SAN DIEGO -- "Diabesity," as Dr. David Heber calls type 2 diabetes, is a lifestyle disease, not a diagnosis that necessarily requires heavy lifting of the prescription pad.
Too many physicians begin and end the conversation by saying, "You have diabetes and I have a drug for you," he said at Perspectives in Women's Health, sponsored by FAMILY PRACTICE NEWS, OB.GYN. NEWS, and INTERNAL MEDICINE NEWS.
Obesity, which packs proinflammatory adipocytes around the heart, liver, and intestines, stands as the greatest threat to women's health in the modern world, said Dr. Heber, professor of medicine, and director of the University of California at Los Angeles Center for Human Nutrition.
It costs $130 billion in the United States each year, impacting nearly every organ system in the body, including the reproductive system (Dr. Heber calls polycystic ovary syndrome "diabetes of the ovary"), musculoskeletal system, and the hepatic system, rapidly becoming a leading cause of liver transplantation.
Dr. Heber emphasized that judging patients by appearance alone, or even body mass index, will miss many women at increased risk for cardiovascular disease and diabetes because of abdominal fat.
"Women have higher body fat than men at every BMI," he said, quoting one study that found that 45% of women with normal BMIs had excess internal fat.
In his office, he uses a bioelectrical impedance meter to measure skeletal muscle versus fat tissue mass, from which calculations can be made for the number of calories per day required to reduce weight in a certain period of time. The devices cost about $500, and provide an excellent opportunity for patient education as well as an accurate assessment of diabetes risk, he said. The next step is to discuss with patients the need for lifestyle modification to preserve health in a way that they can envision.
For example, he explains, "It takes a lot of exercise to make up for a little dietary indiscretion." To burn off 2 ounces of potato chips, it takes a 3-mile run in 30 minutes. Drinking two regular sodas instead of diet sodas is fine, as long as you want to bicycle 3 miles in 30 minutes. Most people can be persuaded to institute 30 minutes a day of exercise, but they certainly won't want to sign up for 90 minutes a day to account for a bag of chips and a couple of sodas.
Unfortunately, emotions and nature work in opposition to weight loss, since "psychology trumps physiology every time. You eat when you are not hungry. Nature wants you to hold onto calories."
Diabetes, he said, "is great genes in the wrong century." For many people, then, a whole restructuring of views about food must counteract impulses and a food industry that has conditioned us to crave foods that are sweet, bland, oily, and creamy "so that you can consume a large amount of food …