LAST WEEK I was treating an anxious 24-year-old man, weighing 110 kg, who had just been diagnosed with diabetes. As is often the case, a question that kept recurring in our discussion was the possibility of reversing his newly acquired affliction. Finally, I told him, “If you lose 10 kg weight, you can possibly get rid of diabetes.” He walked out of my office in disbelief. Was I trying to end the conversation or was I justified in my advice? Can one reverse diabetes through weight loss?
Once considered the hallmark of affluence, health and happiness, obesity is actually our biggest enemy—the mother of all diseases. All obesity is not the same—central or abdominal obesity, which particularly affects Indians, is the worst form. Central or visceral (especially the liver) fat releases chemicals (cytokines) that aggravate inflammation and impact our metabo•lism adversely. A list of diseases linked with obesity would fill this page. Common conditions which are associated with obesity include cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis and depression.
How do we define obesity? Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. Adults are considered obese when their body mass index (BMI) is above a particular cut off. For Indians, the cut offs in kg/m2 are 23-24.9 for ‘overweight’ and 25 for ‘obese’. A waist circumference of 80 cm in women and 90 cm in men is considered obese. Others use waist-to-hip ratio to define central obesity. According to World Health Organization figures, obesity has increased exponentially worldwide, tripling since 1975. In some countries like India, where malnutrition has been a bane for centuries, the rise of obesity has resulted in a coexistence of these two conditions (a double burden), which we are ill-equipped to handle.
Although not all obese persons develop diabetes, obesity can account for more than 80 per cent of the risk of developing it; studies have shown that individuals with a BMI of more than 30 have an eightyfold greater risk of diabe•tes than those with a BMI of over 22. A 5-per cent reduction in body weight followed by regular moderate intensity exercise could reduce your diabetes risk by more than half. Weight loss of over 5 per cent of your body weight also improves cholesterol and blood pressure status.
What can someone with diabetes do to lose weight? Diet remains the mainstay of weight loss programmes. Reducing the consumption of high fat, high sugar, energy-dense food, along with an increase in fibre intake are the basic principles of such diets. Increased consumption of green leafy vegetables, fruit, whole grains and nuts (which contain ‘good’ fat) helps. According to the American Diabetes Association, weight loss requires reducing dietary intake by 500 to 750 calories per day, or roughly 1,200 to 1,500 kcal/day for women and 1,500 to 1,800 kcal/day for men. About 30-60 minutes of physical activity daily is necessary for healthy weight loss and improvement in diabetes control.
The Cleveland Clinic compared various diets for weight loss in diabetes and concluded that the two most effective diets that led to significant sustained weight loss along with improve•ment in diabetes control were a low-carbohydrate diet and the Mediterranean Diet. A low carbohydrate diet involves restriction of carbohydrates (50 to 100 g/day). Carbs are primarily found in sugary foods, rice, pasta and bread. A combination of foods higher in protein (meat, eggs, cheese and nuts), higher in fat (oils, butter) and low-carbohydrate vegetables (broccoli, cucumber, leafy sal•ad) is allowed. The weight loss attained through this diet is rapid, averaging 11 kg over a period of 6 months and is greater than with low-fat diets. Blood sugar control also improves. The problem with this diet is a rapid regain of weight after a few months.
On the contrary, the Mediterranean Diet focuses on moderate ingestion (30-40 per cent) of monounsaturated fats like olive oil, fresh fruit, vegetables, nuts, whole grains, legumes, fish and a moderate wine ingestion. It leads to a relatively slower weight loss (typically 7-8 kg in a year), but with higher adherence rates in patients with diabetes. The weight regain is less than 0.5 kg over a period of two years.
In addition to diet and exercise, newer medications for diabetes (GLP1 and SGLT2 based therapies) also promote weight loss, which makes them an attractive proposition for some patients. For those who are severely obese, bariatric surgery is a sensible option, leading to improvement and at times even reversal of diabetes. The key is not to get misled by fad diets that promise short cuts to weight loss. Follow the science and listen to your doctor.