Are YOU at Risk for Diabetes?

Although the internet is packed with misleading and erroneous medical advice, there certainly are a great number of medically accurate and helpful sites as well. Today I stumbled across an excellent tool to help people quickly assess their risk for DIABETES on the American Diabetes Association website:
The Type 2 Diabetes Risk Test. Their catch phrase is "It's Fast. It's Free. It's Easy."- and it IS all that!

The numbers of people being diagnosed with type 2 (adult onset) diabetes in this country are staggering. There are nearly 2 MILLION new cases of diabetes being diagnosed each year in the United States, and nearly 80 MILLION people thought to have Pre-Diabetes. To clarify, Type 1 Diabetes, previously known as Juvenile diabetes, is a condition typically diagnosed in childhood or young adulthood, when the person's pancreas is not able to produce insulin.

This type accounts for only around 5% of all diabetics. Type 2 Diabetes is the more common type, and in this disease the body makes insulin, but either it cannot make enough insulin or the cells in the body are resistant to the insulin. Either way, blood sugars rise and cause problems in the rest of the body (such as the kidneys, eyes, blood vessels and nerves) and that sugar is not being converted into energy.

Bottom Line: If you are overweight and/or have a family history of diabetes, or simply are wondering about your risk, please take a minute and jump to the ADA website and see where you stand. Then take that number with you and head to your family doctor to see how you can optimize your health and minimize your risk for developing diabetes!

What is BMI?

Yesterday, I mentioned that discussing your BMI with your doctor might be a less emotionally charged way to discuss your weight. Terms like "overweight" and "obese" tend to make us all shut down and stop listening, but it is really important to understand whether or not your weight is becoming a medical issue. The BMI is your "Body Mass Index", and it is a reflection of your relative body fat. Note that I said "reflection"- the BMI is NOT a precise measure of your body fat percentage.

BMI is simply calculated by using a person's weight and height. Specifically, BMI equals your weight in pounds multiplied by 4.88, divided by the square of your height in feet. There are charts to look at and on line calculators as well. Click on this link to the U.S Dept. of Health & Human Services' BMI calculator to see what YOUR BMI is today.

Now that you've got your number, what does it mean? Well, if you are less than 20, you are underweight. If you are between 20-25, you are considered healthy, or "normal" weight. Please pay attention if you are in the 25-29 segment, because you are overweight! If you are >30, you fall into the medical definition of obesity.

Why did I bold face that 25-29 segment? Because in my clinical experience, no one with a BMI of 30 or more is surprised that they weigh too much. However, I would estimate that over HALF of my patients who fall in the "overweight" category are shocked that they have a medical issue with their weight. After college, people often put on a couple pounds per year, very slowly creeping that scale. During that time, they may only go up a size or two in clothing, especially if they are buying more expensive clothes (which tend to run larger and larger.) Before they realize it, they weigh 20 or 30 pounds more than is healthy, yet they don't "feel fat". I don't care very much about cosmetic issues with weight, but I care deeply about increased risk of diabetes, heart disease, low back and joint pain, all of which come into play when your weight goes up.

BMI's are not flawless. If you are an "ARNOLD" with tons of huge muscles, your BMI will be falsely elevated. If you are elderly and frail, chances are good that your BMI underestimates your body fat. In general, however, the BMI is a great tool to assess your weight.

BOTTOM LINE: Take a moment and calculate your BMI, and take an honest look at your weight: 1/3 of Americans are overweight, 1/3 are obese, and only 1/3 are normal or underweight, so the odds are stacked against you.

Why Don't Doctors Talk about Weight?

I have often heard people complain that their doctor did not tell their spouse to lose weight. (While I could do a side blog on why it is that people have this complaint more about their spouse than themselves, I will pass on that aspect today.) The CDC reported that in a recent Disease Control and Prevention survey, only 42% of obese patients were advised by their health care providers to lose weight. Interestingly, those who WERE counseled to lose weight were more likely to be actively trying to do so.

Why don't doctors tackle this more often? Obviously, there are many reasons, but let me list the top ones that immediately come to mind.

