Sherri Shafer, R.D., CDE returns to Diabetes in Control after an extended hiatus. In keeping with our publisher’s focus on prevention she has contributed a feature on Preventing and Treating Type 2 Diabetes with Weight Control and Exercise.
Weight control has been shown to reduce the risk of chronic disease. Unfortunately our country has seen an overall trend in weight gain. At least half of all Americans are overweight, some severely so. Excess weight poses many health risks including heart disease, high blood pressure, and type 2 diabetes. Diabetes has become an epidemic in the United States. Current estimates predict that the problem is going to get much worse. Worldwide, diabetes is expected to double in the next twenty-five years.
There are 21 million Americans with diabetes and an estimated 54 million with “pre-diabetes”. Pre-diabetes is when the blood sugar levels are above normal but not yet high enough to be called “diabetes”. People in the pre-diabetes category still have a chance to postpone or prevent diabetes by controlling their weight, eating healthier and exercising.
Weight loss is at the foundation of preventing and treating type 2 diabetes. While not all people with type 2 diabetes are overweight, most do carry extra weight. Health experts recommend an initial weight loss goal of 5-10 percent of current weight for anyone who is overweight. A suggested rate of weight loss is 1-2 pounds per week. Health benefits can be realized with even modest amounts of weight loss.
A Balancing Act
If the calories you eat are roughly equal to the calories you burn, then theoretically you will stay about the same weight. When you eat more than your body needs, the extra calories are stored as fat.
One pound of body fat stores roughly 3,500 calories! Ouch! To get rid of one pound of body fat requires using 3,500 calories out of storage. That won’t happen in a day. Weight takes time to put on and it takes time to take off. A caloric deficit of 500 calories per day can mean losing one pound per week. To achieve this, it’s best to cut down on the calories you eat, and increase the calories you burn through regular exercise.
Small dietary changes can make a difference over time. Giving up 150 calories per day saves you 54,750 calories per year! (150 calories is the amount of calories in either 1- ounce of regular potato chips, or 12-ounces of regular soda.) When cutting back on calories, be sure to eat a varied and well-balanced diet. You still need the recommended amount of vitamins and minerals.
The Food Pyramid is one tool to assist you in following a balanced diet. The food pyramid has been updated. If you have access to a computer, look at the new interactive website at http://www.mypyramid.gov. You can type in your age, gender, and activity level and the program will give you a printout of a nutritionally balanced diet with appropriate portions, personalized just for you.
Exercise is the other key element in preventing and treating type 2 diabetes. Exercise is also an important component of weight loss. Additionally, it can lower blood pressure, improve cholesterol profiles, improve circulation, and reduce stress. For individuals who have not been engaging in regular physical activity, it is important to do what is comfortable and gradually build the frequency, intensity, and duration of the workouts.
The eventual goal should be an aerobic exercise session that is sustained for 20-30 minutes with a 5-10 minute warm-up period before the main exercise session, and a 5-10 minute cool-down period at the end. Aerobic exercise should be included at least every other day, but daily is even better. Walking is a great form of exercise. Other exercise options include local gyms, community pools, and exercise classes. Home exercise equipment or even an exercise video may be an option for some. Weight lifting with light to moderate weights or resistance exercise machines have proven beneficial for people with type 2 diabetes. Try to include resistance exercises sessions three times a week. Include all major muscle groups and do three sets with 8-10 repetitions each.
You may find it easier to stick with your plan if you hook up with an exercise buddy. Or, maybe it would help to set up a reward system. Keep track of your exercise in a logbook or on the calendar. At the end of each week, or month, give yourself a reward (non-food!) for achieving your exercise goals. Set aside some time every week for family members to do something active together. Spending active time together is good for everyone’s health. You will also create lasting memories.
And Finally, Here are 100 Tips for Successful Weight Management
- Set realistic goals.
- Take it one day at a time.
- Keep a food record.
- Don’t use food as a reward.
- Don’t eat on the run.
- Take small bites and savor each bite before swallowing.
- Don’t eat in the middle of the night (unless, of course, you’re experiencing hypoglycemia).
- Make an appointment with a registered dietitian.
- See a counselor about behavior change.
- Make crafts instead of baked goods.
- Ask your family and friends to be supportive of your weight loss efforts.
- Use smaller plates, cups, bowls, and glasses.
- Serve food from the stove and not from serving bowls at the table.
- Set your fork down in-between bites.
- Eat slowly.
- If hungry, have a small, lowfat snack an hour before the meal to curb your appetite.
- Drink a glass of water before each meal.
- Drink a glass of water before each snack.
- Limit sweets and desserts.
