SAN DIEGO, CALIF. – “Diabesity,” as Dr. David Heber calls type 2 diabetes, is a lifestyle disease, not a diagnosis that necessarily requires heavy lifting of the prescription pad.
Too many physicians begin and end the conversation by saying, “You have diabetes and I have a drug for you,” he said at the Perspectives in Women's Health meeting.
Obesity, which packs proinflammatory adipocytes around the heart, liver, and intestines, stands as the greatest threat to women's health in the modern world, said Dr. Heber, professor of medicine and director of the University of California at Los Angeles Center for Human Nutrition.
It costs $130 billion in the United States each year, impacting nearly every organ system in the body, including the reproductive system (Dr. Heber calls polycystic ovary syndrome “diabetes of the ovary”), musculoskeletal system, and the hepatic system, rapidly becoming a leading cause of liver transplantation.
Dr. Heber emphasized that judging patients by appearance alone, or even body mass index, will miss many women at increased risk for cardiovascular disease and diabetes because of abdominal fat.
“Women have higher body fat than men at every BMI,” he said, quoting one study that found that 45% of women with normal BMIs had excess internal fat.
In his office, he uses a bioelectrical impedance meter to measure skeletal muscle versus fat tissue mass, from which calculations can be made for the number of calories per day required to reduce weight in a certain period of time.
The next step is to discuss with patients the need for lifestyle modification to preserve health in a way that they can envision.
Unfortunately, both emotions and nature work in opposition to weight loss, since “psychology trumps physiology every time. You eat when you are not hungry. Nature wants you to hold on to calories.”
Diabetes, he said, “is great genes in the wrong century.”
For many people, then, a whole restructuring of views about food must counteract impulses and a food industry that has conditioned us to crave foods that are sweet, bland, oily, and creamy “so that you can consume a large amount of food without realizing it,” Dr. Heber said.
Focusing on fruits and vegetables, whole grains, fish, spices, and nuts in a color-coordinated diet (see box) can provide fewer calories and fewer proinflammatory foods, as described in Dr. Heber's book for lay audiences, “What Color Is Your Diet?” (New York: HarperCollins Publishers, 2001.)
Replacing two meals a day (one per day for weight maintenance after weight loss) with high protein, low-calorie, meal replacement shakes makes the transition even easier.
Drinking thick shakes for two meals makes people want chewy, crunchy, colorful foods for snacks and the third meal of the day, he explained. Fruits and vegetables fit that bill.
The strategy also helps patients learn to self-monitor their eating and to better gauge portion sizes and estimate calories.
Perspectives in Women's Health is sponsored by several publications of the International Medical News Group, a division of Elsevier.
Brighten Mealtimes for Weight Loss
Dr. Heber encourages his diabetes patients to eat from the following color groups of fruits and vegetables:
▸ Red. Tomato products, soups, sauces, juices (contain lycopene).
▸ Red/purple. Red wine, grapes, berries, plums (contain anthocyanins, ellagitannins).
▸ Orange. Carrots, mango, apricot, sweet potato (contain β-carotene/α-carotene).
▸ Orange/yellow. Citrus fruits, papaya, peaches (contain citrus flavonoids).
▸ Yellow/green. Spinach, corn, avocado, green beans (contain lutein/zeaxanthin).
▸ Green. Broccoli, Brussels sprouts, cabbage (contain glucosinolates, indoles).
▸ White/green. Garlic, onions, chives, asparagus (contain allyl sulfides).
Dr. Heber tells his patients to avoid white and beige foods, such as white bread.