Type 2 diabetes is no longer an adult onset disease. Obesity is being seen in younger and younger people. There is a causal connection so people are calling it “diabesity”
It is time to stop wringing our collective hands about type 2 diabetes and do something about it. In a well researched editorial in this issue of Nursing in Practice (page XX-XX), Dr Song points out the frightening prevalence of type 2 diabetes and the terrible consequences of the disease. His comments add another page of literature to the existing pile, pointing out that this lethal disease is being seen in younger and younger age groups and treatment with a vast array of drugs does not appear to be solving the problem. He recognises the relationship to excess weight, but typically, really treating the weight is not one of the options considered. Why not? What could be the excuse? Could it be a lack of confidence in the means for treating obesity?
Obesity is not only treatable in theory, it is currently being treated effectively by more than 500 pharmacists in the UK and Ireland. Many of the cases being treated were patients with insulin resistance and/or type 2 diabetes. In patients with diabetes, it was necessary to get the prescribing doctor to stop the hypoglycaemic medication prior to dieting, because the blood sugar comes down very quickly, generally in about three days, and with continued weight loss, it seems to stay down, even with some weight regain. That’s it. No further story.
We are not in favour of the Atkins diet for many sound biological reasons, but when you consider the massive amount of money from vested interests and the well orchestrated expert opinion massed against the Atkins diet, you realise why the only tolerated solution will ultimately be pharmacological. But pharmacology cannot yet deal with obesity. A few kilograms of weight loss over an extended period has little impact on either the weight or disease. Fat people need to lose a lot of weight and playing with a few kilograms of glycogen and water loss is a waste of time and certainly not worth the risk of the side-effects.
Excessive weight is the cause of 95–98% cases of type 2 diabetes and is contributory to hypertension. Weight loss is an effective treatment as it reduces blood pressure in most overweight people. Weight loss improves blood lipid profiles, ameliorates pain in arthritic patients, improves respiratory problems from apnoea to asthma, increases fertility and improves quality of life immeasurably.
Modest reductions in calories could theoretically result in weight loss. Of course, the modest reduction has to be from the equilibrium level, not from current intake. There is a maximum rate of weight loss for any individual. A total fast requires that all the calories necessary for life come from the body reserves, there can not be any greater rate of weight loss for any individual.
A total fast provides no nourishment and therefore is not acceptable. A diet has to supply adequate essential amino acids, essential fatty acids, vitamins, minerals and trace elements, in order to keep the dieter healthy. What is needed is a nutrient complete source, which guarantees nourishment, that at the same time provides the least possible calorie levels so that a maximum rate of safe weight loss can be achieved. Liquid enteral feeds meet the nutrient criteria, but are designed to cause weight stability or even weight gain. These high calorie levels are generally met by relatively high levels of fat. Simply reducing fat levels in enteral formulas solves the calorie problem. An ideal nutritional product with the absolute minimum of calories consistent with a healthy diet is achieved. Lipotrim is an example of such a product.
There are now over 500 pharmacies in the UK and Ireland offering monitored weight loss programmes using Lipotrim, joining the many UK GPs offering Lipotrim to their patients. Suggest a pharmacist to offer your patients real help with their excess weight and reverse the scandal of an ever increasing prevalence of type 2 diabetes.
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