Oct
21
2014

Give Me 10: The Benefits of 10% Weight Loss

Article by Sandra Melloni RN, BSN, BA: Can be found on DiabetesCare.net

Most patients with type 2 come into my office wanting to lose weight.  Often, their goals are lofty:  “Nurse, I really need to lose 130 lbs.”  or “Nurse, I’ve gained 80 pounds over the past decade; I need to lose it all.”  They are often frustrated and overwhelmed. Where do they begin?

We know that weight gain is a major risk factor for developing type 2 diabetes, and that more than 80% of type 2s are overweight. If we study the incidence of type 2 diabetes in America, the statistics are staggering.  With over 29 million people with diabetes in the U.S., the disease is booming. Past forecasts and studies predicted 30 million diabetics in the US by the year 2030, so we are well ahead of schedule. The truth is Americans are becoming increasingly less active and consuming more calories. The result? Our waistlines have increased and so has the incidence of type 2 diabetes.

We have long known that obesity is responsible for the development of hypertension, diabetes, and hyperlipidemia.  Weight gain exacerbates these conditions.  Has your patient put on an extra twenty pounds?  Chances are they will need an adjustment in their diabetes medication, often a dose increase or the addition of another pill. The same goes for their cholesterol and blood pressure.

During the 2013 meeting of the ADA, Philipp Scherer, PhD, professor and director of the Touchstone Diabetes Center at the University of Texas Southwest Medical Center in Dallas, was interviewed on his latest research. He studies diabetes on a cellular level, and obesity’s effects on diabetes, describing fat tissue as a “solid tumor,” containing adipose cells. He explains that when a patient gains weight, fat tissue expands rapidly. This rapid expansion does not allow time for proper vascularization--in other words, the blood supply cannot keep up. The adipose tissues become hypoxic (lack of oxygen) leading to fibrosis of the tissue, and eventually, cell death.  This cell death produces surrounding inflammation, which in turn, damages pancreatic beta cells and causes insulin resistance.  Insulin resistance is the main mode of pathophysiology in type 2 diabetes. (1)

And if weight gain compromises patient health, certainly weight loss will improve it. However, striving for your patient’s weight as a high school junior just isn’t realistic. Sheri Colberg, PhD, author, exercise physiologist and professor at Old Dominion University discusses in a recent article about weight loss and insulin resistance.  “Just a 7% loss of body weight (only 14 lbs if you are 200 lbs) will improve insulin action by 57%. That is a bigger benefit than a patient would get from most diabetes pills.” (2)  The American Diabetes Association confirms that a 10-15 pound reduction in body weight will lower blood glucose, blood pressure, cholesterol, and reduce stress on knees and hips.  And a 10% weight loss may decrease the risk of certain complications like sleep apnea or particular cancers.

In my diabetes self-management classes, I often suggest to patients that they view healthy eating, exercise, and weight loss as importantly as taking their prescribed medications. These are the tools we have to control diabetes, and overlooking them is like not using all the weapons in our arsenal.

Setting a goal to lose 80 pounds can be overwhelming, but requesting they lose just 10% of their body weight is definitely achieveable. I often ask a patient to mentally calculate what 10% of their body weight is. So if a patient weighs 230 pounds, then a 10% weight loss would be about 23 pounds, certainly an achievable goal over a one year time period. Weight loss would average about two pounds per month or a half pound per week. Most projects in life are better managed by splitting them into smaller tasks. At the end of the year, your patient would realize an improvement in blood sugar and no new additional medications.  

So let’s imagine that 23 pounds is our patient’s weight loss goal. This could be achieved with a reduction in calories of about 230 per day. That might be a small bowl of ice cream or a can of soda with some chips. These small changes will add up. Add some physical activity to the mix, and your patient may only need to reduce their calories by 100 per day.

First there are some considerations, particularly if your patient is taking certain medications like insulin or insulin secretagogues, like Glimepiride or Glipizide. Losing weight and eating less may require a change to those medications in order to prevent hypoglycemia. I often suggest that those patients meet with their dietician or diabetes nurse educator before embarking on their weight loss journey. Below are some tips that my colleagues and I often share for weight loss.  Remember, your patient doesn’t have to be perfect but make small changes which will add up.

