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 pounds” 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 percent 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
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 seven percent loss of body weight
(only 14 lbs. if you are 200 lbs.) will improve insulin action by 57 percent.
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 percent weight
loss may decrease the risk of certain complications like sleep apnea or
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
Setting a goal to
lose 80 pounds can be overwhelming, but requesting they lose just 10 percent of
their body weight is definitely achievable. I often ask a patient to
mentally calculate what 10 percent of their body weight is. So if a patient
weighs 230 pounds, then a 10 percent 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:
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 three vegetables and two
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.
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.
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.
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
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!
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.
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.
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.
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