Dr. Ahmed Nutrition for Obesity and Diabetes (Diabesity) is primarily focused on restricting calories. However, most people who have “diabesity“ or “metabesity” find it difficult to continue with the prescribed diet and nutrition for obesity and diabetes.
Nevertheless, nutrition plays a very important role and some form of dietary intervention is usually required in patients with obesity and diabetes.
What is Diabesity?
The term “Diabesity” is known as a condition in which diabetes and obesity occur simultaneously within an individual.
The incidences of diabetes and obesity are increasing rapidly throughout the world and the main cause of this lies in lifestyle and dietary habits, apart from genetic vulnerability.
There has been a six-fold increase in the number of adults with obesity in the past 40 years and an increase in the number of individuals with diabetes will reach 642 million by 2040.
Diabetes, obesity, and their associated complications are major threats in developing and underdeveloped nations.
Diabetes is a condition known to be a slow poison and dietary measures are the most manageable and effective solution to diabetes onset, in addition to obesity.
Diabetes and Obesity are the hallmarks of the condition, however, you can also have other symptoms and signs as mentioned here:
- Abdominal obesity
- Dyslipidemia (low HDL, high LDL, and high triglycerides)
- High blood pressure
- High blood sugar (fasting above 100 mg/dL, Hb1Ac above 5.5)
- Systemic inflammation
- Increased Blood Clotting
What causes Diabesity:
Generally, when we talk about the causes we jump to diabetes and obesity. While the main causes of diabesity are poor dietary habits, lack of exercise, physical inactivity, etc.
When your diet is full of empty calories and abundant in sugars, liquid calories, simple carbohydrates, and refined grains (like bread, pasta, and rice), your cells slowly become resistant to the effects of insulin.
As a result, greater levels of insulin are required to do the same job of keeping your blood sugar normal. All of this leads to a condition known as Insulin Resistance.
Higher insulin levels worsen insulin resistance. The body does not respond to the effects of high insulin levels. Insulin resistance has been associated with various diseases and premature aging.
Individuals with insulin resistance are prone to develop cardiovascular diseases, stroke, dementia, and even cancer.
How can you prevent yourself from Diabesity?
Although diabesity is increasing very rapidly, there is a hope to control it with simple lifestyle changes such as exercise and dietary changes. There is no doubt that diabetes and obesity are the significant causes of mortality in most nations.
But it can be prevented and even reversed by diet therapy. Over the past few decades, it has been controversial, many doctors and healthcare professionals denied that such serious disorders could be cured by diet therapy.
During the past few years with advancements in Nutritional Sciences, it is now believed that diet and lifestyle changes can make a big difference.
You do not necessarily need to take medications or go through surgeries to treat diabesity.
The different diabesity management strategies include the following interventions:
Nutrition for Obesity and Diabesity:
The diet plays a very significant role in the prevention and control of diabetes and obesity. The
dietary regulations are more than the simple reduction of energy expenditure. Some of the dietary recommendations include:
Low Carbohydrates:
Low-carbohydrate diets focus on reducing the total intake of carbohydrates. In a low-carbohydrate diet, carbohydrate intake is limited to less than 20 g to 120 gms.
Limited intake of simple sugars in the form of sucrose and high-fructose corn syrup is suggested because of concerns that these sugars are rapidly digested and fully metabolized.
Low Carbohydrate Diet: Nutrition for Obesity | |
| A daily diet should contain less than 40% carbohydrates | 50 – 100 gm/day |
| Foods not containing Carbohydrates |
|
| Avoid these diets | Rice, Pasta, and Bread |
| Weight loss | Low Carbohydrate diets have been associated with marked weight loss (about 11.4 kgs over six months have been reported). |
| Effect of low carbohydrate diet on glycemic control | HbA1C was reduced by 1.4% in six months. |
| Cardiovascular effects | A low carbohydrate diet reduces triglyceride levels and increases HDL levels. |
| Weight Regain | Weight regain is rapid and may occur within six months. |
| Challenges with low carbohydrate diets |
|
Low Glycemic Index Diet: Nutrition for Obesity and Diabesity
The glycemic index (GI) is a measure of the increase in plasma glucose level 2 hours after ingesting carbohydrates in food compared with a reference food such as glucose that contains an equivalent amount of carbohydrates.