1. TIME- Doctors are all frustrated with less and less time with our patients. Weight loss conversations are rarely brief (and often loaded with emotional baggage) so doctors may avoid the topic purely from lack of time.

2. FEELINGS- Doctors are human (mostly) too, and we don't want to insult or hurt people's feelings. No one seems to be offended by high cholesterol or blood pressure, but universally people are defensive and/or hurt when say they are overweight or obese. Certainly, our society has made fat a four letter word.

3. MIRRORS- If your doctor is overweight, he or she may consciously avoid discussions of weight (why can't you lose your weight, doc?) or subconsciously avoid the topic because of their own frustration with the issue.

4. EXPERTISE- Not all physicians receive equal training in nutrition, so we have different comfort levels in direct counseling. Having said that, know that we can refer to our wonderful colleagues- our registered dietitians- who specialize in nutrition.

So, on your next office visit, why not ask your doctor about your weight? I think the least stigmatized way is to ask about your BMI- your body mass index. What's a BMI? More on that tomorrow...

BOTTOM LINE: Obesity should not fall into the "don't ask, don't tell" category- ask your doctor if you are at a healthy weight!

How are the Poor Obese?

When did it become the norm that poor people are obese? Right now, 1 in 3 Americans are obese, and nearly 2 in 3 are overweight or obese. Throughout history, the poor have been HUNGRY...and thin. Meat has become cheaper than grains and vegetables, while we super-size and sugar everything. Check out the CDC's latest info on obesity in America for some shocking statistics...

Remember when going to the ice cream store meant picking out a single scoop of your favorite one of 31 flavors? Now the ice cream is simply the base, and we put multiple toppings of fudge and CANDY on top of our multiple scoops. In simply the past decade, fast food sales climbed from $107,147 BILLION to $164,836 BILLION dollars per year. Hmm...what if we spent some of those BILLIONS on health promotion, instead?

Obesity has numerous health consequences: Type 2 Diabetes, heart disease, high blood pressure, stroke, cancers (such as colon, breast and uterine), liver disease, sleep apnea and joint problems (especially knee and hip.) Our estimated obesity-related medical costs as a nation are $147 Billion annually. The obese INDIVIDUAL spends at least $1400 more on their medical care than a normal weight person.

BOTTOM LINE: Stop looking for the perfect diet, diet pill, or most amazing gym, and start making common sense small changes, like focusing on eating MORE vegetables and fruits and getting MORE active!

New USDA Guidelines

On January 31, 2011, the United States Department of Agriculture (USDA) released their updated guidelines for the American diet. A panel of 13 nutritional experts, chaired by Linda Van Horn (who has a doctorate in addition to being a licensed and registered dietician) reviewed the available evidenced-based data regarding the impact of diet on wellness and disease prevention. Their findings come as no surprise, with an emphasis on MAINTAINING a HEALTHY WEIGHT (through calorie balance- energy OUT equalling or exceeding energy IN) and focusing on consuming NUTRIENT DENSE foods and drinks.
What does this mean? In short:
MORE: vegetables, fruits, nuts, seeds, seafood, low- or no-fat milk products, eggs, poultry and whole grains.
LESS: Everything else. Seriously! Less solid fats, complex/refined sugars (crackers, cookies, breads, sweets), fatty meats, and drinks with empty calories like sodas, many fruit drinks and alcohol.

So none of this is shocking. Perhaps the one controversy is the level of salt recommended. The USDA okays up to 2300 mg of sodium for the general population, but the American Heart Association (worried appropriately about high blood pressure) suggests that really everyone should max out their salt around 1500mg. The reality is, however, that if people change their diet from highly processed foods to more plant-based and whole foods, their sodium content will fall as well.

WIth more than 1/3 of American children and 2/3 of our adults falling in the overweight or obese category, the USDA is rightly shifting the emphasis of their guidelines towards calorie balanced diets and LIFETIME weight maintenance, through increasing activity as well as increasing vegetable and fruit consumption. Tomorrow I'm going to return to focusing on the MORE philosophy that has successfully helped many of my patients reach their healthy weights.