Weight Loss Tips for Diabetes Patients:

  • Think Do, not Don’t.  If I tell a patient to quit eating chips, it’s often the first thing they crave when they get home.  They begin to focus on the “forbidden goodies.”  But when we ask them to add 3 vegetables and 2 fruits per day, they don’t feel cheated.  Mixing it up with some frozen grapes or some crunchy snow peas with dressing with their lunch will keep things interesting.
  • Water, Water, everywhere. We know water is great but try having your patient drink a tall glass ten minutes before meals.
  • Lose the tube. When we watch TV and eat simultaneously, we eat more due to the distraction. Ask them to shut off the television and sit at a table.
  • Eat to Live.  We have all heard the saying “Eat to live, don’t live to eat.”  Ask your patient which hobbies they miss.  If food is the only source of pleasure, it’s a recipe for disaster.  Suggest music, drawing, volunteering or calling an old friend.  Yes, even sex. To read more about how food can replace sex and intimacy in some relationships, check out a recent DiabetesCare.net blog here.
  • Park Farther and Take the Stairs!  Old, but good advice.
  • Don’t forget Fido. Just walking the dog twice daily for fifteen minutes each time will help your patient reach their goal of 150 minutes per week of exercise.
  • Choose an Exercise you like. If you hate walking, don’t choose it as your exercise.  Aqua classes, biking, and Zumba are becoming more popular for men and women alike. Remind patients that gardening and raking burn calories, so put that leaf blower away!
  • Put the box down and back away.  Everyone is going to cheat sometimes.  If they want some ice cream or chips, have your patient measure it out and put the box away.
  • Catch some ZZZZZ’s.  Lack of sleep can increase stress hormones and cause overeating during the day.
  • Sugar-free gum. If you have a chewing fix, break out the gum and save on calories. 
  • Keep a food diary.  We all know it—we eat more than we think we do. Writing it down in black and white can help to think more about what and how much you consume. 
  • What’s Eating You? If your patient suspects that he or she is an emotional eater, you may want to ask them to keep a journal for one week. Before eating or binging, they might record how they feel, what happened at work, any conversations replaying in their mind and then what they ate. It can certainly be a reflective exercise in why we eat and a great way to become more conscious of the connection between food and emotions.
Again, most people with type 2 want to lose weight. This doesn’t have to be a formidable task or race.  Ask patients to “give you 10.”

Sources: 1, 2
 
Sep
3
2014

Move to the Beat!

Music has the unique ability to be many things to many people. It can be a mood changer, mood-setter, or simply express our current mood in a more artistic and creative way. What can music do for you while you’re exercising? Regardless of the setting you will find headphones in the ears of the majority of the people you see working out.

Why? For starters, music is a great motivational tool for us. It can be a welcomed distraction to the amount of exertion we are using, allowing us to push that much more.  A study even showed that music can improve performance by up to 15 percent.  That number maybe high and also varies depending on the person, but it also makes sense.

What songs tend to have the best effects? Typically songs that have a 120-140 beats per minute (BPM) ratio have the most significant change in an exerciser. Meaning a song like “Timber” by Kesha and Pitbull (130 bpm) could have a different effect on you compared to “Burn” by Ellie Goulding (86 bpm). Both songs can serve a purpose, the lower rate for warm up and the higher rate for cardio.

Depending what you are listening to music can either keep you on pace, or erratically change it.  While exercising, we often find ourselves working out to the rhythm of what we are listening to.  We would like for that rhythm and pace to be steady, however some music can cause dips and spikes in our pacing.

Find out what works for you! The great part about music is one size doesn’t fit all, but there is something for ALL of us. 

Links: Webmd, Huffington Post, Bases.org

Jul
15
2014

Weight Loss is the Best Medicine

From hypertension to bad knees, nowadays you can get a prescription for practically any ailment you have.  However, medication can only provide relief fora certain amount of time and even though you are treating the ailment, you may not be treating the cause.

Obesity can be the cause of many health risks such as elevated blood pressure, high cholesterol, back pain, diabetes, the list can get extensive but I think you get the point. Even though you have different complications they could all be coming from the same source.

Take Jim Carpenter for example, he once weighed 518 pounds, and had the health risks to prove it. Jim suffered from heart failure, diabetes, high cholesterol, high blood pressure, stage one kidney failure, knee pain, and other health issues. Needless to say he took a multitude of medication for these varying ailments. But guess what medicine worked best for him?

After Jim lost almost 300 pounds he no longer needed medications for his diabetes, blood pressure, kidneys, as well as decreased his cholesterol medication. All this from losing weight! Weight gain and obesity can bring on many health problems and risks, but WEIGHT LOSS can potentially to do the exact opposite, without the medications that only deal with the surface and not the underlying problem.

Recent study found that doctors find it more and more difficult to talk to their patients about their weight. As a result when the patient brings up a health problem, instead of getting to the core of the issue, they write a prescription. As a provider, don’t fall victim to filling out prescriptions when there are better more effective ways of treatment. As a dieter, medicine will alleviate the pain (even if temporary), but see if there are other ways to improve your quality of life! 

 

Crossword Puzzle Answers
Across: 1. basketball 2. hockey 3. football 4. Skiing
Down: 1. soccer 2. tennis 3. baseball 4. bowling
Jun
17
2014

Study Shows Benefits to High-Protein Breakfast

A recent study may give another reason why breakfast can be your most important meal of the day, especially for women. 

