Читать книгу Diabetes Meal Planning Made Easy - Hope S. Warshaw - Страница 11
ОглавлениеSecrets of Successful Weight Loss and Control
What You’ll Learn:
• realistic weight loss goals
• how weight loss can improve your ABCs
• an optimal eating plan for weight control
• secrets of successful long-term weight control
• whether weight loss medications or gastric surgery can be effective
During the last decade, much has been learned about the impact of weight loss on health and preventing or managing type 2 diabetes. Research studies have also revealed how people can succeed at losing weight and keeping that weight off over time. Bottom line: It takes a lot more doing than knowing when it comes to short- and long-term weight control.
Be Realistic about Weight Loss
For most people, it’s neither realistic nor necessary to get back down to the weight you were when you were a teen or young adult. This is especially true if you’ve become overweight or obese. Losing weight and keeping it off is tough for everyone for several reasons. People who lose weight seem to require fewer calories to maintain their lighter weight. There are also adaptations of hormones related to hunger and appetite control. Lastly, it appears that the presence of insulin resistance (a problem most people with pre-diabetes and type 2 have) makes weight loss and control even tougher.
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Keep in mind any weight you lose is a move in the right direction. It’s worth noting that on average, an adult puts on two pounds a year, so, just preventing further weight gain is an accomplishment!
Research shows that you’ll be more successful if you lose a small amount of weight (10 to 20 pounds) and work hard to maintain this healthier weight. Numerous studies show that your weight loss will be greatest at six months. If you want to lose a few more pounds, try it several months later; however, remember that maintaining the initial weight loss is what’s most important for your long-term diabetes control.
Weight Loss and Blood Glucose Control
For many years, it was believed that many people with diabetes could control their blood glucose with a healthy eating plan, weight loss, and by increasing physical activity. This notion no longer stands up to research for many people. Some people can control their blood glucose for a time if their type 2 diabetes is detected early (or if pre-diabetes is diagnosed), and they are diligent about implementing a healthy eating plan, etc.
Weight loss accomplished by healthy eating and physical activity can decrease insulin resistance, improve insulin sensitivity, and result in lower blood glucose, lower blood pressure, and improved blood lipids for a time.
You and your provider will be able to determine if healthier lifestyle habits and weight loss are effectively controlling your blood glucose anywhere from 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.
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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
