So how can you lose weight? Draw up a plan.

• Pages in the diet & weight section

  diet & diabetes lose weight...a plan A plan in brief healthy recipes portion size exercise Birmingham's Obesity Service

  Weight..why is is a problem?
• How does being overweight cause or contribute to your diabetes?
• A plan
• Portion size is CRUCIAL
• What is a balanced meal?
• Individual advice
• Exercise
• Eat regular meals
• Alcohol, no binges, a little often
• Be realistic...how much quickly should you lose
• Avoid situations
• Everyday situations
• Hobbies & interests
• What other people do to lose weight
• Xenical
• American Heart Association Recommendations
• Helpful addresses.eg British Heart Foundation
• the advantages of a 10kg weight loss 
• How does your weight change

 

Weight..why is it a problem?

There has been a lot of progress in the causes of type 2 diabetes. However, being overweight is harmful.

First, it makes your body 'resistant' to insulin, so you need more insulin that you would if you were an ideal weight. As insulin shortage is the main cause of diabetes, this becomes a real problem; you become even more short of insulin. Losing weight can make diabetes easier to control, as well as help lowering blood pressure and helping arthritis.

Secondly, some fat is deposited in the pancreatic cells that make the insulin, the beta type of islet cells. Some researchers have found that this fat damages these cells, which stop making as much insulin.

Third, weight increases the risk of retinopathy significantly, even in type 1 diabetes.

So there are many reasons to lose weight, but like many things in life, losing weight is often a very hard battle. However, if you avoid all the food that is very fattening, like cakes, chocolate and full fat dairy food, and have small portions of fattening food like meat and fish, and combine this with an hours walking a day (perhaps 2 x half hour walks), most people will make good progress.
Below is more specific advice that everyone, even if they do not have diabetes, needs to follow to keep healthy.

"Obesity is perpetuated by a series of vicious circles, which...accelerate weight gain." BMJ....the "runaway weight gain train".  The wait gain is usually very slow, by 100 gm a day, equivalent to a large bowl of cereal of 1/2 a mars bar every day.

 

How does being overweight cause or contribute to your diabetes?

In type 2 diabetes muscles need more insulin than normal: this is due to resistance to insulin caused by large amounts of fat and lack of exercise. Details.

For example, a 15 stone or 110kg person needs more insulin that a 11 stone of 70kg person. So if your pancreas, the gland which makes the insulin, is running out of insulin, it may have enough insulin for the 11 stone 70kg person. But if you were 4 stone or 40kg heavier, you would not have enough insulin for the extra weight, so you would be diabetic. (This is a simplified explanation.)

 

 

A plan

Our weight is a balance between intake and output.

If we take in more calories than we burn up exercising we will put weight on.

Large portions, or the wrong food, are likely to contain too many calories. So we have to ensure we eat smaller portions, healthy food, or have more exercise.

If you are serious about losing weight,

• join Weight Watchers or an equivalent weight watching group (no need to buy their food...contact with the people in the group and principles are important)
• cut out all the bad food
• the right food...correct portions
• 2 hours exercise a day is ideal
• ask your friends to help, and not to offer you the wrong food
• no junk food in the house...your relations will have the same genes and likelihood of developing diabetes.

 

Portion size

For most overweight people the portion sizes are larger than thinner people (proven scientifically here & here). See

For most people in the UK, a portion of meat or fish should be no bigger than one weetabix. A cupful of potatoes/rice/pasta, and unlimited salad/vegetables are ideal amounts. See how to calculate portion size for a very active day.

 

What is a balanced meal?

The meal should be balanced to keep healthy:

protein
(fish, meat, pulses such as beans or lentils)
same size as a weetabix
+
fat
same size as your thumb
+
carbohydrate
size of one fist (UK)
+
vegetables/fruit
size of 2 palms

Here are some recipes/links, Fish and pulses are particularly healthy. Two small portions of fish a week helps your circulation.

 

Individual advice..see a dietician

Individual advice from a dietician is important when you are newly diagnosed with diabetes. If your diabetes is difficult to control, or if you cannot lose weight, a dietician can usually offer advice to you as an individual, so ask for an appointment.

