Wednesday, January 30, 2002

Obesity open invitation to diabetes

Losing weight, gaining exercise program can help prevent the disease

By Peggy O'Farrell
The Cincinnati Enquirer

        For Drew Cremisio and Gail Perry, the symptoms were classic: Fatigue, excessive thirst and frequent urination added up to diabetes.

        It was the advice that was challenging: Lose weight or keep losing out to the disease.

[photo] Drew Cremisio works out to control his diabetes
(Enquirer photo)
| ZOOM |
        But both felt so awful, they were willing to try anything — even a 1,200-calorie a day diet.

        “There were days I felt like I couldn't put one foot in front of the other,” says Mr. Cremisio, 43, of Finneytown.

        Dropping the weight worked: Both have cut back on medications they were taking to keep their blood sugar under control. Mr. Cremisio has lost 60 pounds, and Mrs. Perry has dropped about 45.

Second wave


        Mr. Cremisio, Mrs. Perry and millions of other Americans are part of what could be considered the second wave of America's obesity epidemic: Type 2 diabetes.

        Roughly 60 percent of Americans are overweight or obese, and almost 16 million have diabetes now. It's a safe bet that a good portion of overweight Americans who don't have diabetes now will develop it over the next several years.

        People with Type 2 diabetes can't use the hormone insulin, which helps convert sugar in food into energy for bodily functions.

        Obesity, coupled with symptoms like fatigue, thirst and frequent infections, is “the classic presentation,” says Dr. Barbara Ramlo-Halsted, an endocrinologist with the University of Cincinnati.

        The more obese a patient is, the less efficiently he or she uses insulin — a condition called insulin resistance — and the more likely he or she is to develop diabetes. People who are “apple-shaped” — heavy through the chest and abdomen area — are also more likely to develop diabetes, she says.

        “Much of the diabetes we're seeing right now is related to obesity,” says Dr. Nita Walker, an associate professor of internal medicine at the University of Cincinnati. If patients can lose enough weight to keep their blood sugar under control, they can stop taking, or at least cut back on, medications like insulin and Glucophage.

Important conversation


        It's important for physicians to talk to patients about lifestyle modification like weight loss and exercise in addition to medication for diabetes, Dr. Walker says. And, while many doctors are reluctant to talk to overweight patients about their extra pounds, it's an important conversation.

    • 15.7 million Americans have diabetes. Of those, more than 5 million don't know they have it.
    • Diabetes is the seventh leading cause of death in the United States. Almost 200,000 people died of diabetes in 1996.
    • Diabetes is the leading cause of new cases of blindness, kidney failure and non-traumatic amputations in the United States.
    • People with diabetes are two to four times more likely to develop heart disease and stroke than people without it.
    • Direct and indirect diabetes costs total $98 billion annually in the United States.
    Sources: The American Diabetes Association; Centers for Disease Control and Prevention.
        “I try to do preventive maintenance for patients who are heading that way,” she says. “They're basically setting themselves up for diabetes down the line.”

        Researchers are looking for what mechanisms trigger the obesity/diabetes link. Hormones, amino acids, genetic markers and other factors are being studied as doctors look for ways to turn off the “switch” that turns on diabetes in the overweight and obese.

        Mr. Cremisio and Mrs. Perry were part of a study at Jewish Hospital Weight Management Center that compared how well men and women with diabetes could control their blood sugar on a traditional, restricted-calorie diabetic diet versus the use of a meal-replacement product.

        Results are still being compiled, center director Susan Sewell says.

        Mr. Cremisio, the band director at Northwest High School, was hoping he'd be in the group that got the meal replacements. But he was in the group that had to count calories. “You have to be real honest when you do that,” he says.

        Mrs. Perry got the shake. “It was good. It tasted like chocolate milk,” the 46-year-old Waynesville woman says.

        He and Mrs. Perry also met weekly with dietitians and took classes in healthy eating habits. Both say they've had lifelong weight problems.

        Mr. Cremisio works out daily. During band season, when he's out marching with students, it was easy to stay active, he says. Now he goes to the gym every day.

Big improvements


        Both are feeling much healthier — and it shows in the numbers. In addition to the pounds they've lost, they've seen significant decreases in their blood sugar levels. Mr. Cremisio's blood sugar was in the 300s. Anything over 126 is considered diabetic. Since the weight loss, it's dropped to 106 to 109. He still takes Glucophage to help control his blood sugar, but he's cut back from six pills daily to one.

        Mrs. Perry, who would like to lose another 50 pounds or so, had blood sugar levels in the 400s. It's now within normal ranges, and she expects to be able to stop taking her medication soon.

        Many people are motivated to lose weight for cosmetic reasons, Ms. Sewell says. They want to look better. But a diagnosis like diabetes or heart disease or hypertension gives people much more motivation to stick with a weight-loss program.

        “You have a medical reason to get it done,” she says.


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