Obesity and Diabetes
Christine
A. Pollock R.N., Ph.D.
Jacqueline
O. Favret, R.N., M.P.H.
Doctors and researchers have found that obesity and diabetes are connected. Persons who are obese are at high risk for developing Type 2 diabetes (also known as "insulin-resistant" or "adult-onset" diabetes), particularly if a close family member is affected with diabetes. Therefore, it becomes very important to maintain a healthy body weight throughout your life in order to protect yourself from developing a chronic disease like diabetes.
As nurses associated with the Genetics of the Acadian People projects, we have been asked questions at public forums concerning obesity and diabetes. The following is a list of some of the most commonly asked questions, together with our answers and advice.
Is obesity caused
by a specific genetic defect?
Researchers have
not yet discovered a specific gene
that causes obesity, although several
genes are considered to be important
in playing a part. However, we have
come to understand that a person's
genetic make-up can result in a
predisposition to becoming obese.
This means that a person may be
particularly susceptible to becoming
obese through experiencing risk
factors in their life, like high
calorie or high fat diets and lack
of exercise. Your genetic make-up,
which you have inherited from your
parents, may contribute to your
general body type, including how
and where your body deposits fat
in certain places such as buttocks
or thighs. There seems to be a strong
connection between abdominal fat
and diabetes.
What,
then, is the major cause of obesity?
The environment
plays a much larger role in a person's
likelihood of becoming obese than
does any specific gene. By "environment,"
we mean not only what the outside
world does to a person's body but
also what enters a person's body
through eating and drinking. The
two main factors that can cause
obesity are a diet high in fat and
a lack of exercise. In Louisiana,
like elsewhere in America, we think
that we have many people who are
obese for these two reasons.
Everybody in
my family is fat. Can I assume that
I am predisposed to being obese?
Not necessarily.
Genetics play a small role in body
weight. The most important factors
will be the foods that you eat every
day and the amount and type of exercise
you do.
How do I know
if I am overweight or obese when
all of my family is heavy?
Dieticians have
developed a formula to calculate
a number, called your BMI (Body
Mass Index), which they use to make
this decision. The formula is:
BMI = Weight/height2 x 703
(Weight measured in pounds and
height measured in inches)
For Instance, a six-foot tall person
(6 x 12= 72 inches) who weighs 210 pounds would
have a BMI of
= 210 / (72)2 x 703
= 28.48
The following numbers are good indicators of whether are not you are overweight.
Underweight = BMI of
19.8 or less
Normal Weight = BMI of 26.0
overweight = BMI of 26.0-29.0
obese = BMI over 29.0
How can I determine
if my diet is causing obesity in
my family and myself?
One good way
to find out is to keep a food diary
for a week. You should write down
the time, the amount, and the type
of food you eat throughout the day.
Be sure to include liquids as well
as solid food, such as beer, soft
drinks, fruit juices, etc. You will
need to write down the fat grams
and calories for each food item.
Add these up each day. If the amounts
are too high, then you can be fairly
sure that your diet is a factor
in causing obesity in yourself and
in your family.
What is "too
high"? How many calories and
fat grams can I eat every day and
not gain weight?
This number may
vary according to your gender, age
and body frame. However, there are
some guidelines developed
by professionals that may help you
determine how much to eat to maintain
an ideal weight. In general, an
adult woman should eat about 1500
calories a day and an adult male
about 2500 calories. Your diet should
not have more than 35% fat, which
is about 35 grams of fat each day.
If you are interested in determining
your caloric and fat gram needs,
you can refer to the many reference
books and pamphlets available, or you could ask your
health care provider. We have provided some web
site addresses
at the end of this chapter where
you can obtain this information.
How
can I know the calories and fat
grams when I eat food from a fast-food
place?
Most fast-food
chains, such as Burger King, Subway,
McDonalds, Taco Bell, and Domino's
Pizza have this information available
for you on request. This information
can also be obtained in small booklets
that are available in some grocery
stores, bookstores, through some
organizations such as Weight Watchers,
and by accessing Internet resources,
including the ones listed at the
end of this chapter.
What types of
foods should I eat every day?
The most important
guideline is to have a balanced
diet. A balanced diet contains protein,
grains, fruits and vegetables and
only a small amount of fat. The
majority of your diet should consist
of carbohydrates (like whole grain
bread, rice, cereal) and fruits
and vegetables. The best types of
meat are those that are low in fat,
like chicken, fish, and lean red
meats.