The GI measures the postprandial response of different carbohydrates: consumption of high-GI foods relatively raises blood glucose more than medium- or low-GI foods.
Glycaemic Index Value | Glycaemic Index Ranking |
| 0–55 | Low |
| 56–69 | Medium |
| 70 or more | High |
Foods with a low glycemic index can help control diabesity. A meta-analysis that included 11 studies of patients with Diabetes Mellitus who followed a low-glycemic diet for less than 3 months to over 6 months showed a significant reduction of HbA1c (6 studies had HbA1c as the primary outcome, HbA1c weighted mean difference −0.5%; 95% CI, −0.8 to −0.2; P = .001) [Ref].
Five studies reported on parameters related to insulin action, and 1 showed increased sensitivity measured by the euglycemic-hyperinsulinemic clamp in a low-glycemic diet (glucose disposal 7.0 ± 1.3 mg glucose/kg/min) vs a high-glycemic diet (4.8 mg glucose/kg/min ± 0.9, P < .001) [Ref].
In order to reduce weight and achieve a Normal BMI (18.5-25), one needs to cut the extra calories. A lot of complications arise merely due to the increased body weight which means increased fat and a reduction in its metabolism.
A low-fat diet includes approximately 50g of fat for a 1500 kcal diet. In which saturated and trans-fat is <10%. The PUFA’s and MUFA’s present in unsaturated fats and oils reduce insulin sensitivity.
The mechanisms by which they reduce insulin sensitivity include modifications of the cell membrane composition, gene expression, and enzyme activity.
Fatty acids also promote inflammatory cytokines and induce endothelial dysfunction. The type of fat rather than its total amount plays a role in glycemic control and cardiovascular disease risk.
Low Fat Diet: Nutrition for Obesity and Diabesity | |
The daily diet should contain less than 30% of daily Calories | |
| Foods not containing high fats |
|
| Avoid these diets | Saturated and Trans fats |
| Weight loss | Low Carbohydrate diets have been associated with a weight loss of about 5.3 kgs over six months (11% in a year). |
| Effect of a low-fat diet on glycemic control | Minimal effect on HbA1C |
| Cardiovascular effects | Lipid levels need to be monitored for dyslipidemia. |
| Weight Regain | Weight regain has been reported to be around 4% in two years |
| Challenges with low-fat diets |
|
The Mediterranean Diet:
The Mediterranean diet focuses mainly on the moderate ingestion of monounsaturated fats such as olive oil (30% to 40% of daily energy intake), legumes, fruits, vegetables, nuts, whole grains, fish, and moderate ingestion of alcohol.
A study of 259 overweight (mean BMI 31.4) patients with diabetes found a mean weight loss of as much as 7.4 kg at a steady state after 12 months [Ref].
A systematic review of 5 randomized clinical trials of obese adults (N = 998) showed that sustained weight loss (up to 12 months) was greater in the Mediterranean diet compared with a low-fat diet (range of mean values: −4.1 to −10.1 kg vs 2.9 to −5.0 kg), but similar to a low-carbohydrate diet (4.1 to −10.1 kg vs −4.7 to −7.7 kg) [Ref].
This diet also has a positive impact on glycemic control and has been shown to reduce the incidence of Diabetes.
