Diabetes and Weight Management

Some researchers attribute rising obesity, at least in part to increasing numbers of former smokers. Others attribute it to the recent increase in carbohydrate consumption by those trying to avoid dietary fat. Whatever the reasons, overweight and obesity can lead to diabetes (Type 2 Diabetes).

There is strong and consistent evidence that obesity management can delay the progression from prediabetes to type 2 diabetes and is beneficial in the treatment of type 2 diabetes. In patients with type 2 diabetes who also have overweight or obesity, modest and sustained weight loss has been shown to improve glycaemic control and to reduce the need for glucose-lowering medications.

The America Diabetes Association (2020) strongly recommends that one should:

·         Measure height and weight and calculate BMI at annual visits or more frequently.

BMI can be calculated manually as weight divided by the square of height in meters (kg/m2) or electronically using the electronic medical record or other resources.

Overweight is defined as a BMI above 25.0, obese is above 30.0 and severely obese is above 35.0 kg/m2. Being overweight is a result of consuming more energy than is expended.

·         Based on clinical considerations, such as the presence of comorbid heart failure or significant unexplained weight gain or loss, weight may need to be monitored and evaluated more frequently.

·         If deterioration of medical status is associated with significant weight gain or loss, an inpatient (a patient whose treatment needs at least one night’s residence in a hospital) evaluation should be considered, specifically focused on the association between medication use, food intake, and glycaemic status.

·         For patients with a high level of weight-related distress, special accommodations should be made to ensure privacy during weighing.

Weight loss can significantly reduce your insulin resistance. obesity, especially abdominal (truncal, or visceral) obesity, causes insulin resistance and thereby can play a major role in the development of both impaired glucose tolerance and type 2 diabetes. If you have type 2 diabetes and are overweight, it is important that weight loss become a goal of your treatment plan. Weight reduction can also slow down the process of beta-cell burnout by making your tissues more sensitive to the insulin you still produce, allowing you to require (and therefore to produce or inject) less insulin as was suggested by (Dr. Bernstein, 2007).

DIET, PHYSICAL ACTIVITY, AND BEHAVIORAL THERAPY (ADA, 2020) Recommendations:

1.      Diet, physical activity, and behavioural therapy designed to achieve and maintain ≥5% weight loss are recommended for patients with type 2 diabetes who have overweight or obese and are ready to achieve weight loss. Greater benefits in control of diabetes and cardiovascular risk factors may be gained from even greater weight loss.

2.      Such interventions should be high intensity and focus on dietary changes, physical activity, and behavioural strategies to achieve a 500–750kcal/day energy deficit.

3.      Individual motivation, life circumstances, and willingness to make lifestyle changes to achieve weight loss should be assessed along with medical status when weight loss interventions are undertaken.

4.      As all energy-deficit food intake will result in weight loss, eating plans should be individualized to meet the patient’s protein, fat, and carbohydrate needs while still promoting weight loss.

5.      Food availability should be queried, as well as other cultural circumstances that could affect dietary patterns.

6.      For patients who achieve short-term weight-loss goals, long-term (≥1 year) weight maintenance programs are recommended when available. Such programs should at minimum provide monthly contact, as well as encourage ongoing monitoring of body weight (weekly or more frequently) and other self-monitoring strategies, including high levels of physical activity (200–300 min/week).

7.      To achieve weight loss of >5%, short-term (3-month) interventions that use very-low-calorie diets (≤800 kcal/day) and meal replacements may be prescribed for carefully selected patients by trained practitioners in medical care settings with close medical monitoring. To maintain weight loss, such programs must incorporate long-term comprehensive weight-maintenance counseling.

Even moderate activity of just 30 minutes per day has been shown to improve insulin sensitivity, and this is what really helps weight loss. Talk to your dietitian about adjusting food intake and insulin doses. Losing weight can easily lead to a vicious circle if you have diabetes. Taking insulin forces, you to eat even if you are not hungry at the time.

Dr. Ragnar Hanas (2019) “you should avoid losing weight too quickly. A slow and steady loss resulting from a change in habits is better than a quick loss caused by reducing your food intake to a minimum. A sufficient rate is usually 1-3 kg (2-6 lb) per month.”