Be a spin doctor: Help your overweight patients lose pounds
The skinny is to show them simple ways to gain control of their eating
Are your patients with Type 2 diabetes overweight? Chances are good that at least eight in 10 are. The number may even be closer to nine out of ten, says Richard Dickey, MD, president of the American Association of Clinical Endocrinologists, and a practicing diabetes specialist in Hickory, NC.
Experts say there are some new drugs and surgical procedures (see box, p. XX) and some promising new treatment research. But the bottom line is unchanged: Diet and exercise are the most effective means of losing weight and gaining control of glucose levels. (For more information on exercise and glucose control, see Diabetes Management, March 1999, p. 25.)
The term "diet" may not be new, but some experts say patients need to get a fresh perspective on getting a handle on their dining habits. That’s where health professionals can help, experts say, by putting the positive spin on something that has had such a negative perception — trying to lose weight.
"I’d rather not use the word diet’ because for so many people, it’s synonymous with deprivation," says Linda Haas, RN, PhC, CDE, the American Diabetes Association’s president for health care and education and a clinician at the Veterans Affairs Medical Center in Seattle. "I’d rather say that by eating healthy and raising metabolism through exercise, diabetics can make a significant improvement in their glucose control."
Her colleague, Marian Parrott, MD, ADA vice president for clinical affairs in Arlington, VA, agrees. "I would rather suggest that people add something to their diets rather than think of giving something up. Think about adding another vegetable or another piece of fruit." Filling up on the healthy foods may help patients eat fewer foods that are not as good for them.
Small victories bring big results
It doesn’t take a major weight loss for a patient to achieve better glucose control. In fact, a study from Tufts University in Boston recently reported that setting a goal of losing more than 10% of initial body weight is unrealistic for many patients and may promote weight cycling.
Parrott suggests gradual changes can lead to small, but significant weight loss. Identify the occasions where overeating occurs, she says, and decrease eating opportunities. Whether those occasions occur at home, at work, or at social events, "food is everywhere," she says.
Parrott has these tips to pass on to patients:
• Make a movie or a concert the highlight of an evening out, not an enormous meal at a fancy restaruant. Spending the time hiking or biking is even better.
• Those bulk-style warehouse stores may be great for buying detergents and other household items but avoid buying too much food there. The trash-bag sized containers of chips, buttered popcorn, and other snacks are just easy pickings. If patients must eat one of those giant muffins often sold there, tell them to eat only a quarter of one muffin at a time.
• Don’t be tempted by super-sized portions when eating out.
• Adjusting our attitudes toward food is just as important as adjusting our ideas about what is an ideal weight, Parrott says. "It’s the same old boring advice that no one wants to hear."
Substantial research shows that losing and regaining pounds creates weight cycling that makes it increasingly difficult and eventually almost impossible for a patient to lose weight.
Parrott adamantly opposes diets because the short-term fix does little to improve health in the long run because patients tend to return to their old habits. "It’s easier to starve themselves for a couple of weeks than to make long-term lifestyle changes."
Haas suggests patients keep log books of what they eat, not to create guilt, but to make them more aware of the quantities of food they are consuming.
Blood sugar monitoring is perhaps the most effective means of motivating diabetic patients, Haas says, because the results become apparent very quickly. "When they start to lose weight, they will see results in their blood sugars long before they see it on their waistlines or even on the scales, and they’ll feel better," she says.
Don’t place blame
Haas says clinicians are walking a fine line in helping diabetics achieve weight and glucose control. "It’s essential to understand that stress can play a very big role in elevated blood sugars," she says. "If a patient is stressing about the weight issue, reducing glucose levels will be very difficult."
Most importantly, she advises, "Remember that it’s very tough to lose weight, and people who are overweight are not bad people."
[Richard Dickey can be reached at (828) 322-7338, Linda Haas at (206) 764-2721, and Marian Parrott can be reached at (703) 549-1500.]
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