Mediterranean Diet for Obesity and Diabetes | |
The Mediterranean diet focuses on 30% to 40% of calories from monounsaturated fats | |
| Foods |
|
| Weight loss | Mediterranean Diet has been associated with a weight loss of about 7.4 kgs in a year |
| Effect of Mediterranean Diet on glycemic control | HbA1C reduced from 0.4% to 0.6%. The incidence of T2DM is lower |
| Weight Regain | Weight regain is less (about 0.5 kgs over two years. |
| Challenges with the Mediterranean Diet | It has a slower weight loss but adherence is high. |
Table summarizing the key aspects of current dietary recommendations/ Nutrition for Obesity:
| Carbohydrate | Total carbohydrate: 45–60% total energy, influenced by metabolic characteristicsVegetables, fruits, legumes, and cereal-derived foods are preferred. |
| Dietary fiber and glycemic index | Naturally occurring foods rich in dietary fiber are encouragedIdeally, dietary fiber intake should be more than 40 g/day (or 20 g/1000 kcal/day), half soluble (lesser amounts also beneficial)Five servings/day of fiber-rich vegetables and fruit and four or more servings of legumes/week helps to provide minimum requirementsCereal-based foods should be whole grain and high in fiber Carbohydrate-rich low-glycemic-index foods are suitable choices, provided other attributes are appropriate |
| Sucrose and other free sugars | If desired and blood glucose levels are satisfactory, free sugars up to 50 g/day may be incorporated into the dietTotal free sugars should not exceed 10% of total energy (less for those who are overweight) |
| Protein and renal disease | Total protein intake at the lower end of the normal range (0.8 g/kg/day) for type 1 patients with established nephropathyFor all others, protein should provide 10–20% of total energy |
| Families | Most recommendations are suitable for the whole family. |
| Alcohol | Up to 10 g for women and 20 g for men per day is acceptable for |
| Special ‘diabetic’ or foods, functional foods, and supplements | Non-alcoholic beverages sweetened with non-nutritive sweeteners are usefulOther special foods not encouragedNo particular merit in fructose and other ‘special’ nutritive sweeteners over sucrose |
source: Derived from the 2004 recommendations of the Nutrition Study Group of the European Association for the Study of Diabetes: Mann, J.I., De Leeuw, I., Hermansen, K., et al. (2004) Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutri Metab Cardiovasc Dis, 14, 373–94
Healthy amendments:
Diet, physical activity, and behavioral therapy designed to achieve 5% weight loss should be prescribed for overweight and obese patients with type 2 DM to achieve weight loss.
Diets that provide the same restricted calories but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss.
To achieve a weight loss of >5%, short-term (3-month) high-intensity lifestyle interventions that use very low-calorie diets (≤800 kcal/day) and total meal replacements may be prescribed.
Here is a sample Diet Chart comprising 1486 KCal/day:
Carbohydrates = 40% = 150g
Proteins = 25% = 93.75g
Fats = 35% = 58.3g
Meal | Timing | Food Items | Calories |
| Breakfast | 8:00 am | 2 pieces of brown bread + 1 boiled egg | 398 |
| Brunch | 11:000 am | 1 Medium size Apple | 80 |
| Lunch | 2:00 pm | 1 medium-sized chapati with vegetable curry | 242 |
| Snack | 5:00 pm | 1 cup green tea + Digestive biscuits | 142 |
| Dinner | 8:00 pm | 1 cup of boiled rice with two medium chicken steaks | 534 |
| Before bed | 10:00 pm | 1 glass of skim milk | 90 |
Conclusion:
Medical nutrition therapy and a multidisciplinary lifestyle approach are the key components in managing weight and type 2 DM.
It is important to have appropriate calorie intake for weight management and glucose control goals.
Current trends favor the low-carbohydrate, low-glycemic, Mediterranean, and low-caloric intake diets, though there is no evidence that one is best for weight loss and optimal glycemic control in patients with obesity and type 2 DM.
Nutrition for obesity and diabetes, along with exercise and weight reduction may help in curing diabesity and metabesity. Some people go into remission as their blood glucose readings get in the range without taking any pills.
