Dr. Kevin Most: Diabetes & Weight Management

Dr. Kevin Most and Steve Cochran

We have talked in the past numerous times about Diabetes and the epidemic levels we are reaching here in the United States. Diabetes is a terrible disease that can impact our heart, our kidneys, our vision, our circulation our risk for cancer, the list goes on. Diabetes is a condition where the level of glucose or sugar in our blood is much higher than needed. This leads to many problems.

Diabetes is broken down into 2 groups, Type 1 Diabetes ( makes up 5% of all diabetes) and Type 2 Diabetes,( makes up the other 95% of diabetics) they are very different, treated differently but unfortunately can end up with the same complications. So why are we discussing this today, was there a cure found? Is there a new blockbuster drug? Unfortunately the answer to those questions are no. The reason we are discussing is that some very concerning studies came out last week that show that we are probably not going to see a slowdown of the incidence of diabetes and in fact will probably see an increase in the number of case of diabetes, at least Type 2.

So what are the differences between the 2 types of Diabetes. Type 1 diabetes occurs when the pancreas does not make enough insulin, it was known as Childhood Diabetes as it was often diagnosed in Children at a young age as many are born with this condition. Type 2 Diabetes which was previously termed Adult Onset diabetes is a different disease, with Type 2 Diabetes the body actually resists the effects of insulin or in some cases it does not make enough insulin. Insulin is needed to move sugar from your bloodstream to your cells that need sugar.

The treatment for Type 1 diabetes is to replace the insulin that the pancreas is not making with shots of insulin. Technology has allowed us to move from the shots to insulin pumps for many people, and the finger stick to monitor your blood sugar is also seeing technology help with sensors that are placed under the skin that monitor your blood sugar continuously thru the day. These results are tracked and stored on your phone with many apps and in some cases the results are sent to your doctor as well. Prior to these advancements, patients had to stick their finger a few times thru the day to monitor their blood sugar levels which would then dictate the amount of insulin they needed. They would keep a paper copy which they would then bring to their doctors visit for the doctor to review, so technology has allowed us to treat and control Type 1 diabetics much better.

The bigger issue is the Type 2 diabetics, remember this used to be termed Adult onset diabetes. A study that came out in JAMA last week gave us some startling and sobering information. This study showed that 1 in 5 adolescents and 1 in 4 young adults are now termed prediabetic. The term prediabetic means that your blood sugar is higher than normal but not yet high enough to be termed a diabetic. These individuals are on track for a likely progression to a diagnosis of Type 2 diabetes. This is extremely concerning as we have seen a sharp increase in childhood obesity rates over the past decade. Obesity rates in children and adolescents is approaching 20%, which falls right in line with the study showing prediabetic patients being in the 20% rate. The concerning trend is not only with obesity but also with overweight children.

Adults with Type 2 diabetes are treated with medication that makes their existing insulin more effective, but in some cases the patients actually need insulin as well even though they are making insulin. The best treatment for Type 2 diabetes is actually losing weight. The loss of weight allows the insulin to be more effective and thus often eliminates the need for medication.

So why are we discussing this now, It has nothing to do with our Thanksgiving meal discussion however it does relate to the fact that many individuals will gain weight over the winter. There are many reasons for our winter weight gain. Below are a few reasons.
1.) We sleep more in the winter and thus are not actively burning calories for the same time as we do in the summer
2.) Cold weather keeps our outdoor activities limited
3.) We have a few major holiday meetings as well as holiday parties laden with unhealthy high caloric foods
4.) We enjoy comfort foods in the winter, stews and pastas are common in the winter and additional servings are not felt as much as they are in the summer
5.) We find less fresh produce in the stores and when there the prices have increased dramatically
6.) Believe it or not, the extra heavy clothes we wear don’t give us visual clues of any weight gain and thus do not remind us to eat properly
7.) We actually use more salt in the winter, be it from the comfort foods we are eating or the heavier foods and snacks we eat are high in sodium
8.) Let’s not forget the specialty coffees we see at this time of the year whether they are pumpkin latte, peppermint coffee or even spiced apple drinks, the calories add up

Now this would all be fine as we all know about the weight swings we see from winter to summer, however a study was released last week that shared with us the fact that we have many more American’s that weigh over 200lbs than we have ever had and that the majority of individuals in the United States are either overweight or obese. This increase has been noted in both sexes, in 2001 we had 38% of men over 200lbs, now that number is 42%. For women in 2001, 12% had a weight over 200lbs, this year we are closer to 15%. Couple that with measurement of BMI where height is taken into consideration and we find that 70% of American’s are actually over the desired BMI of 25. These statistics tell us why our issue with diabetes is increasing in this country. This additional weight also contributes the heart disease, high blood pressure and joint pain.

The more concerning finding in the study is that American’s overall are more content with their weight and we find that more individuals have no desire to lose weight. American’s are less likely to be bothered by their weight and actually feel that their current weight is “about right”. This study done by Gallup, contradicts the study recently studied in JAMA which said more Americans are trying to lose weight. The reason for the awareness is that obesity is felt to be responsible for 20% of deaths each year and countless other illnesses and injuries.

The feeling of being accepting of our weight certainly played out this week with the backlash from the commercial from exercise bike company Peloton. The commercial which Peloton produced to celebrate fitness and wellness journey was slammed in the media for being sexist and weight loss focused. I find it hard to slam a company that makes exercise equipment for those who want to exercise and stay healthy, but many others obviously disagree.

If we don’t accept that we have a problem with obesity and diabetes in this country then we should be accepting of the increased cost in healthcare. I can tell you that treating diabetes, heart disease and kidney disease is not inexpensive, yet a large portion of those issue can be eliminated or minimized with weight control.

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