- Don’t skip meals; it sets you up for overeating later.
- Choose calorie-free beverages. (Except for milk.)
- Choose nonfat and lowfat dairy products.
- Don’t eat for emotional reasons such as anger, depression, or stress.
- Don’t shop for food when you’re hungry.
- Don’t shop for food when you’re tired.
- Don’t overeat at holidays or celebrations.
- Be patient with yourself.
- Choose smaller portions of high-calorie foods and larger portions of low-calorie foods.
- Keep meat portions the size of the palm of your hand, up to twice a day.
- Keep fat portions the size of your thumb for each meal.
- Packaged snack foods should have less than 3 grams of fat per serving.
- Use a measuring cup to measure reasonable portions.
- Think positive thoughts.
- Take time at the grocery store to look for lower-fat, more healthful options.
- Use lowfat cooking methods.
- Choose lean meats.
- Read food labels to compare calorie content and fat grams.
- Limit fast food restaurant dining.
- Eat vegetables at lunch and dinner.
- Choose higher fiber foods.
- Don’t buy tempting foods if they aren’t healthy for you.
- Limit alcohol intake.
- Let your friends and family know what your food needs are.
- Include regular exercise in your life.
- Take the skin off the chicken and turkey.
- Don’t eat fried foods.
- Start your meal with a broth-based vegetable soup (choose low sodium, if appropriate).
- Bring a healthful snack along when traveling or away from home.
- When at work, don’t eat at your desk.
- Skip the butter, margarine, and mayo (or use nonfat/lowfat varieties).
- Use diet soft drinks.
- Share dessert when dining out.
- Join a support group.
- When served large portions, put half of your restaurant meal in a to-go bag before you eat.
- Don’t eat standing in front of the refrigerator.
- Don’t eat in front of the television.
- Don’t eat standing up.
- Chew a piece of gum while preparing meals.
- Brush and floss your teeth right after dinner.
- Love and accept yourself.
- Strive for five: eat at least five portions per day from the fruits and vegetable groups.
- Reward yourself for making progress (but don’t use food as the reward).
- Visualize yourself losing weight.
- Don’t eat a larger portion just because it’s a reduced-fat version.
- Bring a healthful dish to parties so there will be an appropriate choice available.
- Drink at least 8-10 cups of water (or calorie-free beverages) each day.
- Weigh yourself first thing in the morning, but no more than once a week.
- Snack on raw vegetables and fat-free dip.
- Make a plan in advance for how you’ll handle a tempting situation.
- Make a list of reasons why you want to lose weight and review it often.
- Avoid fad diets.
- Look for the words lowfat, nonfat, or fat-free on the package.
- Divide your food evenly throughout the day; don’t eat heavy evening meals.
- Don’t go to sleep right after a meal.
- Finish your meal with a walk instead of dessert.
- Call a buddy when things get tough.
- If you do eat a food that isn’t a good choice, limit the portion size.
- If you feel like you’ve fallen off the wagon, get back on.
- Don’t give up.
- Pick up new hobbies.
- Keep healthful snacks handy.
- Plan your menus in advance.
- Buy a lowfat cookbook.
- Shop from a list; don’t impulse buy.
- Package and freeze leftovers for future use.
- Don’t strive to be a member of the clean plate club.
- Wait at least 15 minutes after you finish your meal to decide if you’ll have seconds.
- Start your meal with a salad; use lowfat dressing.
- Fill at least half of your dinner plate with vegetables.
- Have fresh fruit for dessert.
- Don’t skip breakfast.
- Eat only when you’re truly hungry.
- Stop eating when you’re satisfied.
- Don’t arrive at a restaurant or party too hungry; have a small snack first.
- Schedule main meals 4–6 hours apart.
- Schedule snacks at least 2 hours after a main meal.
- Use a small teaspoon to sample while you cook.
- Politely refuse, rather than feel obligated to eat something you shouldn’t.
- Ask the waiter which menu selections are low in fat.
- If it’s a high-fat but favorite item, include it in small portions and infrequently.
Be sure to discuss your diabetes management plan with your health care provider. It is important to be up to date with your medical care and health screenings. Your physician may have specific exercise advice or cautions for you.
Sherri Shafer, R.D., CDE
Sherri Shafer received her BS in Nutrition and Dietetics from the University of California at Berkeley. She has been a Dietitian at UCSF Medical Center since 1992. Sherri specializes in medical nutrition therapy counseling for individuals in adult and pediatric diabetes clinics, and is an Instructor for classes on diabetes self management for Type 1 and Type 2 diabetes. In addition she teaches 7 lectures per year in the school of medicine (to med students, residents, pharm students, and physical therapy students.)