relied on single survey questions, which may not fully capture complex experiences. In addition, about 38% of participants did not complete the second survey, which could affect the results. Still, the findings suggest that a general tendency to forgive others is linked to better well-being across many areas of life. In episode #110, Dr. Arthur Brooks breaks down the science of happiness, the role of struggle and suffering in a meaningful life, and the habits that make love, purpose, and emotional well-being more durable.