Weight management is important in the management of Type 2 Diabetes. GPs and PNs are key advocates for highlighting the importance of a healthy lifestyle and to refer clients to additional supports as needed.
In 2007 50% of obese women described themselves as very overweight/obese compared to 34% in 2012. Only 25% of obese men described themselves as very overweight/obese.
- 61% of adults aged 16-65 years are currently overweight/obese
- 79% of adults >65 years are currently overweight/obese
- Men are more likely to be overweight than women (42% vs 31%) with obesity being more closely aligned (25% men vs 22% women) (1).
A health professional can assess whether a client's current weight is healthy or not. This means measuring weight and height accurately to calculate BMI.
Waist circumference (WC) is a useful measure to check if someone is carrying excess weight. WC is an independent risk factor for Cardiovascular Disease (CVD) regardless of weight.
A WC > 37” (94cm) for men or >32” (80cm) for women indicates an increased risk of CVD
A WC > 40” for men or >35” for women indicates a substantially increased risk of CVD
26% of adults in Ireland have an increased risk of CVD based on WC and 37% have a substantially increased risk (1).
Raising the issue
The topic of weight can be a sensitive area for a health professional to raise. The following can help:
- If weight monitoring becomes a routine part of consultation, then it becomes easier to discuss.
- Discussing weight with the help of a BMI chart can be a useful way to broach the subject.
- The ICGP published a Weight Management Treatment Algorithm and useful resources to help assist health professionals in the assessment and discussion of the benefits of weight-loss in the management of overweight adults.
It can be encouraging for clients to understand the benefits of 10% weight loss and linking the benefits of any weight-loss to the relevant co-morbidities.
For an individual with diabetes, the benefits of a 10% reduction in body weight include:
- 30% ↓ in diabetes-related death
- 50% ↓ in fasting blood glucose
- 10mmHg ↓ in blood pressure
- 30% ↓ in triglycerides
- 15% ↓ in LDL cholesterol
- 10%↓ in total cholesterol
- 8% ↓ in HDL cholesterol
It is important to be realistic when discussing weight-loss .Firstly, stop further weight gain, then aim for 5-10% weight reduction of original weight- maximum weekly weight-loss of 0.5-1kg. (3)
Assessing current lifestyle habits
Currently in Ireland:
- 27% eat 5+ portions of fruit/vegetables daily
- 60% eat 4 top shelf portions daily
- 42% eat 6+ top shelf portions daily
- 14% consume sugary drinks daily (22% aged 15-24)
Any dietary advice given should take current dietary patterns into consideration and dietary changes should modify existing dietary habits.
Therefore, taking the above statistics into account, a food diary or a fitness diary can be a helpful first step or ongoing self-monitoring tool to help identify areas in the diet to change eg top shelf/portion sizes.
Healthy eating and lifestyle advice
If overweight, lifestyle changes including diet or physical activity are the first steps to manage weight.
The three key messages from the Healthy Eating Guidelines:
- Limit high-fat, sugar, salt foods/drinks from the Top Shelf
- Eat more vegetable/fruit: 5-7 servings
- Know your serving sizes
Below are resources that can be helpful to give clients
Healthy Eating Guidelines
Healthy Eating Advice for Type 2 Diabetes and Pre-Diabetes
Weigh2Live website for practical tips on losing weight
Community Nutrition and Dietetics section has information on the dietetic individual and group services available in CHE for weight management.
Changes to physical activity in conjunction with dietary changes are the first steps to managing weight. See the Physical Activity and Exercise section for information.
Health and wellbeing Support
Some patients may benefit from health and wellbeing support to help manage their weight. See the Health and Wellbeing section for more information .
Specialist weight management support is available in CHE. Visit St Columcille's Hospital Weight Management Service for information on their service and referral criteria.
(2 ) Safefood Ireland, 2012