PHILADELPHIA – A multidisciplinary approach to weight loss and maintenance in obese patients with diabetes produced sustained weight loss and biomarker improvements that lasted for 4 years in 57 of 119 patients (48%) followed that long. The 57 patients who maintained their weight loss had an average reduction of 24 pounds, 10% of their baseline weight, 4 years after they entered the single-center program and began the 12-week weight-loss phase, Gillian Arathuzik, R.N., said at the annual meeting of the American Association of Diabetes Educators. The 62 patients (52%) who were unable to maintain their initial weight loss had an average 8-pound loss after 4 years, about 3% of their baseline weight. All these patients participated in the Weight Achievement and Intensive Treatment (Why WAIT) program, run since 2005 at the Joslin Diabetes Center in Boston, said Ms. Arathuzik, a nutrition diabetes educator at Joslin. Why WAIT includes intensive diabetes treatment, a structured diet intervention, an individualized exercise plan, cognitive behavioral support, and group education. "The big challenge is maintaining initial weight loss," she said. The starting diet involves daily restriction of about 1,000 calories, with a weight-loss goal of 7%-10%. The composition is 40% carbohydrate, 30% protein, and 30% fat. "Reducing carbohydrates and increasing protein and fat make patients feel satisfied. The program wouldn’t be successful if patients felt hungry all the time," said Amanda Kirpitch, R.D., a nutrition and diabetes counselor who also works at Joslin. The diet is high in fiber and in mono- and polyunsaturated fatty acids, and low in saturated fatty acids and sodium. The initial diet uses one or two meal-replacement drinks per day, which "establish structure and are satisfying," said Ms. Kirpitch. "We discuss with patients what [aspect of their diet] is a struggle and what works for them and can be maintained. We try to think about what they can manage 10 years out. And we try to limit their diet monotony. We encourage patients to tell us what drives them off track," she said. The exercise program starts slowly, aimed at a goal of 60-90 minutes six or seven times a week for weight loss, and 30 minutes five times a week for fitness and weight maintenance. These target amounts can be achieved in several exercise periods that last 10 minutes, and are regarded as a goal that may not be realistic for all participants. "Our target is 60 minutes six times a week," said Ms. Kirpitch. Each patient receives an individualized exercise plan that can include aerobic classes, resistance and strength training, and flexibility exercises. Resistance training is important because it decreases loss of lean body mass and increases muscle mass, fat oxidation, and energy expenditure. The ideal long-term goal for patients is to perform 10-12 resistance training exercises three or four times a week. "We use exercise as medicine," she said. Cognitive behavioral support occurs during 30- to 60-minute sessions facilitated by a psychologist. The focus is on realistic and attainable goals with long-term sustainability. Sessions deal with relapse prevention, mastering unique challenges, planning ahead, and managing automatic, negative thoughts.
Posted on: Sat, 24 Aug 2013 06:03:51 +0000
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