Moderate Weight Loss Most Effective Therapy

Physicians say they are counseling their overweight type 2 diabetes patients to lose weight, but patients say that the message is not getting through, according to a new survey.

Eight in 10 physicians surveyed said that they discuss weight issues with their patients every/almost every visit, yet half as many patients - only four in 10 - report having these discussions with such frequency. In particular, roughly half of overweight patients and a third of obese patients say their physician seldom or never discusses their weight with them.

Almost all of surveyed physicians (85 percent) acknowledge that losing even a little weight can help manage type 2 diabetes. When discussing weight issues with their patients, 90 percent of physicians surveyed report that they tell their overweight patients to lose weight. However, when the surveyed patients were asked whether or not their doctor ever suggested that they lose weight, only 66 percent of them said yes.

"Type 2 diabetes is often associated with obesity. Losing weight can help to improve blood glucose, blood pressure, cholesterol and so much more. But it is notoriously difficult to lose weight and to keep it off and this can be even more difficult for someone with diabetes," said Founder and Chief Executive Officer of the Behavioral Diabetes Institute William Polonsky, PhD, CDE. "Genetics and our immediate, food-rich environment play large roles in making weight loss tough, but disconnects between physicians and patients can make weight loss efforts even more difficult and frustrating."

The phone survey conducted by Yankelovich, part of The Futures Company, assessed the behaviors, opinions and attitudes of 703 people with type 2 diabetes and 200 physicians that treat patients with type 2 diabetes. The survey was conducted in the fall of 2008 on the heels of the release of the American Diabetes Association and the European Association for the Study of Diabetes consensus statement placing increased focus on weight management as a treatment consideration in type 2 diabetes care.

According to the U.S. Centers for Disease Control and Prevention (CDC), 23.6 million people in the United States have diabetes, an increase of more than 3 million in two years. This means that 7.6 percent of the U.S. population has diabetes, mostly type 2 diabetes, which is linked with obesity, improper diet and a lack of exercise. Estimates show that another 57 million people have pre-diabetes, a condition that puts people at increased risk for diabetes. In addition, about two-thirds of US adults--133.6 million--are overweight. Of these, 63.3 million are obese.

The survey also found that when physicians and their type 2 diabetes patients are talking about weight loss, it is not always in specifics. While more than half of patients do report having been referred to a dietitian or diabetes educator, told to eliminate certain foods from their diet and receiving literature about weight loss, only 27 percent of patients say their physician prescribed specific recommendations for exercise and less than 20 percent say their physician suggested a commercial diet plan such as Weight Watchers. And, even though more than half of the physicians said their patients understand that diabetes medications can cause weight gain, only 34 percent of surveyed patients report being warned by their physician that this could occur.

In addition to the communication gap, the survey found a number of other barriers impacting physicians' and patients' abilities to properly manage weight as part of diabetes treatments.

• Physicians see patients' reluctance to change lifestyle as the biggest barrier to achieving the level of care they would like for their patients.
• While some physicians say that their patients don't try hard enough to lose weight, they also recognize that willpower alone is not enough. However, nearly half of surveyed patients (46 percent) believe that losing weight is mostly a matter of willpower and if they try hard enough, they can lose weight.
• Physicians see the lack of support for education services and prevention by the healthcare system as another major barrier to successful treatment of type 2 diabetes.

"There are effective strategies for overcoming the weight management obstacles patients with type 2 diabetes face. Physicians and patients can start by talking together about the best ways to manage weight by developing a comprehensive plan of action that includes diet, exercise and the right medications," Dr. Polonsky said.

Practice Pearls:
Easy Tips for Physicians to Successfully Manage Their Type 2 Diabetes Patients' Weight:

• Don't be reluctant about discussing the importance of weight loss issues with your patients, but do so in a way that is not blaming, shaming or judgmental.
• Refer your patients to weight loss programs and health care professionals in your area who specialize in nutrition and weight management
• Provide your patients with basic tools to enable them to make appropriate lifestyle changes
• Reinforce the importance of setting manageable, achievable goals
• Encourage your patients to be patient with their own efforts and progress; acknowledge with them that weight management is not easy and occasional setbacks are common
• In a collaborative and caring manner, remember to ask your patients how they are doing each and every visit

The Behavioral Diabetes Institute and Amylin Pharmaceuticals, Inc. collaborated on the design of the survey. The survey was sponsored by Amylin and conducted by Yankelovich, part of The Futures Company, assessing the behaviors, opinions and attitudes of 703 people with type 2 diabetes and 200 physicians that treat patients with type 2 diabetes. The survey was conducted in October and November of 2008. The margin of error for the physician study is +/- 6.9 percent and for the patient study it is +/- 3.7 percent.

For more information about behavioral strategies for successful weight loss and diabetes management, visit the Behavioral Diabetes Institute (www.behavioraldiabetes.org).

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