Obesity and weight reduction
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| Diabetes Melltius: Healthy eating and drinking |
Obesity is common across the Western World. The Health
Survey for England 2011 found that 89 % of men, and 84% of women were either overweight
or obese. Many patients with type 2 diabetes are obese. It is easy to gain
weight and hard to lose it. Treat the patient with courtesy and respect. Listen
to his or her story (Box1).
Different methods of calorie restriction suit
different people. Some prefer general restriction, others low fat, or low CHO,
others meal replacements (e.g. with shakes or bars for some meals, others very
low calorie diets (expert supervision essential). Once weight loss has been
achieved the main problem is sustaining the new, lower BMI. Most patients
regain weight. Recognize patients’ difficulties in finding the willpower to
lose weight, and their need to have the occasional forbidden food. Discuss the
overall goal but set a reasonable interim goal in agreement with the patient.
Aim for a loss of 0.5–1 kg per week (1–2 lb per week). Praise success, however slight.
Success breeds success. Note difficulties reaching the goal. Encourage further
efforts. Group support may help as may paying for support, as in
Weight Watchers. Enlisting a family member to watch
the diet and give encouragement may help for some people.
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| Diabetes Melltius: Healthy eating and drinking |
Ask the patient to monitor his or her own progress.
Advise weekly weigh-ins, preferably by someone else, at the same time of day
and in the same clothes, with the result written on a graph. There is no easy
formula to help people lose weight—the one constant factor of most studies is
that continued interest and support is helpful.
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| Diabetes Melltius: Healthy eating and drinking |
Diet diary
Most people do not realize how much they eat (Box2). A diet diary (underline the importance of honesty) for a
week is helpful guide if the patient wishes to comply. Otherwise take a dietary
history.
Modify the type of foods eaten
• Reduce fat
• Reduce alcohol
• Reduce manufactured foods and take-aways
• Increase green leafy vegetables; reduce solid
starchy vegetables
• Increase large watery fruits or high-fibre crunchy
fruits; reduce small sweet fruits or starchy fruits
• Avoid sauces or dressings unless low-calorie
Reduce the quantities eaten
Obese people often choose larger portions than slim people.
Use a small spoon and a small plate. Eating out often presents larger portions.
Ask
for a smaller helping, or leave some.
Eat more slowly so that the food lasts.
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| Diabetes Melltius: Healthy eating and drinking |
Slow down
Rapid eaters consume more than slower eaters and
speedy eating is linked with obesity (J Am
Diet Assoc. 2011; 111:1192–7; doi: 10.1016/j.jada.2011.05.012).
When is the food eaten?
Eat at mealtimes and not in between. Enjoy the food.
Avoid habit eating, e.g. while watching television, while driving (dangerous,
illegal), while working at a desk, while serving behind the counter, while
chatting. This food is chewed but not savoured. Substitute calorie-free chewing
gum or a minimum calorie drink.
Why do people eat?
Overweight people need to eat very little to survive.
Appetite can overcome satiety—we can be completely full of meat and vegetables
but still fancy a piece of chocolate gateau. Food is a great comforter. It is
an excuse for a social or family gathering. It is an expression of welcome, a
thank-you present, a sign that you care, a religious symbol. It is sometimes
used as a weapon, especially by children. Eating may simply be something to do with
your hands. Find out why your patient is eating the foods he or she eats and
suggest substitution of another activity or lower calorie foods as appropriate.
Where is the food eaten and with whom?
Eating alone allows unwitnessed greed. Eating with a
bad influence can encourage dietary sinning. No-one actually likes being good
all the time. What food is available at work? Could a packed lunch be taken? Home-cooked
meals may prove difficult if the cook is not the person with diabetes and does
not understand dietary requirements. Wives usually change their diet to suit
their husband’s diabetic diet. A husband rarely changes his diet if his wife
has diabetes. Binge eating and night eating (‘midnight snacks’) are commoner
among obese people than those who are slim.
Read the label
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| Diabetes Melltius: Healthy eating and drinking |
Most foods now have detailed content and calorie
lists. However, few packs weigh exactly 100 g. And what is a gram? Many British
cooks still think in pounds and ounces: 100 g is 3.5 oz; 1 ounce is about 30 g.
Increase exercise
Advise at least 30 min of moderate intensity physical
activity on at least 5 days a week Continue this regardless of weight lost. Any
exercise is better than none—just walking round the garden, for example.
Avoid hypoglycaemia
As people exercise more and eat less, less glucose-lowering
treatment will be needed. Warn patients of the risk of hypoglycaemia and take
steps to avoid this, especially during or after exercise.
Written by Renate Drousch
diabetes tipo 2
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