HELP ON DIABETES

THE BEST APPROACH: A LOW-CALORIE BALANCED DIET, BEHAVIOR MODIFICATION, AND INCREASED PHYSICAL ACTIVITY

Studies show that the best weight-loss and weight-maintenance results are obtained by structured programs that emphasize a combination of three interventions:

• A low-calorie balanced diet

• Behavior modifi cation

• Increased physical activity

Reduce Calories

Your nutritionist can help you determine your energy needs, educate you about the caloric content of foods, and help you devise a diet that will allow you to be in a negative energy balance. First, limit fat intake to less than 30 percent of calories because fat is the most energy-dense nutrient. Second, control your portion size. A key approach to weight control is to eat foods that you enjoy in moderation. The plate method is helpful in controlling portions and meal composition. Take a nine-inch plate and fill a quarter of it with lean protein such as lean meat the size of your palm; another quarter with starch such as bread, rice, pasta, or starchy vegetables; and half the plate with leafy vegetables, carrots, or broccoli. The food should not be piled up (no more than one inch thick). You can also have one serving of fruit (a small apple or orange) and one serving of dairy (one cup of milk or a small dish of sugar-free pudding). For breakfast, use half the plate (one-quarter for meat and one-quarter for starch) and leave the other half empty, and for lunch and dinner use the whole plate. This gives you about 1,400 kcals daily.

Change Behavior

Eating patterns and activity are learned behaviors, and so they can be modifi ed. In a behavior modification program, you do the following:

• Set specific goals. Plan a regular meal pattern, always sit down when you eat, and lengthen meal duration by ten minutes. Use low-fat, low-calorie foods and set specific goals, such as losing one pound a week. Introduce regular physical activity into your day.

• Self-monitor. Keep a detailed record of the foods you eat so that you do not underestimate your daily caloric intake. Be a fat detective—read food labels and think about the fat content of food that you eat. It is very easy to underestimate caloric intake. Monitor physical activity—get a pedometer and use it to monitor the amount of walking you do.

 • Control triggers. Identify the things that promote negative eating behaviors. Keep only healthy snacks at home, and avoid vending machines at work. Also, watching television is a major barrier to physical activity.

• Solve problems. Once you have set a goal, try to identify factors that facilitate or hinder the goal. For example, if eating while watching television causes excess caloric intake, try eating in the kitchen or dining room without the TV. If you cannot achieve the goal, identify new approaches to overcome the barriers. Successful weight management is based on skills that can be learned and practiced.

• Change the way you think. Your thoughts (cognitions) directly affect your feelings and behaviors. Having negative thoughts can lead to negative behavior. For example, if you overeat and then feel like a failure, you may go on to eat even more. Identify negative thought patterns and learn to counter them with positive statements. If needed, a cognitive therapist can help you set realistic goals for weight and behavior change. Make small changes rather than large ones—they give you successful experiences to build on.

Increase Exercise/Physical Activity

Physical activity alone is not very effective in causing weight loss: you may lose only 2 to 3 percent of your excess weight. Physical activity will, however, let you keep off the weight that you lose with a reduced-calorie diet. So introduce physical activity into your day, such as taking stairs instead of elevators, walking up escala­tors, and parking the car farther away from your destination so you walk more. Par­ticipate in moderate physical activity (defi ned as burning more than 300 kcals per hour) such as walking, bicycling, or tennis for sixty minutes five times a week for long-term weight maintenance.

In a research study called the Diabetes Prevention Program, individuals with a combination of physical activity of at least 150 minutes per week, a low-calorie, low-fat diet, and behavioral approaches were able to maintain a 5 to 7 percent weight loss for an average of 2.8 years. When the National Weight Control Registry fol­lowed five thousand individuals who were able to maintain an average weight loss of sixty-six pounds for six years, they found that these individuals initially used a combination of diet and physical activity to lose the weight. Continuing the low-fat diet, monitoring food intake and calories, and moderate physical activity (sixty minutes per day) allowed these individuals to keep the weight off.