Everybody with diabetes should see a dietician each year for individual advice. Ask your GP to refer you. This is naturally especially important if your diabetes is not controlled or you are overweight.  If you are very overweight, your GP may be able to refer you to an Obesity clinic, where there may be a doctor specialising in obesity, a dietician, a physiotherapist, and may be a psychologist. For more success losing weight it is very helpful to have personal support, see.

Join Weight Watchers or an equivalent weight watching group (no need to buy their food...contact with the people in the group and principles are important)

 

Exercise

Exercise is critically important. 10000 steps a day are needed to lose weight. See Exercise page. If you are disabled, exercise is still very important, try to walk round the house every half hour, and go out and walk outside for short walks, perhaps 4 times a day.

If you have arthritis and cannot walk or take any exercise, you will only need 1200 calories a day...this is not much at all, and it is hard to eat so little.

Losing weight is important, but so is getting fit. Many people who are overweight have arthritis, and leisure centre gyms or fitness clubs can help. Staff there can tell you what exercise may help. Even if you cannot lose weight, exercise has many health benefits.

Swimming  is really helpful if you have arthritis in the knees. An exercise bike can help if the arthritis is only mild, but there are plenty of upper body muscle strengthening exercises a fitness instructor can tell you about. Once you know what they are, you can do some at home.

If you do not have arthritis, walking and cycling can be helpful. Do not drive when you are shopping for small items, walk. See losing 3.5 stones in 8 months.

 

Eat regular meals

Eating regularly is important to help you lose weight. Meals should be based around starchy carbohydrate foods (such as bread, potatoes, rice, pasta and cereals), see .

 

Alcohol

Alcohol has many calories, so it is fattening. It also puts your blood pressure up. Try to drink alcohol only in moderation.

A reasonable amount is 2 units for women and 3 units for men each day. Always have something to eat with your drink or shortly before. See what binge drinking does to blood pressure here.

 

 

Be Realistic

It is no good expecting to lose too much weight too quick

ly. It is often best lost slowly, whilst at the same time changing your lifestyle (as below, essentially eating less rich food, more vegetables and fruit, and exercising more).

Even losing 10% of your weight is a really hard job, so do not expect to lose too much too quickly.

Losing 1lb a week is ideal. Even a little less will still be helpful. Losing weight to quickly tends to lead to a rebound increase in weight. Some new research did demonstrate that more weight loss is possible with expert help.

You do need to weigh yourself weekly to check your progress.

 

A Snack

If you want a snack, fruit is much better that chocolates or biscuits. A brown bread salad sandwich or banana is often fine.

Remember the filling..cheese is very fattening indeed, and is best avoided, or eaten in tiny amounts. (If you are very overweight, even fruit may be fattening, especially bananas, and really you need expert help if you are very overweight.) All fruits temporarily put up sugar levels, but unless you have lots of fruit all in one go this is generally not harmful.

Bananas are slightly fattening, but are healthy and much healthier than junk food. If you sugar levels rises considerably you may be best with less sweet fruit and more vegetables.

Experiment with different snacks, but do not worry is your sugar rises a little after you eat. The really important sugar level to test is first thing in the morning (type 2 diabetes), or half an hour before meals (type 1 diabetes, but see for details) see glucose testing.

Don't eat other people's left overs...this is very fattening

 

Avoid situations

Some situations are just too tempting. Going to certain cafes, certain friends who tempt you, certain shops, may provide too much temptation. It may be best not to go to these places.

Ask your friends to help you by not tempting you with the wrong food or too much food. They may be overweight too.

I suggest keeping all 'junk' out of the house. As type 2 diabetes runs in the family, it would be wrong for grandparents to encourage their grandchildren to eat junk food in the house. If cakes, chocolates, sweets, and fast food are in the house, anyone of of us would be tempted to eat it at times. If you are tempted, stick to fruit. Remember, junk food is addictive ...it just makes you hungrier.

 

Everyday situations

Try to build in exercise into your daily life. Go shopping on foot; wash the dishes by hand; clean the house; visit friends on foot, go for walks. Grow some vegetables.

Just the opposite of routine 2007 life!

