Type 2 Diabetes Weight Control
Obesity is a major risk factor for development of diabetes, and excessive energy intake is a major contributor to poor glycemic control in Type 2 diabetes. The impact of obesity on risk for diabetes as well as coronary heart disease (CHD) risk factors and the benefits of weight loss in decreasing risk for developing diabetes and improving glycemia and CHD risks were reviewed. A systematic review of the medical literature to assess the impact of obesity and weight gain on risk for diabetes and CHD was done.
We performed a meta-analysis of the effects of weight loss for obese diabetic individuals. Controlled clinical trials assessing lifestyle changes on risk for developing diabetes and weight loss effects on glycemia and CHD risk factors were reviewed. Obesity and weight gain can increase risk for diabetes by greater than ninetyfold and CHD by about sixfold. Very-low-energy diets (VLED) decrease fasting plasma glucose values by ~50% within two weeks and these changes are sustained with continued energy restriction. Twelve weeks of energy-restricted diets were associated with these significant decreases: body weight, 9.6%; fasting plasma glucose, 25.7%; serum cholesterol, 9.2%; serum triglycerides, 26.7%; systolic blood pressure, 8.1%; and diastolic blood pressure, 8.6%. Larger weight losses were associated with larger reductions in these values.
The reviewed data suggest that US health care providers should endorse the American Heart Association’s and European diabetes associations’ recommendations that diabetic persons achieve and maintain a BMI of <=25 kg/m2. Weight management may be the most important therapeutic task for most obese Type 2 diabetic individuals.
For those suffering with type 2 diabetes weight control, they understand the importance of this factor in their overall health.
Type 2 Diabetes
Type 2 diabetes is also known as non-insulin dependent or adult onset diabetes and is the most common form of the illness. According to the National Diabetes Information Clearinghouse, in 2005 there were over sixteen million people in the United States with type 2 diabetes and more than another six million people who have it and do not even know it.
As the number of cases each year continues to grow a startling change is starting to take place. Type 2 diabetes is affecting more children and adolescents than ever before. It is believed that the number of increased cases of a type 2 to diabetes is directly associated with obesity and inactivity in the population of both children and adults.
Obesity and Type 2 Diabetes
One of the main risk factors of type 2 diabetes is obesity. As weight is gained, the body becomes insulin resistant placing a much greater demand on the pancreas to produce insulin. In adults it is known that even modest weight loss, of five to ten percent of total body weight, helps reduce the ongoing progression of type 2 diabetes. In certain cases, weight loss has prevented type 2 diabetes from developing further and even reversed the disease.
Type 2 Diabetes and Weight Control
Weight control for anyone suffering with type 2 diabetes can be a life saving measure. Each year over 200,000 people die from diabetes and complications of the disease. In order to lose weight, it is necessary to burn more calories than you take in. A healthy weight is measured by using a body mass index, known as a BMI. A BMI below 25 is considered healthy, 25-29 is considered overweight and 30 or more is considered obese.
The health benefits of controlling or lowering your weight when you have type 2 diabetes are numerous. You will:
- Feel better
- Lower your blood sugar
- Improve your overall health while lowering your weight and reducing your BMI.
However, any type 2 diabetic weight loss plan should always be under supervision of your doctor as your blood sugar, insulin levels and medication intake needs to be closely monitored.
Dietary Recommendations for Type 2 Diabetes Weight Control
Dietary recommendations from the American Diabetes Association encourage following a healthy, low-calorie diet that provides a consistent slow weight loss. The recommended safe weight loss is between one half to 2 pounds per week. The number of calories taken in per day for women should be between 1000-1200 and for men between 1200-1600.
An excellent tool for weight control with diabetes type 2 is using the Food Pyramid. This pyramid varies slightly from the USDA food guide due to food groups being based on their protein and carbohydrate content instead of their food classification.
Weight Control for Type 2 Diabetes
The American Diabetes Association recommends that patients aim for a small but consistent weight loss of ½ - 1 pound per week. Most patients should follow a diet that supplies at least 1,000 - 1,200 kcal/day for women and 1,200 - 1,600 kcal/day for men.
Even modest weight loss can reduce the risk factors for heart disease and diabetes. There are many approaches to dieting and many claims for great success with various fad diets. They include calorie restriction, low-fat/high-fiber, or high protein and fat/low carbohydrates. Some evidence suggests that people may respond differently to specific diets depending on whether their weight is overly distributed around the abdomen.
Here are some general weight-loss suggestions that may be helpful:
- Start with realistic goals. When overweight people achieve even modest weight loss they reduce risk factors in the heart. Ideally, overweight patients should strive for 7% weight loss or better, particularly people with type 2 diabetes.