Study conducted by the University of Missouri-Columbia resulted in the conclusion that a high-protein breakfast helps women maintain their glucose control. Why is this beneficial? Eating naturally increases glucose levels. However, too much of an increase can lead to poor glucose control, possibly resulting in diabetes or other health complications.

"Protein-rich breakfasts led to lower spikes in glucose and insulin after meals compared to the low-protein, high-carb breakfast," says Kevin Maki of Biofortis Clinical Research. Protein is found in many popular breakfast items such as eggs, oatmeal, and cottage cheese and if this study is any indication, we may be better off reaching for these items in the morning compared ones higher in carbs such as certain cereals or juices. 

Link: University of Missouri-Columbia 

Mar
12
2014

Hit the Ground Running

On my calendar is a bright red circle around March 20th. If you, like me, are tired of being stuck in the house due to continuous snow storms and other inclement weather, it’s time to prepare for warmer temperatures, improved weather, and longer days ahead!

What better way is there to enjoy the beginning of spring than by hitting the ground running, literally! Outdoor running can be refreshing and great for a cardio workout, but without the right preparation, technique, and gear, the new spring in your step could also result in injury. Use the tips below as you begin your running season:

Take Your Time: If this is your first time running in a while, doing too much too soon could lead to injury. Learn to pace yourself early, when it comes to how fast you’re running as well as the distance travelled.

Must Be the Shoes:  Unlike running indoors, running outdoors includes being on harder surfaces and at times different terrain. Make sure that you have the right shoe that blends comfortability, durability, and support.

Preventative Maintenance: Stretching is vital when you are preparing for a run. It warms up the muscles that you will be primarily using while you’re running. Also, if a part of your body is quicker to get injured than others, chances are it is a trouble area for you. Strengthening that area can help prevent injury and improve your overall performance.

If you have any other tips or advice on running outdoors, feel free to leave a comment in the box below. 

Links: Shape.com, Active.com 

Jan
14
2014

Which Gym is Right for You?

Is your New Year’s Resolution to lose weight and be healthier in 2014? You’re not the only one. According to a study by the University of Scranton, 45% of Americans make New Year’s Resolutions, with 38% of those resolutions being weight-related. That means that losing weight is the number one resolution of 2014, topping the likes of getting organized, quitting smoking, and falling in love.

One of the first steps many of us take (me included) in achieving those weight-related goals is to sign up for a gym membership. However, how do you know which gym is right for you? There are positives and negatives to every gym and making sure you choose the one that fits your needs will be essential to sticking with your resolution. So what do you need to know? What are some of the things you need to think about before choosing a gym?

Determine Your Needs- What you want in a gym is probably the most important question you have to ask yourself. Consider your budget, types of equipment/activities you’re looking for, if it offers private training/assistance, the atmosphere, and more. Make a list of what you want and what you need and evaluate your options

Proximity- Whether it’s close to your house or close to work, choosing a convenient, accessible location increases the likelihood you’ll maintain your new routine. Driving by the gym on your way home from work means you’ve removed the “hassle” of making a special trip to get there.

Give it a Chance- Many gyms offer free trials where you can go for a day (or more) to give it a test run. Take advantage of it! Get a tour of the facility. See if it is suitable for what you want. Evaluate if it meets your wants and needs list. Is it clean? What kinds of classes do they offer? How is the staff? How are the other members? What are the hours?

Eventually the excitement of the New Year will fade away, but the motivation is what needs to stay. Choosing the right gym for you is a VERY BIG first step in the right direction. Remember, achievements are reached through commitment. Like a relationship, the only way this will work is if you are fully invested and are willing to do what it takes to make it work. Make this year a great one!

Source: Fitday

Health.com

Forbes

Dec
4
2013

Burn Calories with Common Holiday Activities

This holiday season, as your social calendar fills up and you find less spare time to fit in a workout, look for ways to burn extra calories in many of the activities you already plan to partake in. Use these non-traditional activities to help burn off the extra calories consumed in some of your favorite seasonal snacks. 

Hanging Lights: Turn this holiday activity into a low-impact workout by focusing on using your core to stabilize you, isolating different muscles and working on your balance.

Amount burned in 1 hour of stringing lights: About 200 calories 

Ice Skating: Take your friends and family over to the local ice rink for a fun filled winter treat. Your laps around the rink are a great way to burn a substantial amount of calories.

Amount burned in 1 hour of ice skating: About 534 calories 

Shopping: To give is to receive. In buying presents and lugging shopping bags around the local mall, you’ll burn calories and strengthen your arm muscles. So remember, the heavier the bag the better the workout.

Amount burned in 1 hour of shopping: About 274 calories 

Stacking Firewood: Stock up on firewood to have on-hand for a cold winter night. Lifting and piling can burn a few calories and make snuggling up with a warm hot cocoa near the fire even more rewarding.

Amount burned in 1 hour of ice skating: About 190 calories

Do you have any calorie-burning holiday activities? Leave them in the box below and spread some holiday cheer!

Source: Robard Corporation

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