BOTTOM LINE: (Straight out of the USDA's Press Release)"The bottom line is that most Americans need to trim our waistlines to reduce the risk of developing diet-related chronic disease. Improving our eating habits is not only good for every individual and family, but also for our country." Cheers.

Metabolic Syndrome- What's That?

Have you heard of "metabolic syndrome"? You should have, because almost one fourth of American adults- 47 million- have it! In fact, metabolic syndrome is passing smoking as the number one risk factor of heart disease in America. That's the BAD news. The GOOD news is that with lifestyle changes, you can reverse or at least delay onset of metabolic syndrome.

So, what is it? It is not your "metabolism", although it sounds like that. Metabolic syndrome occurs when you have three or more of the following:

A. Large waistline (>40” M; >35” F)
B. High triglycerides (similar to cholesterol)* (>150)
C. Low HDL* (the good cholesterol) (<40 men; <50 women)
D. HIgh Blood Pressure* (>130 top number or > 85 bottom)
E. High fasting blood sugar* (> 100)

The * means that if you are on medications for any of these conditions, it "counts", regardless of your current numbers.

What's the answer? Ultimately, weight loss is the answer. Start by moving MORE, and eating MORE vegetables and fruits.

BOTTOM LINE: If you have high cholesterol or are overweight, SEE YOUR DOCTOR and ask about metabolic syndrome, and what you specifically need to do to avoid or reverse it!

MORE- A Novel "Diet"

On this last day of the 2010 AAFP Scientific Assembly, I will be speaking about nutrition. As family physicians, we are all motivated to help our patients achieve the best health they can, and often the major issues stem from being overweight. We know excess weight leads to high blood pressure, elevated sugars and diabetes, and high cholesterol levels, which can lead to heart attacks and strokes. So why don't more family doctors talk to their patients about their weight?

Of course, there are many reasons, but here are a few:
1. The doctor doesn't want to insult or upset the patient by telling them they are overweight, especially if the doctor herself is overweight.
2. Weight loss counseling can be very time consuming, and we are already time pressured without opening this can of worms.
3. Many doctors lack knowledge or training regarding current nutrition, and are unsure of which "diet" to recommend.
4. Often patients want weight loss drugs, and most doctors are unsure of the risks and aware of the high percentage of relapse once the medication is stopped.

My goal today will be to teach primary care physicians some simple tools that they can use to help motivate their patients to lose weight. They will learn about BMI, 24 hour dietary recalls and exercise prescriptions, and learn about my MORE philosophy! We all know that MORE fruits and veggies will push us towards better health, but having a concrete plan for More fruits/veggies, Optimizing Snacks, Ramping up Fiber and Exercising daily will be a terrific start! In fact, our surgeon general, Dr. Regina Benjamin, emphasized that we need to stop focusing on what we CANNOT have/eat, and start focusing on what we can and should be eating, which is exactly the MORE message I have been sending the past few years

BOTTOM LINE: Focus on MORE fruits and veggies, MORE exercise, MORE fiber and stop the culture of restrictive dieting!

Break the "Eat, Repent, Repeat" Cycle!

Tired of that eat, repent, repeat cycle? Dr. Michelle May's new book, Eat what you love, Love what you eat! is your ticket out. BUY THIS BOOK when you are really ready for change. This book is not a new diet to follow, and is not a quick read- but it is worth every minute you invest. Dr. May, a fellow family physician, has done an amazing job of helping readers be able to figure out the WHY behind their weight issues. She is a recovered yo=yo dieter herself, so she clearly understands the complexities of weight management.
I began recommending her book fresh off the presses, and I already have several success stories to share! The best news to me, however, is that my patients have universally agreed that this is the first book where the author "got inside (my) head". Dr. May teaches you to really "eat mindfully", enjoying and savoring flavors, smells, and the company at meals, rather than mindlessly tossing back food on the run.
BOTTOM LINE: If you have struggled with being overweight, buy and read Eat What You Love, Love What You Eat and figure out how to "eat mindfully and live vibrantly"!