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Defeat Diabetes
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Diseases Linked to Obesity and Insulin Resistance: Obesity: Building A Program For Success

Posted: Saturday, December 27, 2003

This is the last in a series of articles that have all focused on a single theme – obesity and the ravages which ensue from a long standing battle with being overweight. We’ve examined the overwhelming evidence linking heart disease to obesity; linking diabetes to obesity; linking hypertension, high cholesterol, and stroke to obesity. Those are just the major illnesses. There are countless minor ones. These diseases are the leading cause of death in most of the world we live in. Yet, the evidence is far from clear about what to do with that information.

Being obese or overweight is entirely someone’s choice; however, it is really up to the health care practitioner to help and encourage in any way they can. In fact, recent studies have uncovered that there are few studies that prove that losing weight increases your life span. Thinner people live longer but does that mean that you have to have been born thin? Is an overweight person bound to die earlier regardless of how much they weight? We really don’t know the answer to those questions and only time and research will provide us with the knowledge of what to do.

Since we do not know the answer to that very important question of, “will my intervention make any difference in life expectancy?;” we must examine things that we do know will a difference, and learn to ask the right questions. Perhaps the question we need to ask is, “is my intervention going to improve someone’s quality of life?” If they don’t live a day longer, will they feel better on each of those days they are alive.

Perhaps I am a little discouraged today because in my office this week, I saw a patient who was very sad. He was 13 and weighed 280 pounds. His blood pressure was through the roof; he couldn’t walk, and had rashes all over his body. The worst part of it all was that he did not care. He had no motivation or desire to lose weight and feel better. He was completely resigned to his fact of life. I have to feel that making an intervention in his life will make a difference in not only his quality of life but in the prolongation of his life.

We do know that giving diabetics a proper diet will decrease the risk for peripheral vascular disease. This is accomplished through better control of blood sugar. Improved blood sugar control will also decrease risk for kidney disease and hence less need for dialysis; decrease incidence of blindness and less need for seeing-eye dogs; less numbness and tingling; less gum disease so less trips to the dentist (that means more fun in my life); and a longer sex life (who isn’t up for that?). There are many more that we could mention too. Things that a diabetic stops enjoying because their blood sugar is not well controlled; or, they waited too long to get serious about their disease.

Diabetes is one of my least favorite diseases because people get lazy about it as they don’t feel its effects necessarily on a daily basis. Until they are paralyzed from a stroke, they could easily forget that they have high blood pressure. Unless they get third degree burns from keeping their hand on a stove or pot too long because they couldn’t feel the heat, they might never know they had no sensation in one of their extremities. Unless they get jaundiced, they may never know there liver is failing from the multitude of drugs being given to them by their well meaning physician to help keep them in check. Besides, who is going to pay for all of these expensive drugs? And, are they even necessary?

Some drugs are certainly necessary but they are prescribed at overwhelming amounts and always the newest, most expensive ones. This can be a real burden, not just on the person, but on the taxpayer as well. So, let’s examine the implications of everything I’ve written about on the future of health care.

If you recall, 20% of those over the age of 65 are diabetic. If this figure holds true as the baby boomers age, we are facing an enormous potential problem. It will become financially impossible to care for all of these people. There won’t be enough hospital beds to handle the cardiac implications of this, let alone anything else. Most hospitals and health care operations are already at the brink of bankruptcy – what is going to happen if we don’t stop this tide?

Are you prepared as a practitioner to handle the onslaught of a diabetic patient population? They need more care, more time, and more of everything; yet, time is finite and our day won’t be getting any longer – the amount we will have to work in that day may though. We are all going to have become more knowledgeable about the natural history of the disease and what to look for. Expect to see many more people using canes to walk, needing joint replacements of every sort and needing more room on the subway.

Our practice or counseling strategy is going to have to change to include time counseling the chronic overweight. Most overweight people are not first time offenders by the time they show up in our offices. By the time they get to see a professional, they have tried most of the other options available to them and have failed. Or, they were successful in the short term but failed to keep the weight off. Recidivism is extremely high for overweight people. One study even showed a failure rate of 95% for all weight loss programs across the board. To make matters worse, popular diets are being compared to each other and the outcomes so far appear that they are all equally ineffective. This is a very confusing proposition for the chronically overweight. They do not need another obstacle to stand in their way.

Therefore, simply devise a program that works for you and that you think will work for your patients. Then, you have to stick to your beliefs. Not every patient will be successful no matter what we try. That is why sometimes you have to have certain tricks up your sleeve for those troublesome patients. That is okay as long as the message you send out about what they should be eating is consistent. If you waiver, then so will they. They will lose faith and then you have lost them for good.

We are going to have to devise a program that is successful for our patients. For me, that program includes a good psychological support system. Behavioral medicine is extremely vital to the success of my patients. The issues patients face and the defense mechanisms are so powerful, partly because they are so primal and have been present for so long; that they have to be addressed as a separate entity from how to eat and what nutritional supplements to take.

Another important part of my program, Thin For Good, is an incentive program. Incentives need to be built into each patients program individually and something they can relate to. For example, one of my patients wants to lose weight so he can take me diving – not something I relish at all; but a simple price to pay if he lost the weight and got control of his diabetes.

Part of the challenge in tackling this recidivistic clientele is overcoming boredom. Try doing this by offering varied menu choices when making suggestions. Visit local fast-food places and local restaurants and delis and advise on what they should and should not eat. Most of my patients really appreciate the 7 day or 14 day sample menus that I give them. Since I individualize my diet programs, they are always not going to be accurate; but, it gives them a good idea of what you want them to do. This just makes it a little easier. Even if there are many things they have to change on those plans, they feel as if they have gotten something that they could really use. Go the extra step and your patient will appreciate it.

Something else to consider is the number of different nutritional supplements and the amount of pills that you ask them to take in a given day. This can be really overwhelming for some, especially if they have never taken them before. Remember to tell them to build up to the amount of supplements slowly. Sometimes it even takes my patients two weeks or more to get to the amount that I recommend. That is fine as long as you get to the goal – which is long term compliance. Assess the personality of the patient and if you can’t get a good handle on them, then ask straight out – how do you feel about taking vitamins. Most people will have an opinion. Then come to a compromise that still maintains the integrity of the program you want them to follow with something they can handle.

And, lastly, set a good example. If you are overweight, smoke, drink to excess and don’t exercise, what kind of example does that set for your clientele? Never eat something in front of them that you recommend against. Never allow your staff to do that either. They must believe that you practice what you preach; or why should they? That is not to say that you have to be thin and beautiful to take care of patients. You have to look like you are trying. Making an attempt is usually all your patient asks of you. Many diet and obesity doctors are overweight - even famous ones. Your clientele simply must believe in the faith of your convictions.

Whether you choose, or your patient chooses to lose weight or not, there is overwhelming evidence that suggest that there are foods that will support a healthier lifestyle. I think that will be my new series of articles – focusing on all the recent developments in the nutrition industry. We can review the latest studies and really explore the basis of a diet and lifestyle change that is necessary and long overdue. I can even give you sneak previews of my new book which is on this topic. Probably not too many or my publisher will get angry, but enough to whet your appetite.

I hate saving really good information. Since I just handed this book in, it will be at least 6 months before it gets to the stores and I am expected to keep all the good information to myself. That is very hard to do so I will leak it to all of you during the next few articles. So, until next time, when we examine fats, happy eating because you may have to change some of those habits once you are finished hearing what I have to say.  

Source: Diabetes In Control.com

 
 
 
 
 
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