Updated 15 February 2017

Obesity and diabetes: Solutions

There are solutions to the seemingly unstoppable epidemics of obesity and diabetes that are threatening to engulf the world.

There are solutions to the seemingly unstoppable epidemics of obesity and diabetes that are threatening to engulf the world, according to Prof Stephan Rössner, who recently spoke at the First Regional Congress on Obesity organised by the International Association for the Study of Obesity.

The solutions include bariatric surgery, weight reduction diets and physical activity.

The reason why researchers feel that any intervention is worth trying is demonstrated by a large study done among patients suffering from type 2 diabetes. The findings showed that patients who had received interventions experienced a risk factor reduction of 50%.

This is most encouraging because it shows that both conditions are treatable and that the negative scenario of obesity and diabetes can be reversed if something is done about them.

Bariatric surgery
Bariatric surgery involves a variety of surgical techniques that are used to reduce food uptake from the digestive tract, such as reduction of the stomach or duodenum. During the study, patients who had undergone bariatric surgery lost an average of 20 kg. They maintained this weight loss for a period of six years.

Although some of the risk factors associated with obesity and diabetes, such as high blood cholesterol levels and elevated blood pressure, had returned to pre-operation levels after six years, other risk factors were dramatically reduced. For example, the improvement in blood glucose control and the incidence of diabetes had remained at the 0,2% level, or 30% less than in the control group.

Bariatric surgery is, therefore, an option that can be considered when a patient is obese, has not lost weight with conventional diet and exercise therapy, and is exposed to the risk of complications such as diabetes.

Success factors

Prof Rössner also outlined research findings that showed which factors are characteristic of successful interventions in obese and/or diabetic subjects. The following factors were predictors of weight loss and an improvement in symptoms:

Ninety percent of the subjects used a combination of diet and physical activity measures to lose weight. Although the diets and types of physical activity differed considerably, those patients who were successful all used similar tactics. These included:

  • a low-fat, high-carbohydrate diet
  • frequent self-monitoring
  • eating breakfast
  • using up 2700 kcal/week by doing physical exercise

These results confirm what dieticians have been saying for years: fad diets, starvation diets, diets that exclude whole good groups such as the Atkins Diet (which restricts carbohydrates to practically zero), as well as diet pills and products, just don't work.

The most sensible diet you can use to lose weight and to improve your blood glucose and insulin control is a balanced, low-fat, high-carbohydrate diet that employs carbohydrates with a low glycaemic index (GI).

This study also underlines the importance of eating breakfast and not skipping meals. When you diet to lose weight, it is essential to eat as normally as possible and to make sure that you have a good breakfast which will help you not to overeat during the course of the day.

Fasting and skipping meals in the hope that it will make the fat melt away, is simply not a good idea. Your body needs regular meals to maintain its equilibrium and to provide adequate supplies of energy for body processes and to fuel exercise.

The study also highlights the important role played by physical exercise to ensure sustained weight loss. The amount of energy that the subjects in this study used up on a weekly basis was not more than one day’s energy allowance, but it made all the difference to the success of the weight loss programme. This means that you don't have to exercise until you drop, but that you do need to engage in about 30 minutes of moderate exercise every day.

Factors that prevent weight loss

There are many factors in the modern world that prevent weight loss. These include:

  • The “obesogenic” environment, which includes mountains of fat-rich food of a great variety that are brought to our attention all day long by advertisements in every medium (radio, TV, magazines etc.), and our slothful lifestyles which are exacerbated by modern transport and effort-saving gadgets.
  • The fact that modern people tend to eat more and more meals away from home. Take-away food is usually rich in fat and highly processed carbohydrates and most of the portions are far too big. One study among teenage girls showed that the girls who ate two or more take-away meals a week weighed more and were more inclined to gain weight than girls who did not buy fast food. The troubling fact that emerges from this research is the finding that these future mothers don’t know how to prepare a meal and also don’t appear to be able to manage their lives in a healthy way. This will have a great impact on future generations.
  • The inability of the human body to utilise liquid energy in the form of sweetened cold drinks. The Nurses’ Health Study has produced evidence that drinking more than one sugary drink a day increases the risk of type 2 diabetes significantly. Researchers suggest that the negative effect sweetened cold drinks have on body weight and type 2 diabetes may be due to excess calorie/kilojoules intake, and the fact that these sugars are absorbed much more rapidly than sugars in solid food. Slimmers should, therefore, avoid all sweetened drinks if they want to succeed in losing weight and preventing diabetes.

Therefore, the solutions to obesity and type 2 diabetes are:

  • diet, exercise and behavioural treatment (so that lifestyle changes can be implemented);
  • medications like sibutramine (Reductil) and orlistat (Xenical) that assists with weight loss;
  • bariatric surgery for highly obese individuals.

– (Dr Ingrid van Heerden, DietDoc, December 2004)


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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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