The Doctor Weighs In

Not too long ago, my husband and I vacationed in Israel.  We had dinner with some Israeli friends.  One of them, Avinoam told us a story about his brother, a lawyer, David.  David is in his late 50s, a hard-driving attorney who pays attention to everything but his own personal health. 

Avinoam describes his brother as a "big man."  In fact, his description places him squarely in the severely obese category.  He can barely move, never walks if he can help it, and he smokes cigarettes, as do way too many Israelis.  Recently, he went to see a doctor for the first time in many years. 

No surprise.  David was diagnosed with diabetes, high blood pressure, and early kidney disease.  David, from a medical perspective, is what we clincians call "a walking time bomb."  He is at high risk for coronary artery disease, stroke, peripheral vascular disease, kidney failure, nerve damage and diabetic eye disease.   Doctors sometimes refer to patients like this as potential "train wrecks."

David has gone from taking no medications and being blissfully unaware of his medical problems to a high risk patient.  He now takes, per Avinoam, seven different types of pills.  Despite his diagnosis and risk status, he is still smoking. 

Unfortunately, there are way too many people in the US and around the world who are just like David.  They eat too much, exercise too little, smoke, and are ignorant of their risk factors.  Given the high prevalence of obesity, diabetes, pre-diabetes, and metabolic syndrome around the globe, the impact of these time bombs is enormous.  No wonder the former Surgeon General of the US, Dr. Richard Carmona, recently referred to obesity and the associated problem of type 2 diabetes "the terror within."

In addition to proper diet and exercise, I believe everyone should know their risk of developing health problems when they get overweight.  Some of these risks include having a family history of type 2 diabetes, having high blood pressure, abnormal lipids, insulin resistance, glucose intolerance or frank diabetes. 

Women with a history of gestational diabetes, big babies (greater than 9 pounds), or polycystic ovary syndrome also have increased risk.  Risk of type 2 diabetes increases with increasing age as does habitual inactivity.  Certain racial and ethnic groups have increased risk of type 2 diabetes, including Native Americans, Latinos, African Americans, Asian Americans and Pacific Islanders.  Type 2 diabetes is now occuring in very young children who are overweight or obese, a phenomenon that is relatively recent.

If you are at risk for type 2 diabetes or its precursers (metabolic syndrome or pre-diabetes), here are some things you can do.

• Lose weight.  If you are normal weight, initiate lifestyle changes that will assure you maintain this weight throughout your life. 
• Increase your physical activity aiming to eventually achieve 30-60 minutes of moderate to vigorous physical activity most days of the week
• Know your numbers.  See a health professional or attend a health fair to learn your diabetes risk statistics:
  • Weight, BMI, waist circumference
  • Blood pressure
  • Fasting glucose
  • Fasting lipid panel
• If you smoke, stop!

If any of your numbers are out of the normal range, talk to a health professional about developing a plan to bring them into an acceptable range.  The plan should establish specific goals for you to achieve (e.g., blood pressure of less than 130/90, HDL greater than 50).  It should also include recommendations for lifestyle changes (weight loss and increased physical activity).  It may include medications.  There are good medical studies that show that lifestyle changes (and some medications) can improve diabetes control and, if you are pre-diabetic, prevent progression to type 2 diabetes. 

My mantra for every one at risk for type 2 diabetes is simple:  "know your numbers, reach your goals."  Your life depends on it.