six weeks to three months after you start to change your lifestyle habits. For most people with type 2 diabetes, lifestyle changes and weight loss, though beneficial for a variety of reasons, will not be substantial enough to control blood glucose over time. By the time you are diagnosed or decide to take action, you may have had type 2 for years and your insulin-making capacity may have dwindled by 50 to 80%. Weight loss alone is unlikely to sufficiently improve blood glucose numbers. This doesn’t mean that you’ve failed, it means that your type 2 diabetes is progressing.
ADA recommendations suggest that most people diagnosed with diabetes be started on a blood glucose-lowering medication like metformin at diagnosis. There is no doubt that healthy eating, being physically active, and keeping your weight down will help any medication work more efficiently to help you control your ABCs over time.
Optimal Eating Plan for Weight Control
Research over the past few years points to the conclusion that the best eating plan for weight loss is one that fits your food and cultural preferences and one that you can follow comfortably for years to come. Sufficient research on low carbohydrate diets suggests that people can’t follow these plans any more effectively than high-carbohydrate (>50%), low-fat (<30%) plans. A large two-year study published in early 2009 showed that overweight people who were on a variety of diets gradually gravitated back to a carbohydrate range of 43-53%, within the range of current carbohydrate recommendations.
Secrets of Successful Weight Control
With the combination of research results and several studies of large groups of people who have lost weight and kept it off, the secrets of weight control success are emerging. Keeping weight off takes discipline and persistence and implementation of these successful strategies.
• Slowly change your food and activity habits.
• Put together an eating plan that considers your food preferences.
• Focus on eating less fat. Eat no more than 25-30% of your calories as fat.
• Get and stay physically active (the most common form of activity is walking) at least 30 minutes a day. Have a realistic and achievable weight-loss goal in mind.
• Incorporate sufficient dietary fiber in your eating plan. This includes fruits, vegetables, and whole grains.
• Eat breakfast every day. It gets you off to a healthy start and revs your metabolism.
• Consider the use of meal replacements (bars, meals, soups, drinks) that are calorie- and portion-controlled foods.
• Weigh yourself at least once a week, if not more.
• Watch less than 10 hours of TV per week.
• Keep records of various aspects of your plan. Record keeping continues to prove valuable in maximizing success.
• Maintain frequent and ongoing contact with a health care provider, behavioral counselor, or other support system.
Learn more at the National Weight Control Registry, www.nwcr.ws.
What about Weight Loss Medications?
Today, there are only a couple of weight loss medications approved by the Food and Drug Administration (FDA)—sibutramine (Meridia) and orlistat (Xenical). Orlistat is now available over-the-counter in a low dose formula called Alli. Research studies do not generally show that any of these medications greatly improve weight loss or long-term control. They may help give some people an extra boost as part of a healthy lifestyle plan. Keep your eyes open for many other weight-loss medications, which are in the drug pipeline.
Obesity Treatment with Surgery
There’s growing interest in the use of several bariatric surgical techniques to put pre-diabetes and type 2 diabetes into remission. These surgeries are referred to as bariatric, gastric or metabolic surgery; and have the potential to promote significant weight loss and control of blood glucose in obese people with pre-diabetes and type 2 diabetes. The surgeries most successful for pre-diabetes or type 2 diabetes reroute the intestines to avoid the duodenum (first section of the small intestine).
Any type of gastric surgery should be done within a program that offers a comprehensive approach to care. This means that pre- and postsurgical medical, psychological, and nutrition counseling are included. Some health plans and Medicare require that the surgery be done at a Center of Excellence. This status is achieved through the American Society for Metabolic and Bariatric Surgery and can be found at http://www.surgicalreview.org/locate.aspx.
QUICK TIP
The decision to have gastric surgery is a life-changing decision and shouldn’t be entered into lightly. It will require significant changes in your eating habits and lifestyle.
Interestingly, the success of gastric surgery appears to be beyond simply helping people lose more weight with relative speed. It appears that these surgeries have an important impact on correcting abnormalities of hormones involved with appetite, hunger, and blood glucose control.
The ADA suggests that people with type 2 diabetes whose body mass index (BMI) is at or greater than 35 can consider discussing bariatric surgery with their health care provider as a means to achieve weight loss and metabolic control. However, ADA strongly notes that people who have one of these surgeries will need lifelong support and medical monitoring.
Learn more
• www.win.niddk.nih.gov/publications/gastric.htm—Weight Control Information Network (NIH)
• www.asmbs.org—American Society for Metabolic and Bariatric Surgery
• www.acsbscn.org—American College of Surgeons Bariatric Surgery Center Network
Personalize Your Healthy Eating Plan
What You’ll Learn:
• the best calorie range for you
• the main food groups
• the number of servings to eat each day from each main food group based on your calorie needs
• how to divide your calories and food servings into meals and snacks
• how to plan meals and snacks within the calories you need each day with several samples
In previous chapters, you’ve learned the general guidelines for healthy eating, as well as the specifics on healthy eating with diabetes. You’ve also seen that these messages about healthy eating are very similar and that their intention is to get and keep you healthy This chapter helps you learn how to create a healthy eating plan that works for your lifestyle.
The Right Calories for You
You might wonder how many calories you need each day. The answer depends on many factors:
• your age and sex
• how active you are
• whether you want to lose or gain weight or stay at the same weight
• whether you have lost and gained weight many times or this is your first effort, and more.
The chart below can help you figure out how many calories and servings of various types of foods you need each day. Servings of food, for the purposes of this book, are defined in the tables provided at the end of each food group chapter in section 2. These servings are in sync with those in Choose Your Foods: Exchange Lists for Diabetes compiled by the American Dietetic Association