Preventing obesity and diabetes

The prevention of obesity and diabetes is both slow and difficult, according to Prof Stephan Rössner, a leading international authority, who recently spoke at a special course for diabetes specialists at the first Regional Congress on Obesity held in South Africa.

This is due to a variety of factors:

• Patients do not comply with advice given by health professionals such as dieticians and doctors;
• Governments throughout the world are more likely to spend money, time and effort on prevention programmes that are of a more urgent nature, i.e. the HIV/Aids pandemic;
• Economic priorities prevent governments from spending the vast amounts that will be required to combat these diseases;
• The information overload leaves patients confused about what to believe about their conditions and treatments.

The results of a Dutch study, which aimed to prevent weight gain in a group of obese diabetics over a period of 10 years, showed that even small interventions could have positive results.

The researchers found that by simply preventing overweight or obese diabetics from gaining any more weight (not losing weight), the incidence of osteoarthritis and work disability were reduced by up to six percent in the study group.

This shows that small inputs can produce major preventive outcomes.

The role of obesity

A study conducted among women in the USA, has shown that the risk of type 2 diabetes mellitus increases as body weight increases.

Women with a BMI of 22 were not at risk, but the moment the BMI increased to 27, these women had a risk of 20% of developing diabetes, while subjects with a BMI of 35 were eight times more likely to have type 2 diabetes than women of normal weight.

So, if you are female and overweight or obese, your chance of developing type 2 diabetes is up to eight times higher than if your weight is normal.

The role of ageing

Increasing age has a highly detrimental effect on weight gain. It has now been determined that the basic metabolic rate (BMR - the amount of energy we require to keep our body processes going when we are at complete rest), drops by 1% per year, as we grow older.

This decrease in BMR will cause an increase in body weight of 2-3 kg per year, unless the individual makes adjustments to his/her food intake and exercise level.

In diabetics, this increase in body weight with increasing age is usually even more pronounced than in people without diabetes - a finding that researchers cannot explain.

To counteract this inexorable increase in body weight, people need to start following healthy diets and doing regular exercise.

How successful are weight loss programmes?

Prof Rössner outlined various ‘indicators of success’ that are used to measure the outcomes of weight reduction programmes. These include:

1) No further weight gain in obese patients already represents a moderately positive result.
2) Minor weight loss combined with dietary adjustment to prevent complications of obesity is regarded as a positive result.
3) Modest weight loss of approximately 5-10% of body weight with an improvement in risk factors, such as a decrease in blood pressure, is a highly positive result.
4) Attainment of pre-obesity normal weight is the pinnacle of success but it is very rare and difficult to achieve and maintain.

Therefore, anyone who is obese should at least aim to maintain his/her weight and not go on and on gaining weight all the time. Probably the most desirable and achievable goal for obese patients is no. 3 - a reduction in body weight of 5-10% with an improvement of risk factors, such as a decrease in blood pressure, and/or a reduction in diabetes and heart disease risk factors.

Diabetics struggle to lose weight

A number of scientific studies have shown that diabetics find it even more difficult to lose weight than obese individuals who do not suffer from diabetes. The following factors all play a role:

• Diabetics are often diagnosed at a relatively late stage in life when their BMR has already dropped significantly, thus retarding weight loss.
• Diabetics are also less responsive to low-energy diets.
• Smoking cessation hampers weight loss, which does not mean that diabetics should not stop smoking (a vital step to prevent cardiovascular complications in diabetics), but that this factor should be kept in mind in treatment programmes.
• Diabetic medications may hamper weight loss and promote weight gain (i.e. beta-blockers, insulin).
• The complications of diabetes can prevent the patient from exercising. Consequently, he/she will lose out on one of the best treatment options to reduce weight and improve diabetic problems.
• Diabetics are often depressed, which also contributes to weight gain and hampers weight loss.
• Diabetics have a lower lean body mass than individuals without diabetes, which further slows down weight loss.

In view of the fact that 60-80% of diabetics are obese and that weight loss can cause dramatic improvements in diabetic complications (lower blood pressure and reduce raised blood fat levels) and the need to use diabetic medications, all diabetics should strive to either maintain their body weight or to lose weight if they are obese. – (Dr Ingrid van Heerden, DietDoc, November 2004)