Director of Nutrition and Dietary Services at Nutrisystem
Mary Gregg, RD, Director of Nutrition and Dietary Services at Nutrisystem, had the opportunity to interview dietitian and diabetes expert Hope Warshaw about the significance of weight loss for people with pre-diabetes and type 2 diabetes. Hope Warshaw, MMSc, RD, CDE, is a dietitian, certified diabetes educator and bestselling author of several books published by American Diabetes Association. Hope is currently working with Nutrisystem as a diabetes expert/consultant on its Nutrisystem® D® Program for people with diabetes who need to lose weight. To learn more about Hope, link to her website: hopewarshaw.com.
(Q) Mary: Why is weight loss so important in pre-diabetes and what health benefits can it reap?
(A) Hope: Research shows that being overweight, combined with having a family history of type 2 diabetes, is the biggest predictor of pre-diabetes. (Definition of pre-diabetes: the medical condition where a person’s blood glucose levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. The initial treatment for pre-diabetes today is to lose some weight and try to keep it off by eating healthy with proper portions, fruits, vegetables, whole grains, foods low in fat, sodium and sugars). Research also shows that pre-diabetes doesn’t just happen overnight. It can take years to develop. So often people gain a couple of pounds a year. Soon that adds up to 30, 40 pounds of excess weight. This extra weight can speed the cycle of chronic inflammation and insulin resistance, both of which play a key role leading to pre-diabetes or type 2 diabetes. (Insulin resistance is the body’s inability to use the insulin you make in your pancreas to function normally and control blood glucose.)
Weight loss, even a few pounds, can quickly put insulin resistance in reverse. Weight loss seems to greatly improve insulin sensitivity and decrease insulin resistance. Improving insulin sensitivity, making the body more responsive to the insulin a person still makes, in turn helps their body use their insulin more effectively and efficiently. Better insulin sensitivity can help lower blood glucose, lower blood pressure and improve blood lipids (cholesterol). And clearly keeping those pounds off for good is what will, over the years, hopefully prevent or delay the pre-diabetes becoming or progressing to type 2 diabetes.
(Q) Mary: Why is weight loss so important in type 2 diabetes and what health benefits can it reap? When is weight loss most effective in the treatment of type 2 diabetes?
(A) Hope: I could say ditto to the answer above about pre-diabetes. The difference is that once a person has type 2 diabetes, he or she is that much further along in the process of type 2 diabetes progressing. Research now shows that when people are diagnosed with type 2 diabetes they have a lot of insulin resistance and have lost at least half of their ability to make insulin in their pancreas. This is exactly why there’s no time for delay in taking action to lose weight and halt the progression. The sooner weight loss happens, the better. The key message is TAKE ACTION NOW! The most important action to take is LOSE WEIGHT! However, according to guidelines from the American Diabetes Association (ADA) many people also need to start on a blood glucose lowering medication soon after they learn they have type 2 diabetes.
(Q) Mary: How many pounds do people need to lose to see health benefits?
(A) Hope: People often think they need to lose weight down to their desired body weight. This is far from true. Studies in pre-diabetes and in type 2 show that losing 5 to 7% of your body weight (so for someone at 200 pounds, losing 10 to 20 pounds) is enough to increase insulin sensitivity and lower blood glucose, lower blood pressure and improve blood lipids (cholesterol). For some people losing these few pounds may also be enough to improve sleep, make moving around less painful, and lead to other health benefits. For most people a bit of weight loss can help them feel better about themselves and more positive about reaching their weight and health goals. Once a person loses enough weight, the all important effort to keep as many of those pounds off as possible is of utmost importance. And it’s not easy. Research shows it’s very important for people to continue to seek and get support from a program such as Nutrisystem D. Many people will continue to find that the portion-controlled, easy-to-fix Nutrisystem D foods really help them not overeat and stay on track over time. The key is for people to find a program that works for them long term because keeping weight off is a long term effort.
(Q) Mary: What does the research suggest about the benefits of a food plan with portion-controlled meals and snacks, like Nutrisystem D?
(A) Hope: Interestingly a few studies, including two National Institutes of Health multi-center studies, provided some portion-controlled foods and drinks (Nutrisystem foods were not included) to study subjects. The study in pre-diabetes is the Diabetes Prevention Program (DPP) and the study in type 2 diabetes is Look AHEAD (Action for HEAlth in Diabetes). Both of these studies, particularly early in the studies when there was a big push to lose weight, showed that people were more successful with weight loss and keeping pounds off the more they used these portion-controlled snacks and beverages. For some people a structured eating plan, such as Nutrisystem D, takes away the need to make food decisions, prepare foods and measure them. It’s just what people need to take control and see a positive impact on their weight and blood glucose.
(Q) Mary: What do the current American Diabetes Association nutrition guidelines recommend is optimal for people with pre-diabetes and type 2 diabetes?
(A) Hope: The current nutrition recommendations from the American Diabetes Association reflect the research which shows that people with pre-diabetes and type 2 can achieve their health and nutrition goals with a range of calories from carbohydrate, protein and fat.
When it comes to carbohydrate the most important fact to keep in mind is that Americans eat about 45% of our calories as carbohydrate. That’s a moderate amount of carbohydrate. This amount is fine…in fact a bit more is even healthier. Our problem with foods containing carbohydrate is not that we eat too much of them, it’s the types of carbohydrate containing foods we eat (or don’t eat). Consider that Americans on average eat 22 teaspoons of added sugars a day from sugary drinks, refined grain foods (think pastries, white bread, cookies)! Plus we don’t eat enough fruits, vegetables, fiber-filled whole grains and low fat dairy foods. The Nutrisystem D program offers healthier sources of carbohydrate. The amount of carbohydrate in the Nutrisystem D program is well within the ranges recommended by ADA.
(Q) Mary: What are the biggest challenges facing people when they are first diagnosed with pre-diabetes or type 2 diabetes?
(A) Hope: The biggest challenge is taking the bull (sorry!) by the horn and gearing up to take action. It is SO EASY with the diagnosis of pre-diabetes or type 2, which don’t cause daily physical pain but do cause a physical toll on the body, to be in denial and not take action. What we know today from years upon years of research is the time for action is TODAY! Don’t spend time regretting what you haven’t done or how you’ve let yourself gain weight and develop diabetes. Say to yourself “Today’s the first day of my life” and start to take small actions to make changes in your lifestyle to slow the progression of pre-diabetes or type 2.
Yes, simple to say, much harder to do! But try it. Make a few changes in your eating habits, start to take a walk most days. One action people can take is to consider starting the Nutrisystem D program to give a big assist with weight loss.
(Note: Hope Warshaw, MMSc, RD, CDE is a paid consultant to Nutrisystem and the Nutrisystem D program. Her responses in this interview are her own and reflect her knowledge and expertise in diabetes and nutrition.)