Weight loss diets for diabesity

Diabetes is in epidemic proportions. According to the World Health Organization (WHO), the number of people with Diabetes worldwide is approximated at 150 million, most of whom are found in the Asia Pacific region. By 2025, conservative estimates show that the number is expected to increase to over 300 million. Data has shown that the prevalence is rapidly increasing in countries where significant socioeconomic changes are occurring. The direct and indirect costs could greatly affect the healthcare budget of these countries.

There is a large body of data showing that there are differences when comparing Diabetes among Caucasians vs. Asians. Acceleration of heart disease risks has been demonstrated to be similar between Chinese communities (Hong Kong and Singapore) with body mass index (BMI) values greater than 23 or lower weights compared to Americans or Europeans. It also believed that there is higher visceral fat (these are fat located in our internal organs of the abdomen) noted among Asians compared to Caucasians with similar BMI. There is also higher mortality rate of coronary heart disease (CHD) in migrant South Asians compared with other populations. In comparison with the European group, the South Asian group had a higher prevalence of Diabetes, higher blood pressures, higher fasting and post-glucose serum insulin concentrations, higher plasma triglyceride, and lower HDL cholesterol concentrations. Mean waist-hip girth ratios and trunk skinfolds were higher in the South Asian than in the European group. Aside from cardiovascular diseases, kidney diseases have been found to occur earlier and more frequently among Asian diabetics. This, indeed, is a huge problem.

Can we do something about it? Fortunately, there is now robust evidence that Diabetes can be prevented by people at high risk, and the progression of many of the complications associated with Diabetes can be delayed and even halted. Pan’s study on Diabetes Prevention among Chinese and the Diabetes Prevention Program are great testaments that diet and exercise works. Medications such as metformin could be used after failure of diet and exercise.

Despite the prevalence of malnutrition in the country, an increasing risk of Diabetes and Obesity is seen in the last 5 years. About 25% of the Philippine population is overweight and obese, and 7% is diabetic. The link between Diabetes and Obesity is so remarkable that it led to the coining of the term Diabesity.

Diabesity is the continuum of health problems ranging from mild insulin resistance and excessive weight to diabetes and obesity which increases the risk of heart disease and stroke to 2 to 4 times.

The cornerstone in the treatment of Diabesity is diet. Studies have shown that diet is very important and even a 5-10% weight loss will yield significant metabolic benefits – decrease in cholesterol and triglycerides, decrease in blood sugar, decrease in blood pressure among others. Several diet regimens are available and most will require the help of an Endocrinologist, Registered Dietitian, or Weight Management Team for proper

monitoring.

Low calorie diets are the mainstay of weight loss regimens in Diabesity. Healthcare providers have at least two dietary options when prescribing one. The first option is as a Very Low Calorie diet

(VLCD) that uses calorie-controlled, vitamin/ mineral-fortified liquid meals taken as the sole nutrient source. These diets are medically supervised and provide 800 kcal/day. VLCDs are typically prescribed for the morbidly obese or for those in whom rapid weight loss is a medical necessity. VLCDs also contain the recommended daily requirements for vitamins, minerals, trace elements, fatty acids, and proteins. Carbohydrates may be entirely absent or substituted for a portion of the protein. They are usually in powder form and mixed with water. Very-low-calorie diets usually have a remarkable short-term effect (about 1.5 to 2.5 kg per week weight loss), and energy restriction and weight reduction are positive factors for the glycemic control of obese diabetic subjects. However, the long-term efficacy of these methods remains doubtful since weight regain is a common phenomenon. This also should only be done by a health care provider.

The second option is a Low Calorie Diet (LCD) supplying in the range of 1200–1600 kcal/day. These are food-based strategies that can be divided into three categories. First is the Traditional Reduced Calorie Diet (RCD) – a plan that utilizes nutrient-deficient diet (e.g. Atkins Diet, Ornish Diet, South Beach Diet, etc.). Second is a meal plan of prepackaged food and snacks that are vitamin/ mineral-fortified (e.g. Weight Watcher’s Regimen, Sexy Chef, Goodbox PH, Gourmade PH, Happy Diet delivery, Diet Buddy PH, Diet Diva, Gourmet Guys, Lunch Box Diet, etc.). Third is Partial Meal Replacement (PMR) – a plan that prescribes one or two portioned/controlled, vitamin/mineral-fortified meal replacements (e.g. Optifast, Glucerna, Cambridge, Herbalife, Slimfast, etc.).

Each of the LCD strategies is usually designed to lower caloric intake by 500–1000kcal/day while most programs for weight reduction have demonstrated good results in terms of metabolic improvement (i.e. lowered blood pressure, improved blood sugars, lowered bad cholesterol, and short-term weight loss results). Long-term observations (a year or greater) have shown high rates of recidivism and weight relapse.

Before starting any of these diet regimens, it is wise to seek the help of a professional to guide the individual in terms of progress and monitoring.

Dr. ROBERTO C. MIRASOL finished his Endocrinology Fellowship at the University of the Philippines and his Diabetes Fellowship at the Lidcombe Hospital, University of Sydney. He was past President of the Philippine Society of Endocrinology Diabetes and Metabolism and the ASEAN Federation of Endocrine Societies. He is currently the St. Luke’s Medical Center – Quezon City Chief for Section of Endocrinology Diabetes and Metabolism. You can email him at mirasolroberto@gmail.com or call 7230301.