Weight Management and Type 2 Diabetes

HOW DOES OBESITY RELATE TO TYPE 2 DIABETES MELLITUS?

Obesity is a biological and treatable disease. This condition has physical, metabolic and psychological complications that take away from our health. The metabolic complications of obesity develop gradually. It increases the risk of heart attacks and stroke. Obesity is not a character flaw, and it is not just about the pant size or the looks. Obesity is not something we wish on ourselves, and it is not our fault if we have it. Some say that people with obesity lack character or will, and their opinion is naive. In reality, there are a myriad of biological processes that together cause the accumulation of fat mass.

Our body is like a car: it needs to be refueled, and waste needs to be removed. Fuels come from what we eat. Each meal gets digested to protein, carbohydrate and fat. In turn, the intestines absorb the building blocks of each of these nutrients. In the blood we get circulating fats (cholesterol and triglycerides), circulating sugar (glucose), and the building blocks of proteins (amino acids).

Energy balance is the relationship between the calories that we ingest and the calories we burn every day. Energy balance is negative if we burn more calories than we ingest. In this situation we may need to borrow calories from energy stores. Over time a negative energy balance leads to fat weight loss. Energy balance is positive if we ingest more calories than we burn. We are very good at storing these excess ingested calories in fat cells, also called adipocytes. Over time a positive energy balance leads to fat weight gain. Individual adipocytes get bigger and bigger (hypertrophy). Fat deposits get redistributed with weight gain. Some fat pools, especially the fat inside of the abdominal cavity, may then cause disease.

Hormones are substances that are made in a part of the body, enter the circulation, and have biological effects in other parts of the body. They help regulate our internal environment and, therefore, play a crucial role in regulating our weight. When hormones do not work properly, illness develops. Insulin is a hormone made in the beta cells of the pancreas. Insulin works like the hose and nozzle at the gas station, it moves fuel. At the gas station the hose and nozzle move gasoline from the gas pump into a car’s gas tank. Similarly, insulin moves fuels from the circulation into cells. The major fuels that insulin helps move are glucose and triglycerides. When insulin does not work, glucose and triglycerides do not go into cells, they stay in the circulation. This makes the blood sugar and blood triglycerides rise. If the blood sugar goes up enough, an individual can develop type 2 diabetes mellitus.

Type 2 diabetes mellitus is caused by the accumulation of fat in most people. Fat inside the abdominal cavity, also known as visceral fat, causes insulin resistance. Visceral fat becomes a treatment target for patients with diabetes. The best measure of visceral fat is the waist circumference. The more overweight a person is, the bigger the waist circumference, and the bigger the waist circumference, the higher the risk of getting diabetes.

Weight loss makes blood sugar control easier, and can prevent diabetes in the first place. Even modest weight loss has tremendous benefits!

HOW DO I LOSE OR CONTROL WEIGHT AND PREVENT OR TREAT DIABETES?

Your current behavior needs to be modified. To lose weight you have to achieve a negative energy balance. Your caloric expenditure needs to be more than your caloric intake. The National Diabetes Education Program, a joint venture of the NIH and CDE, which AACE and ACE support, has a program that you can embrace, “Small Steps: Big Rewards.”

■ Increase your caloric expenditure.
  • Get regular physical activity.
  • Try to be physically active at least 30 minutes every day.
  • If you are able, go for a brisk walk, participate in sports, start dancing classes, or engage in active games (Frisbee, sledding, making snowmen or snow angels, etc.)
  • If you are very overweight remember this: a two minute walk every hour on the hour becomes a 30-minute walk at the end of the day. Every hour stand up, walk away for a minute, and then walk back. Two little minutes add up!
  • Decrease your caloric intake.
The most important thing to do is limit portion sizes. Always go small!
  • Eat healthy meals rich in vegetables, fruits, and whole grains. try to eat 10 servings of fresh fruits or vegetables every day.
  • Eat less refined carbohydrates, such as sweets and white bread.
  • Limit the amount of high-sugar beverages you drink, such as soft drinks and fruit punches.
  • Limit the intake of high-fat foods like ice cream, butter, peanut butter and high-fat meats.
  • Limit alcohol to no more than 1 drink per day for women, 2 per day for men. Avoid drinking alcoholic beverages if you have any difficulty controlling them.
  • Always eat a balanced breakfast, and try to place most of your daily calories with this morning meal.
  • Have a small dinner and don’t eat after 7 p.m.
■ Aim to lose 5 to 10 percent of your current body weight over the next 6-12 months.
  • For a 240-pound person, this is 1-4 lbs. per month.
  • Losing weight too fast can be unhealthy and often leads to rebound weight gain.
  • The three keys to success with weight management are patience, persistence, and realism. Set goals that you can realistically achieve, and give yourself the time to meet these weight loss goals.
■ Get your family and friends involved!
  • When your support people work with you, success is easier!
  • Encourage your family and friends to eat healthy meals and be active with you.
  • Put peer pressure on everyone around you to be healthier.
Good nutrition and increased physical activity are lifestyle changes that must be continued long-term to keep weight off and have better diabetes control.

The bottom line is this:

Focus on being the healthiest person you can be every day. Think of every day as an opportunity to have better nutrition and more physical activity. Medications are simply tools that your endocrinologist puts in your hands to help you. Have a healthy day every day. Then the weight will go down and the diabetes will improve!

Ayesha Ebrahim, MD, FACE, is board-certified in Internal Medicine and Endocrinology. Dr. Ebrahim earned her medical degree from King Edward Medical College in Lahore, Pakistan, in 1995, and completed a two-year Endocrinology and Metabolism Fellowship at New York Medical College. She provides endocrinology care for adolescents and adults.

J. Michael González-Campoy, MD, PhD, FACE, is Medical Director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME). He earned his MD and PhD from Mayo Medical School and Mayo Graduate School of Medicine in 1991. He is board certified in Endocrinology, Diabetes and Metabolism. Dr. González-Campoy is a recognized national expert on diabetes and obesity and a proponent of adiposopathy as a treatment target. Dr. González-Campoy is Clinical Assistant Professor of Medicine at the University of Minnesota.