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DIABETES AND
OBESITY

genes are estimated to predict only 15 per-
cent of type 2 diabetes and 5 percent of
obesity risk.
Furthermore, longstanding and not
well-controlled diabetes can lead to vi-
sion problems such as diabetic retinopa-
thy, neuropathy and kidney disease which
unfortunately, once this damage starts on
the kidney, is almost always irreversible
and leads to end-stage renal disease and
dialysis.
but there is hope! We can take action
and prevention is the key. There is evi-
dence that even modest weight reduction
— whether through lifestyle/behavioral interventions, obesity med- as diabetes, hypertension, or sleep apnea, develop. because weight
ications, or bariatric surgery — can improve glycemic control and problems develop over the entire lifespan, emphasizing obesity pre-
reduce diabetes risk and all of its consequences. vention is urgent and must include the cooperation of public health
In general, programs including individual or group counseling to institutions, the school systems, and the private (e.g., food industry)
modify behavior result in 5 to 10 percent weight loss and are effec- sector.
tive for six to 12 months, after which weight regain is the rule. Suc- Current understanding of both pathophysiology and manage-
cessful lifestyle intervention programs typically involve ment suggests the need to adopt a chronic disease model of care
self-monitoring of weight, dietary intake, and activity; behavioral linking obesity and diabetes care management systems. besides in-
modification; frequent contact; and caloric balance through diet, cluding stepped-care approaches similar to those used for other
with or without exercise. For example, short-term intervention stud- chronic diseases, this model involves basing interventional (phar-
ies suggest that dietary changes, which emphasize less fat and re- macological and/or surgical) approaches on severity, duration and
fined carbohydrates, make it easier to reduce total caloric intake in individual risk/benefit.
obese adults and overweight children. In summary, what is needed is a comprehensive social, economic,
Medications have been used to assist in weight loss for almost 80 and workplace approach to prevention and intervention. In addi-
years, but adverse effects frequently restrict utility. They have been tion, community-setting approaches supplemented by physician in-
developed based on physiological insights, more recently targeting volvement can work when combining treatment modalities.
central nervous system control of appetite and metabolism or, op- Multidisciplinary teams including nutritionists, exercise physiologists
portunistically, when weight loss was noted as a side effect of ap- and behavioral/mental health professionals can achieve both initial
proved medications. In general, weight loss achieved with these and sustained weight management and glucose control. This ap-
medications ranges from 2 to 8 percent greater than placebo, with proach to attaining and maintaining weight reduction is critically im-
some suggestion that combination therapy may either increase portant both in alleviating the intensive defense of body weight by
weight loss or ameliorate side effects and increase tolerability. How- multiple biological systems and in reducing risk of β-cell decom-
ever, most drug trials last only six to 12 months, and thus there is pensation and, over the long-term, decreasing the morbidity/mor-
little long-term data showing that weight loss can be sustained. tality associated with diabetes complications and improving the
Some physicians often introduce secondary interventions when quality of life of our patients!
patients surpass a bMI threshold or when patients self-identify for
cosmetic or health reasons. They introduce tertiary intervention Sherryl D. Mitchell Hernandez, MD is with Kidney and Hypertension
when obesity-related complications responsive to weight loss, such Specialists of San Antonio.

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