LAS VEGAS — Physicians need to monitor diabetic patients in weight loss program more closely than nondiabetic ones, Holly R. Wyatt, M.D., said at the annual meeting of the North American Association for the Study of Obesity.
These patients are more difficult to manage than the general population, according to Dr. Wyatt, medical director of the Colorado Weight Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver. Nonetheless, they can lose weight, she said, and they will be able to reduce or stop many of their medications if they do.
“You have to become an expert and believe you can help your patients lose weight,” she rallied clinicians at the meeting, cosponsored by the American Diabetes Association. “We're not talking a huge amount of weight loss; we are talking a realistic amount,” she said.
Diabetic patients need a multipronged approach, incorporating diet, activity, behavioral counseling, and medication, Dr. Wyatt said. Diet by itself is not enough. Moreover, adjustments will be necessary when the goal shifts from short-term weight loss to long-term weight maintenance.
Restricting calories is most important early on, according to Dr. Wyatt, but the clinician has to produce a plan the patient can follow. “Just telling patients to eat less is not an approach. You have to do more than that,” she said. For example, she cited meal replacements (such as Slim Fast) as being very effective in the short term because they help patients control portions.
Clinicians must monitor blood glucose and insulin levels as these will change when diabetic patients start to lose weight. The physician may need to stop or reduce insulin and some other medications by 25%-50%, Dr. Wyatt advised.
Exercise is critical to long-term success in weight maintenance, she said. But telling sedentary patients to move more does not work any better than telling then to eat less, she said. Instead, she recommended writing an exercise prescription for these patients.
“One of the most effective is a pedometer, and slowly getting them up to 10,000 steps a week,” she said. An interim goal would be having the patients increase their steps by 500 over baseline each week.
“At the end of the day when they look at the pedometer, they know they made a difference,” she said.
“Self-monitoring is absolutely critical,” Dr. Wyatt continued. “Patients who use food and activity diaries are more successful than those who don't.”
Physicians should use all available tools, including medication, according to Dr. Wyatt. Weight-loss drugs can help maintain 10% weight loss at 1 year, she said.
Finally, Dr. Wyatt said the physician should not become discouraged if a patient starts to gain back weight.
“When patients come in and they've regained some weight, you feel like they failed and you failed as caregiver,” she said. “No one failed. It's common in a chronic disease. Some people fail several times before they actually succeed.”