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Obese (Class 2)

>40

Morbid obesity

Diet and diabetes: prevention and control 129 Table 7.2 Risk factors for developing Type 2 diabetes

• Increased age

Hypertension

• Very low HDL (high-density lipoprotein)-cholesterol levels (<40mg/dL)

• Elevated triglyceride levels (>250mg/dL or higher)

• Family history of diabetes

• Ethnicity (African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino heritage)

• Gestational diabetes or giving birth to a baby weighing > 9 pounds (4.1 kg)

• Inactive lifestyle diabetes versus 31 per cent in the metformin group. The clear message is that a realistic weight loss programme together with increased physical activity contributes to a reduction in weight and its maintenance with related positive health benefits.12 According to the ADA Position Statement on the Prevention or Delay of Type 2 Diabetes 2003, 'Structured programs that emphasize lifestyle changes, including education, reduced fat and energy intake, regular physical activity and regular participant contact can produce long-term weight loss of 5-7 per cent of starting weight and reduce the risk for developing diabetes'.13'14 Regular physical exercise is also advised to those who have a family history for diabetes in order to reduce their risk even if they do not have diabetes.15'16 Improvements in fitness help keep glycaemic control and promote psychological well-being. The American Dietetic Association states that 'successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviours emphasizing sustainable and enjoyable eating practices and daily physical activity.'17

A small caloric deficit of 500-800 kcal/day is sufficient to achieve a weight loss of about 1 or 2 pounds (1/2-1 kg) per week.18 Total fat intake, particularly saturated fat, should be reduced as recent studies have reported the negative effect of dietary fat, especially saturated fats on insulin sensitivity. Moreover, reduction in fatty foods helps to lower the incidence of cardiovascular risk factors independent of weight reduction. People should be taught to select low-fat foods and their substitutes. They also have to reduce their portion sizes as it has been shown that overweight subjects tend to choose larger portions of high-fat foods and to underestimate their size.19 A higher intake of dietary fibre has also been related to a decrease in the risk for type 2 diabetes. Some studies have also shown some positive effect of moderate alcohol intake in relation to improved insulin sensitivity and reduced risk for diabetes.20 However, data supporting this evidence remain elusive.

Changing eating habits is very difficult and support is needed from health professionals who should develop individual therapeutic programmes for each patient according to his/her lifestyle requirements and tastes. In order to increase adherence every minimal success should be stressed to increase motivation and compliance with treatment. Nutritional counselling and visits should be very close to each other to prevent relapse and to enable patients to make long-term lifestyle changes.21

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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