- A regular exercise program is essential for maintaining weight loss. If there are no health prohibitions, choose one that is enjoyable. Check with a doctor about any health consideration.
- For patients who cannot lose weight with diet alone, weight-loss medications such as orlistat (Alli, Xenical) and sibutramine (Meridia) may be considered. Sibutramine should not be used by patients with high blood pressure or kidney or liver problems.
- For severely obese patients, weight loss through bariatric surgery can help in produce rapid weight loss and improve insulin and glucose levels in people with diabetes.
Even repeated weight loss failure is no reason to give up.
Calorie Restriction
Calorie restriction has been the cornerstone of obesity treatment. Restricting calories in such cases also appears to have beneficial effects on cholesterol levels, including reducing LDL and triglycerides and increasing HDL levels.
The standard dietary recommendations for losing weight are:
- As a rough rule of thumb, 1 pound of fat contains about 3,500 calories, so one could lose a pound a week by reducing daily caloric intake by about 500 calories a day. Naturally, the more severe the daily calorie restriction, the faster the weight loss. Very-low calorie diets have also been associated with better success, but extreme diets can have some serious health consequences.
- To determine the daily calorie requirements for specific individuals, multiply the number of pounds of ideal weight by 12 - 15 calories. The number of calories per pound depends on gender, age, and activity levels. For instance a 50-year-old moderately active woman who wants to maintain a weight of 135 pounds and is mildly active might need only 12 calories per pound (1,620 calories a day). A 25-year old female athlete who wants to maintain the same weight might need 25 calories per pound (2,025 calories a day).
- Fat intake should be no more than 30% of total calories. Most fats should be in the form of monounsaturated fats (such as olive oil). Avoid saturated fats (found in animal products).
Exercise
Aerobic exercise has significant and particular benefits for people with diabetes. Regular aerobic exercise, even of moderate intensity (such as brisk walking), improves insulin sensitivity. People with diabetes are at particular risk for heart disease, so the heart-protective effects of aerobic exercise are especially important.
Exercise Precautions for People with Diabetes. The following are precautions for all people with diabetes, both type 1 and type 2:
- Because people with diabetes are at higher than average risk for heart disease, they should always check with their doctors before undertaking vigorous exercise. High-intensity (not high-impact) exercises are best for people who are cleared by their doctors. For people who have been sedentary or have other medical problems, lower-intensity exercises are recommended.
- Strenuous strength training or high-impact exercise is not recommended for people with uncontrolled diabetes. Such exercises can strain weakened blood vessels in the eyes of patients with retinopathy. High-impact exercise may also injure blood vessels in the feet.
- Patients who are taking medications that lower blood glucose, particularly insulin, should take special precautions before embarking on a workout program: Monitor glucose levels before, during, and after workouts (glucose levels swing dramatically during exercise). Avoid exercise if glucose levels are above 300 mg/dl or under 100 mg/dl.
- Inject insulin in sites away from the muscles used during exercise; this can help avoid hypoglycemia.
- Drink plenty of fluids before and during exercise; avoid alcohol, which increases the risk of hypoglycemia.
- Insulin-dependent athletes may need to decrease insulin doses or take in more carbohydrates prior to exercise, but may need to take an extra dose of insulin after exercise (stress hormones released during exercise may increase blood glucose levels).
- Wear good, protective footwear to help avoid injuries and wounds to the feet.
- Some blood pressure drugs can interfere with exercise capacity. Patients who use blood pressure medication should consult their doctors on how to balance medications and exercise. Patients with high blood pressure should also aim to breathe as normally as possible during exercise. Holding the breath can increase blood pressure.
Resources for Weight Control for Type 2 Diabetes
- An excellent resource for weight control for people with type 2 diabetes is Jack Labat’s and Annette Maggi’s book Weight Management for Type 2 Diabetes: An Action Plan is available from Amazon.
- Written by Gary Frost, Anne Dornhorst and Robert Moses, Nutritional Management of Diabetes Mellitus focuses on the general topic of diabetes including dietary management and the metabolic principles of nutrition.
- The First Year Type 2 Diabetics: an Essential Guide for the Newly Diagnosed by Gretchen Becker is an excellent book with answers to many questions and frustrations that newly diagnosed patients experience.
Conclusion
In many cases type 2 diabetes can be prevented or the progression of the illness slowed, by following a healthy lifestyle and eating a well-balanced diet. Anyone that is at risk for type 2 diabetes, is prediabetic or has been diagnosed with the disease, needs to be aware that for type 2 diabetes weight control is extremely important.
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