Doctor's Review: Medicine on the Move

August 19, 2017
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Moving AHEAD on diabetes

Started in 2000, the Look AHEAD (Action For Health in Diabetes) study is a multi-centre trial that is looking at different treatment models and outcomes for type 2 diabetes.(1) This is a well-designed study, with 5145 participants who are overweight or obese, have type 2 diabetes and are between 45 and 76 years old.

The participants have been divided into two treatment arms. In one group, participants receive an intensive lifestyle intervention that includes group and individual counselling on how to decrease caloric intake and increase physical activity. Weight-loss efforts are supported with meal replacements and prescription weight-loss medications. The second group of participants received routine diabetes support and education.

Ten years into the study, results have indicated that patients who participated in the more intensive lifestyle intervention and weight-loss program decreased their use of medication for diabetes, hypertension and hyperlipidemia. This follows similar results from the Diabetes Prevention Program (DPP) Outcomes Study, which showed that patients receiving intensive lifestyle intervention had lower rates of diabetes than those who took metformim or who were in the placebo group.(2)

This is great news! It means we can both prevent the onset of diabetes and treat it using lifestyle modification. That said, a recent survey by the Canadian Obesity Network revealed that 65 percent of overweight Canadians and 40 percent of obese Canadian have never discussed weight-loss with a licensed health professional.(3) Many clients who seek weight-management advice or weight-loss surgery are self referred.

Instead of feeling helpless, here are some strategies that you can use as a physician to manage a patient’s weight and improve his or her chances of controlling diabetes, blood pressure and dyslipidemia.

  1. Ask your patient for permission to discuss weight and lifestyle. Even if you don’t directly target weight loss, there are lots of places to intervene, since studies show that many patients don’t consume a nutritious diet and aren’t physically active.(4)

  2. Do what you can not to prescribe medications that can contribute to weight gain.

  3. Weight gain is a symptom of depression, ADHD and sleep apnea. We need to treat these problems aggressively so patients have a better chance dealing with food and exercise issues. Up to 30 percent of patients with severe obesity may have ADHD.(5) Treating the ADHD obviously makes it easier for the weight-management to be successful.

  4. Patients often take their cues from their physicians. If they feel their doctor isn’t encouraging even the smallest of steps, they may lose faith in their ability to make lifestyle changes. If they feel that medication is more important than lifestyle changes, they may not bother trying to exercise or diet.

  5. Build your own team to treat obese patients. Find a specifically trained dietitian, psychologist and kinesiologist.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.

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