I know you put the caveat "mostly" in here but it's important to state that this is not always true.

I was diagnosed with T2 a couple of years ago. During that time I was cycling 25 miles a day. After the diagnoses I completely eliminated all carbs from my diet. My blood sugar was still not under control. My fasting blood sugar (first thing in the morning, and 18hrs of fasting) was the highest point of the day. (14-18 mmol/L) I fasted (water only) for 1 week. no difference.

I was on a bunch of medication, none of it helped.

It wasn't until I started taking a GLP-1 drug that my sugar came under control.

So medication (ozempic) was critical to me getting my blood sugar under control. Diet didn't fix it. Exercise didn't help.

I've lost ~90lbs since then. I'd probably have died/gone into a coma if not for GLP-based drugs.

My anecdote does not contradict wide-spread science and medically derived knowledge. But it should help temper the fat and diet shaming that exists in society.

If you lost 90 lbs, you must have been at least 90 lbs overweight. That isn't a little bit of fat. That is a lot of fat. And it takes a lifetime to put on that much fat. You can't really claim that you had proper exercise and diet before you started taking medications. I have seen many episodes of My 600 LB Life and similar shows where the clients and their caretakers swear on their mother's graves that they even eat at all, but that isn't how reality and physics work.

Don't misunderstand, I'm glad they made the GLP-1 drugs, but still, they have for years been reversing Type 2 diabetes through exercise a diet.

A bit of a tangent, but the biking stuff is not relevant. What matters is your caloric consumption. Biking 25 miles, depending on your weight, is going to burn something like 1300 calories. For some contrast, a 2L bottle of coke has about 800 calories. So treat yourself to a big serving of Coke after (or during) the biking, maybe a fast food burger or whatever, and it's like you're not even biking at all in terms of caloric effect. This is also true with 'sports drinks' which are also loaded with calories which can be really easy to chug when doing cardio intensive work.

And this can easily happen because biking 25 miles is going to send your appetite skyrocketing. This is why working out to lose weight is probable one of the worst ideas imaginable. Working out is a critical part of staying in good health, but it simply has to be paired with a good diet, permanently. In other words you can't work away a bad diet at the gym (or on a bike), it just doesn't work.

So very rough estimate:

25 miles of biking is somewhere in the world of 400ish Calories.

If you were doing that and not losing weight, you were eating 400ish excess Calories on average.

That's the equivalent of a single packet of Ramen, or about 4 Oreo cookies. Food is extremely energy dense.

Exercise, especially using efficient means like biking or running or walking, just isn't that effective. You need caloric restriction to make any ground for the majority of people.

>But it should help temper the fat and diet shaming that exists in society.

Why would it? Factually, if Ozempic and similar solved your weight issues, it directly means you were eating "too much" food. People who see that as a personal failing will continue to do so, and will see Ozempic as enabling "weak willed" people, or a crutch for "lesser" people.

If you say that diet did not fix it, but then you lost ~90 lbs, which is a massive weight loss [(1) congratulations, 2) we are becoming used to people losing 200 lbs and 90 is a victim of weight-loss inflation], it looks like the problem was that the diet, which can be defined as a particular way of eating and/or caloric restriction, was not really a diet in the second meaning of the term.

Ozempic helped you lose weight primarily by making you stick to a diet, due to its suppressing effects on appetite.

What fat and diet shaming? If it feels shameful to you that you were at least 90lbs overweight and didn’t manage to follow a diet, that’s on you.

I merely said most incidence of type 2 can be prevented and treated with diet and exercise. Which is completely true.