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New Guidelines on Heart Disease Prevention and Diabetes – The Whole Story on Weight Management

I mentioned in an earlier post that the American Diabetes Association and American Heart Association have just released an update on the prevention of heart disease in adults with type 2 diabetes. Since heart disease is so incredibly important and so connected to diabetes, I want to be sure you have the most current information on prevention. One unique aspect of this publication is the data included on weight loss, beginning with lifestyle (diet and exercise) but also including both drugs and weight-loss surgery.

Lifestyle change is, of course, the preferred approach to weight management, and this review of newer data cites two studies – the “Look AHEAD” trial and the “Italian Diabetes and Exercise” study. In the Italian study, as an example, the study group showed significant improvements in physical fitness, A1C, systolic and diastolic blood pressures, HDL and LDL cholesterol levels, waist circumference, BMI, insulin resistance, inflammation, and heart disease risk scores. I find two keys to success in these studies. First, the “Look AHEAD” study identified “self-monitoring” – record keeping – as a key to success, primarily recording food intake and exercise. Second, in virtually every study showing the success of lifestyle changes, including these two, the successful participants are inevitably in a study group which gets regular support and guidance in individual and/or group sessions. Take note – success comes with having professional help, and with self-engagement.

The consideration of drugs to assist with weight loss should begin, according to these new guidelines, with evaluating whether a patient is taking medications that may cause weight gain, and looking for suitable alternatives. For instance, some blood glucose reducing medications are associated with weight loss. The new guidelines mention several FDA-approved weight loss medications (most are “controlled” substances), but do not offer any new data related to heart disease risks.

The story on bariatric surgical procedures is complicated by the variety of procedures, and a need for more long term data. There is compelling evidence, however, that surgery can result in significant weight loss (15% – 25% of initial body weight), and in significant improvement in blood glucose (A1C reductions of 1% to 3%). The “Swedish Obese Subjects” study on weight loss surgery showed a type 2 diabetes remission rate in 72% of participants two years after surgery, but reduced to 36% at 10 years post-op. Still, surgery gave a more effective result for controlling diabetes than in the study’s nonsurgical control group. Short term data on weight loss surgery seems to show a reduction in heart disease risk as well, but data here is even more scarce. As you might expect, the bottom line on weight loss surgery is considering the potential benefits with the risks. Interestingly, the highest post-surgical risk is for vitamin deficiencies, making long term follow-up in nutrition counseling essential.

My “take home” message on weight loss is simply this – don’t give up on lifestyle until you have made a serious effort at diet and exercise with professional help. Lifestyle change can produce impressive results, but your chances for success are multiplied with individual or group guidance and support.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.