My family really
likes Cajun foods. What can I do
to make these healthier?
Fortunately,
Cajun cooking includes many fresh
vegetables and spices that are healthy
for you and your family. If you
are using any meat to flavor your
vegetables, use only lean meats.
Avoid using lard and bacon fat.
The best way to prepare meats is
by grilling or roasting and not
by frying foods in fat or oil. If
you need to fry some foods, use
vegetable oil instead of butter
or lard. Boiled seafood is healthier
than fried seafood and can be made
very tasty by using Cajun spices.
For dessert, add fresh fruit to
small portions of low fat or fat-free
desserts.
Is there a pill
I can take to help me lose weight?
There are many
pills being sold that promise miraculous
results by helping you control your
appetite and lose weight. However,
many of these pills are ineffective--they
do not help people lose weight.
Even worse, many of these pills
have negative side effects that
can cause serious health problems,
like heart problems. Researchers
have shown that when people stop
taking pills to help them lose weight
they gain back the weight they had
lost. The best and healthiest program
for losing weight is to eat a nutritious
balanced diet and exercise regularly.
Such a program may require some
changes in your lifestyle.
What type of
exercise is best?
The most important
thing to remember about exercise
is that it should be done on a regular
basis, which means about three times
a week for 30 minutes each time.
To encourage yourself to exercise
regularly, you should choose an
activity or set of exercises that
you enjoy. For instance, walking
is an excellent exercise for most
people. However, in Louisiana where
our summers are hot and humid, walking
outside should be done when it is
cool, such as early in the morning
or in the evening. Many people like
to walking in the shopping malls
or other indoor facilities in order
to get their exercise on a regular
basis. Swimming is also a good exercise
that many people enjoy. Other activities
many people enjoy include dancing,
jogging, and sports.
Can
I pass the family tendency to be
overweight on to my children?
Researchers have
determined that only a slight predisposition
for obesity is inherited. The best
way for children to avoid being
overweight is to eat a diet that
is balanced and is low fat. Their
diet should consist of lots of fresh
fruit and vegetables. Snacks like
chips, cookies, ice cream, and soft
drinks should be limited. Again,
this may require a lifestyle change
in your family. It is very important
that all children become involved
in physical activities on a daily
basis. Too many of children spend
their free time in front of computers,
television, and video games, and
this results in a growing number
children who are obese and who will
likely suffer medical consequences
of obesity as adults.
What are some
of the health problems my family
and I can have if we are overweight
or obese?
People who are
overweight or obese have a greater
chance of having heart disease,
diabetes, cancer, muscular and skeletal
problems, and a variety of other
health problems.
I know a lot
of people who have diabetes, but
I don't really understand what the
disease involves. What exactly is
diabetes?
The disease we
typically call "diabetes"
is known as Diabetes Mellitus. The disease
has been known for centuries, and
it is known to run in families.
Diabetes Mellitus is a disease of high blood sugar. It is dangerous, even fatal, to have too much or too little sugar in the blood. The level of sugar in a person's blood is very important in maintaining day-to-day and even minute-to-minute health, and one of the body's major functions is to control blood sugar at proper levels. Controlling blood sugar involves the liver, pancreas, kidneys, and fat. It's the pancreas that lowers blood sugar by producing a hormone known as insulin. Insulin removes sugar from the blood and forces it into cells, where it is used to make energy for the body.
There are two types
of diabetes, Type 1 and Type 2.
People who have Type 1 diabetes
do not produce enough (or any) insulin
and need to take insulin injections
every day to help regulate their
blood sugar levels. This type of
diabetes is also known as Insulin-Dependent
Diabetes Mellitus (IDDM). People
with Type 2 diabetes produce insulin,
but the cells of the body cannot
respond properly to insulin. This
type of diabetes is also known as
Non-Insulin Dependent Diabetes Mellitus
(NIDDM), and this is the type of
the disease that a person has when
he or she is "insulin resistant."
Many chronic health problems can
occur to individuals with diabetes,
especially if the blood sugar levels
are not controlled. These problems
include kidney failure, blindness,
and problems in blood circulation,
which may lead to amputations.
My mother has
diabetes. Does that mean that I
will become a diabetic?
In order to become
a diabetic, two factors need to
be present. First, you need to inherit
a predisposition to the disease,
and second the environment must
trigger a response in your body.
Your genes alone are not enough.
