Take a look and it's hard to miss this fact: Americans of all ages are gaining weight. In fact, the Centers for Disease Control and Prevention (CDC) reports that 61 percent of Americans are now overweight and that 26 percent are obese. Just 10 years ago, only 56 percent of us were overweight and 23 percent were obese. What can't be seen so readily is one of the serious implications of becoming overweight: type II (non-insulin-dependent) diabetes. Diabetes occurs when the body no longer makes or is unable to use insulin, a hormone produced by the pancreas. Insulin allows energy from carbohydrates in foods to be used by the body's cells. When insulin is not present or is ineffective, blood sugar levels rise. Over time, high blood sugar levels can cause damage to the eyes, nerves, kidneys, and other vital organs. Table 1 describes the various forms of diabetes.
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Table 1: Descriptions of the Various Types of Diabetes
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| Type of Diabetes |
Description |
| Type I |
Autoimmune disease in which the cells of the pancreas no longer produce insulin. Most commonly occurs in children and young adults. Affected individuals inject insulin daily. |
| Type II |
Most commonly occurs in adults. Incidence increases with age and body weight. Disease can often be managed with diet and exercise. |
| Gestational |
Gestational Develops in 2 to 5 percent of pregnancies but disappears afterward. Women who experience gestational diabetes have a higher risk of developing type II diabetes later in life. |
Most people with diabetes have type II diabetes, the kind that usually develops later in life. Although the exact causes of diabetes are not known, there are known risk factors. You are at higher risk for diabetes if you are an African American, Latino, Asian American, Pacific Islander, or Native American; have an immediate family member with diabetes; or are a woman who has had a baby who weighs more than 9 pounds. In addition, research strongly indicates that controllable factors, including body weight and physical activity, play a significant role in the onset of type II diabetes. According to Phyllis Barrier, MS, RD, CDE, national director of program publications for the American Diabetes Association, "Everyone over age 45 should be screened for diabetes every three years, and if they have a family history of diabetes or other risk factors, they should be screened earlier and more frequently."
However, it's not only adults who need to be concerned about type II diabetes. Health professionals are also concerned about reports that indicate that type II diabetes is becoming more common among overweight children.
Although not all people with type II diabetes are overweight, many are. One way that health professionals assess weight is to measure body mass index. As the body mass index (see Figure 2) increases, the tendency to develop diabetes also increases. Many health professionals are extremely concerned that diabetes rates, which are already rising, will soon be skyrocketing due to rising obesity rates. According to the CDC's National Center for Health Statistics, the prevalence of diabetes has risen 33 percent since 1990 across all age groups, educational levels, and ethnic groups.
The good news is that type II diabetes can be managed with a combination of meal planning, physical activity, and, if needed, medications such as oral glucose-lowering agents or insulin. Research has shown that the complications of diabetes (eye problems, kidney disease, and nerve damage) can be significantly reduced when blood glucose levels are closely monitored and controlled.
| Figure 2:
Body Mass Index
Body mass index (BMI; which has units of weight/height2) is based on an individual's height and weight and is a helpful indicator of obesity and underweight in adults. To calculate your BMI, use the formula below or go to http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm to calculate it. A person with a BMI of 25 to 29.9 wt/ht2 is considered overweight, whereas a person with a BMI of 30 wt/ht2 or higher is considered obese.
BMI = [weight in pounds / height in inches / height in inches] x 703
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Tools for Health: Nutrition and Physical Activity
For people with diabetes, one important goal is maintaining blood sugar levels as close to normal as possible. Usually, this means eating regularly spaced meals throughout the day, getting plenty of physical activity, and taking medications, if needed. Some people with type II diabetes are able to maintain their blood sugar levels with diet and physical activity alone. For others, following a healthful meal plan and being physically active can reduce the need for medication.
Body weight can also influence the need for medication. People with type II diabetes are encouraged to lose weight or at least to not gain weight, since higher levels of body fat can decrease insulin's effectiveness. For many, weight control is an ongoing battle. When it comes to weight loss and health, a little goes a long way. According to Phyllis Barrier, "For many people, losing just 10 to 15 pounds can make a big difference in their blood sugar levels."
Most nutrition experts agree: managing portion sizes can help control calories and weight gain. Ann Coulston, MS, RD, past president of the American Dietetic Association and a nutrition consultant who has conducted research on diabetes for 20 years, believes that the current trend toward larger serving sizes at restaurants, at movie theaters and in retail packages can make it more challenging for consumers to eat portions with reasonable sizes. According to Coulston, "It's hard for people to resist the temptation to eat more than they need." When eating out, she advises that people eat only part of what they are served or share their meals with a friend.
Physical activity is the other tool that can help people manage their diabetes and their weight. The American Diabetes Association and many other health care organizations encourage people to be physically active on most days. After checking with their health care providers, most people with diabetes can gradually build up to 30 minutes of physical activity each day. Physical activities like walking, swimming, and bike riding are great ways to have some fun while exercising. In addition, normal household activities like gardening, raking leaves, or house cleaning can count toward physical activity. Physical activity has been shown to help improve a person's ability to control blood sugar levels and may also help prevent weight gain.
Carbohydrates and Diabetes
For many years it was believed that eating foods made with sugar, such as cakes, cookies, or soft drinks, would raise blood sugar levels, and people with diabetes were encouraged to avoid them entirely. The rise in blood sugar levels, however, is similar to the rise in blood sugar levels found with other carbohydrate-containing foods such as bread, pasta, potatoes, beans, or corn. People with diabetes are now encouraged to pay close attention to the total amount of carbohydrates they eat, making sure to include foods with plenty of fiber, vitamins, and minerals. Total elimination of sugars, desserts, and other sweet treats is no longer part of the prescription. Instead, it is recommended that people with diabetes eat fewer and/or smaller portions of foods made with sugar but that they make sure to balance out excess calories or carbohydrates consumed by exercising a little more that day and eating fewer carbohydrates at the next meal.
Although people who have diabetes can enjoy sugar in moderation as part of their meal plans, there are other options for enjoying sweet flavors. For people who want more than a little dessert now and then or who enjoy drinking sweet-tasting drinks, low-calorie sweeteners may offer a way to boost flavor without adding calories or carbohydrates to a meal plan. Barrier, who also counsels patients in her private practice, feels that low-calorie sweeteners "can be a real bonus for people with diabetes. Choosing a soft drink or a yogurt flavored with a low-calorie sweetener makes it possible to include another carbohydrate source such as bread or fruit into a meal plan. Low-calorie sweeteners can give people tremendous flexibility in their meal planning." The low-calorie sweeteners approved by the FDA and currently used in the U.S. include acesulfame potassium, aspartame, saccharin, and sucralose.
For the most part, people with diabetes are encouraged to enjoy the same healthful meal plans recommended by the U.S. Department of Agriculture's (USDA's) Food Guide Pyramid. Barrier recommends that "People who have diabetes have the kind of meal plan that everyone can eat for good health." There are, however, a few differences between the Food Guide Pyramid and the Diabetes Food Pyramid since people with diabetes need to pay closer attention to foods with carbohydrates in their meal plans. The Diabetes Food Pyramid is similar to the USDA's Food Guide Pyramid except that the base of the pyramid is called the "grains, beans, and starchy vegetables group" instead of the "bread, cereal, rice, and pasta group." Instead of placing high-carbohydrate foods such as corn and beans in the vegetable and meat groups, respectively, they are considered part of the base of the Diabetes Food Pyramid.
If you or someone you know has type II diabetes, here are some resources you can turn to for information:
