Diabetes and obesity- "The twin epidemics"
by Evan Klass, M.D.
Chair, Department of Internal Medicine
University of Nevada School of Medicine
Obesity has become the nutritional disease of our age. Although famine and starvation still ravage the third world, our survival is threatened by obesity. The causes of obesity are multiple and complex. Certainly our sedentary lifestyle contributes but it is easy access to inexpensive, calorie dense foods which are primarily responsible. In the setting of genetic predisposition to type 2 diabetes (formerly adult onset diabetes), increasing body weight increases the risk for developing diabetes.
What are we to do? We can't change our parents so our genetic risk is permanent. Certain conditions increase the risk for developing diabetes and we need to be aware. If a woman had diabetes in pregnancy (gestational diabetes) her chance of developing diabetes in the future is significantly increased. Likewise women who have polycystic ovarian syndrome are at increased risk as are patients with hypertension. Your doctor should be aware of these conditions and perform regular screening for diabetes in high risk individuals.
We should all aim to increase our level of physical activity. When patients ask how often they should exercise I say, "What's the matter with every day?" Exercise does not mean buying a gym membership. It means walking more, using the stairs, mowing the lawn on foot, etc.
Anything that gets you moving counts. We all need to pay attention to our weight. When we don't, it climbs. Then we need to honestly evaluate where our calories come from and recognize that we all underestimate what we eat. Then we need to start reducing. Many people benefit by meeting with a Registered Dietician. Remember, there are so many diets because none of them are very successful. The best bet is sensibly reducing your calories and remembering that real weight loss is a slow process. You can't lose heart! The sooner you start the sooner you get to your goal.
Finally, it is very important to work with your physician to insure that, if you have diabetes, you are employing all of the appropriate current therapies and that all other cardiovascular risk factors (blood pressure, cholesterol, smoking) are aggressively managed.