Author: Dr. Stephen Glazer, MD FRCPC FCCP FAASM, Internal Medicine, Critical Care Medicine, Diplomat of the American Board of Obesity Medicine, President of the Canadian Association of Bariatric Physicians and Surgeons, Medical Director Bariatric Medical and Surgical Program, Humber River Hospital
More than 5.7 million Canadians are living with diabetes and 11.7 million Canadians are living with either diabetes or prediabetes. The prevalence of diabetes has been increasing at an average rate of 3.3% per year. The incidence of obesity in adult Canadians is greater than 27%, or more than 7.3 million adults. Often diabetes and obesity coexist, and obesity is a risk factor for the development of diabetes. Read on to learn more about diabetes and weight management.
How can nutritional intervention help with weight management?
Healthy eating is important for all Canadians, regardless of their body size, weight or health. Canada’s Food Guide is an excellent resource for nutritional and food-related education. There are also many nutritional intervention options available for those living with obesity but there is no one-size-fits-all eating pattern for the management of obesity.
Nutritional interventions should be based on your individual preferences. The focus should be medical nutrition therapy, which is the intake of specific types of foods and quantities directed at achieving healthy outcomes, in order to treat or minimize the consequences of obesity and other chronic diseases. When evaluating nutritional interventions, the focus should be on your eating patterns and food quality – as well as your relationship with food – and not exclusively numbers on a scale.
Is it important to watch your calories?
Calorie restriction may be successful for short-term weight loss, but it is not sustainable in the long-term. Our brain is wired with complicated circuitry whose function is to control appetite and hunger, cravings and the regulation of body weight. Not only is the circuitry determined by our genes, other factors such as environmental, social, medication and illnesses, contribute to weight. Collaboration with a registered dietitian who has experience in obesity management and medical nutrition therapy to discuss calorie intake would be beneficial. You can ask your diabetes healthcare team to refer you to a dietitian.
What is the role of exercise in weight management?
Exercise is beneficial for achieving and maintaining weight loss. It can increase your metabolism to burn more calories and maintain or increase your lean body mass. In addition, regular physical activity is very important as it results in a wide range of health benefits in adults and may go beyond its effect on weight loss. It is recommended that you perform 30 to 60 minutes of moderate-to-vigorous-intensity aerobic physical activity at least 4 days per week, if not most days of the week. In addition, resistance training is effective in promoting weight maintenance and increasing muscle mass or fat-free mass and mobility. Aim to do resistance exercise 2 to 3 times per week.
Regular physical activity may also improve blood sugar levels, insulin resistance, blood pressure and cholesterol. Beyond that, regular physical activity may improve quality of life, mood disorders such as depression and anxiety, and body image in adults living with overweight or obesity. Consult your healthcare team to see if it is safe to undergo increased physical activity. You can also seek guidance from trained experts in exercise programs.
What about medications?
For some individuals, there is a role for medications to help with the treatment of obesity. Medication should be part of a comprehensive approach to weight loss, including medical nutrition therapy and increased physical activity. Further discussion with your healthcare team about the use of medications for weight management should be considered on an individual basis.
Can behaviour modification therapy help with weight management?
Specialized programs that involve behaviour modification therapy in conjunction with meal replacements are available. These programs must be medically supervised and are accessed through centres of excellence for the treatment of obesity. Consult your healthcare team for further information and locations that offer these programs either in person, virtually or a combination of the two.
What is the role of weight loss surgery and who is a candidate?
At the present time, criteria for bariatric surgery are based on an individual’s body mass index (BMI), which is a calculation used to classify the degrees of obesity.
- Class I obesity = individuals with a BMI greater than or equal to 30 kg/m2
- Class II obesity = individuals with a BMI greater than or equal to 35 kg/m2
- Class III obesity = individuals with BMIs greater than or equal to 40 kg/m2
Although this measurement may have inherent inaccuracy in predicting individuals at risk for, or who possess the metabolic consequences of obesity, BMI remains the criteria for bariatric surgery based upon years of research.
Bariatric surgery is considered for individuals with a BMI greater than or equal to 35 kg/m2 who also have obesity-related comorbidities (such as diabetes, hypertension, sleep apnea or severe acid reflux) or individuals with a BMI greater than or equal to 40 kg/m2, even in the absence of obesity-related comorbidities. If you are currently smoking tobacco, you will not be eligible for bariatric surgery until you have stopped smoking.
Several types of bariatric surgery are available, including Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch or single anastomosis duodeno-ileal bypass with a sleeve gastrectomy. Gastric banding is not considered a clinically useful tool for the management of weight loss as it is associated with significant complications, as well as failure in the management of weight loss.
Surgery still remains the most effective tool for weight management with respect to quality of life, long-term weight management and resolution of obesity-related comorbidities such as diabetes, sleep apnea, fatty liver and elevated blood pressure. Bariatric surgery may also improve life expectancy. Long-term follow-up, including vitamin and mineral supplementation, is necessary for those undergoing bariatric surgery. These surgical procedures are performed in dedicated centres of excellence for bariatric surgery with a multidisciplinary team. To learn more about your eligibility for bariatric surgery, speak with your healthcare team.