 

 

 

 

New hobbies and interests

Some new hobbies, like dancing, will be of obvious benefit. But most hobbies and interests will help by helping you feel better. Psychologists have worked out what makes us happy: the combination of exercise, music, sex, and learning is an ideal combination (as in dancing).

But simply learning any new skill, like surfing the internet, can help people feel happier. A happier person will be able to cope better with a strict diet!

Try and join a few clubs, developing new interests.

So if you think you eat because you are bored or fed up, this could be you. Try and get out and enjoy yourself, see your friends, and so on.

 

 

What other people do to lose weight

• This article is excellent (subscription needed), with a strategy (modified slightly):
• reduce fat in the diet
• reduce/cut out fizzy drinks...tap water (or low sugar drinks) instead
• avoid sugary foods and high-fat meat products
• increase low energy foods such as fruit and vegetables
• choose natural foods if possible, but if choosing processed food, choose those with a low energy density
• choose small plates
• avoid large/super-size portions
• never eat with fingers
• always eat sitting down
• join a gym, use the gym, walk to the gym
• walk more and don't use the gym
• get a pedometer and use it to monitor increased walking  (improves success)

 

Drugs ..Xenical to help you lose weight

Xenical can help you lose weight. See. It can be safely used in diabetes, whether or not your diabetes is diet controlled, you use tablets, or insulin.
By helping you lose weight it can lower your sugar levels and blood pressure. It can be used with most types of medication (but not cyclosporin), with no interactions.
Ideally you need to lose weight (2.5kg) in the 4 weeks before you start. You should lose 5% of your weight at 3 months, and 16% at 12 months.

 

American Heart Association Recommendations 2000

At least five servings of fruits and vegetables daily.

Six or more servings of whole grains and legumes (beans).

Six ounces of lean meat or poultry per day.

At least two servings of fatty fish, such as tuna or salmon per week

No more than one alcoholic drink per day for women and two for men, for those who consume alcohol.

To prevent weight gain, the new guidelines also recommend at least 30 minutes of brisk walking daily. The walking can be done all at once or in segments throughout the day.

The guidelines also stress the importance of preventing obesity, which research has shown can contribute to medical problems such as diabetes, high blood pressure and heart disease. The association's diet plan recommends a gradual weight loss no more than one to two pounds per week using a simple process of cutting calories and increasing exercise.

 

Advice from the British Heart Association and others

• www.bhf.org.uk
• National Institute of Health Recommendations
• Weight Watchers
• www.weightconcern.org.uk/

 

The advantages of a 10kg weight loss

• Total mortality decreased 20-25%
• Diabetes related deaths decreased 30-40%.
• Obesity-related cancer deaths decreased 40-50%.
• systolic blood pressure decreased 10mmHg
• diastolic blood pressure decreased 20mmHg
• Symptoms decreased 91%
• Exercise tolerance increased 33%
• Total cholesterol decreased 10%
• LDL cholesterol decreased 15%
• Triglycerides decreased 30%
• HDL cholesterol increased 8%
• Risk of developing diabetes decreased more than 50%
• Fasting glucose decreased 30-50%
• HbA1c decreased 15%

 

How does your weight change

from this report NEJM 2011

• Crisps (0.4 lb/year)
• potatoes (0.3 lb/year…but we need our energy from somewhere)
• sugar-sweetened beverages (0.3 lb/year)
• unprocessed red meats (0.25 lb/year)
• processed meats (0.25 lb/year)
• alcohol use (0. 1 lb/year [1 drink a day])
• smoking (new quitters, 1.25 lb/year; former smokers, 0.03 lb/year)
• sleep (more weight gain with <6 or >8 hours of sleep)
• television watching (~0.1 lb / year [1 hour a day])

and was inversely associated with the intake of

• vegetables (−0.04 lb/year)
• whole grains (−0.1 lb/year)
• fruits (−0.01 lb/year)
  nuts (−0.15 lb/year) (although too many nuts are very fattening)
• yoghurt (−0.82 lb) (P≤0.005 for each comparison)
• physical activity (−0.4 lb /year);

Total dietary changes were associated with substantial wieght reduction of 1 lb/year.