This has been shown in studies of
groups of identical twins: When
one of a pair of twins develops
diabetes, there is only a slightly
increased chance that the other
sibling will develop the disease.
Because identical twins are identical
genetically, the environment of
the individual must play a role
in the development of diabetes.
However, because both genetics and
environment are typically shared
by family members, we recognize
that persons with a family history
of diabetes have a greater risk
for developing the disease.
It
would be important to know what
type of diabetes you mother has.
Type 1 diabetes has a strong genetic
component that appears to involve
several different genes. It is formally
called "Juvenile Diabetes",
and it is the second most common
childhood illness in developing
countries. It is thought that people
need to inherit genes from both
parents in order to get Type 1 diabetes.
Some environmental risk factors
thought to play a role in triggering
the development of Type 1 diabetes
are such things as cold weather,
exposure to viruses, being Caucasian,
and infant diet (having formula
and an early introduction of foods).
Individuals who get diabetes later
in life get Type 2 diabetes. Type
2 diabetes used to be called "Adult
Diabetes," but, unfortunately,
we see many younger people, particularly
those who are obese, developing
this disease. There are two main
risk factors for getting Type 2
diabetes: obesity and a family history
of the disease. A family history
of Type 2 diabetes is one of the
strongest risk factors for getting
the disease, especially if the person
eats a diet high in fat with too
little carbohydrates and fiber and
if they get too little exercise.
Type 2 diabetes is common in people
who have these habits and uncommon
in people who do not, even though
they have a high genetic risk. Obesity
is a very strong risk factor for
getting Type 2 diabetes, especially
if the person became obese at an
early age or if the obesity has lasted a long time.
What is the
chance that my children will become
diabetic?
This is difficult
to say, because there are so many
factors involved. If you have Type
1 diabetes, the chance that your
child will get diabetes is about
1 in 20. This risk is slightly less
if you are female. This risk is
doubled if both parents have diabetes
or if you developed diabetes before
the age of 11. Tests can be done
to determine the risk status of
your children, and these tests include
finding out the body's response
to glucose and measuring if there
are any antibodies to insulin.
Type 2 diabetes runs in families,
both due to learned behaviors, such
as eating high fat foods and not
exercising, and to genetic
factors. The chances of your child
getting diabetes is approximately
1 in 7 if you were diagnosed before
the age of 50 and 1 in 13 if you
were older than 50. However, if
both you and your partner have diabetes,
the risk is 1 in 2 that your children
will become diabetic. If your child
has a high risk for developing diabetes,
it is important that good food and
exercise habits are followed to
avoid obesity.
How can I tell
if I am developing diabetes?
One of
the easiest ways to determine if
you are developing diabetes is to
have either your blood or urine
tested for sugar. The results will
be higher than normal if you have
developed this disease. In addition,
you may develop some specific symptoms
that would suggest that you need
to have your blood or urine tested
for sugar levels. These symptoms
include increased thirst, unexplained
weight loss, excessive hunger, and
frequent urination. You also need
to consider any factors that would
increase your risk, like advanced
age, sedentary lifestyle, and high blood
pressure. Some special risks for
developing Type 2 diabetes involve pregnancy: If you are a woman who
has been pregnant, who is developing
gestational diabetes, or who is
having a baby weighing more than
ten pounds.
If you have any
concerns about whether you have
diabetes, you should talk to your
health care provider as soon as
possible. This condition is very
serious and needs to be identified
and treated according to what is
specific to you and your body. The
sooner you visit your health care
provider, the healthier the rest
of your life will be.
For more information,
contact the authors at the following
addresses:
Christine A. Pollock
cpollo@lsuhsc.edu
Jacqueline O. Favret
jfavre@lsuhsc.edu
How to Learn More
This is the American
Diabetic Association website. It
contains basic information about
diabetes, as well as current news
on health issues related to diabetes,
local diabetic information, recipes
for diabetics, and a section on
healthy living.
This is the site for
the American Obesity Association,
whose main mission is education,
research and community action. There
are a variety of topics including
information on obesity, treatment,
and medical conditions associated
with obesity. Membership applications
are offered on this site.
This is the site for the Orion Township Public Library. Access the Public Library and they click on "useful internet sites" and then click on the "medicine and health care" section for various health information on a variety of topics, including "Ask the Doctor", nutrition and fitness, and diabetes. In the nutrition and fitness section, you can find out the nutritional values of all foods, including fast foods.
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