- Percent of adults age 20 years and over who are overweight, including obesity: 69.2% (2009-2010)
- Percent of adults age 20 years and over who are obese: 35.9% (2009-2010)
- Percent of adolescents age 12-19 years who are obese: 18.4% (2009-2010)
- Percent of children age 6-11 years who are obese: 18.0% (2009-2010)
- Percent of children age 2-5 years who are obese: 12.1% (2009-2010)
CDC/National Center for Health Statistics
Obesity and Overweight
Lifestyle and nutritional choices can effect the risk of developing type II diabetes. Simmons, Harding et al. found an inverse relationship between acheivement of five life changes and the progression from pre-diabetes to diabetes. Study participants who were able to meet five goals: 1) BMI <25 kg/m2, 2) fat intake <30% of energy intake, 3) saturated fat intake <10% of energy intake, 4) fiber intake ≥15 g/4,184 kJ, 5) physical activity >4 h/week) prevented or significantly delayed the onset of diabetes. Of course the challenge is in meeting the goal and maintaining healthy lifestyle changes to extend the benefit acheived.
The American Diabetes Association (ADA) supports the use of medical nutrition therapy (MNT) as part of a multidisciplinary approach in the treatment of diabetes. MNT applies nutrition and behavioral science to treat a specific physical condition. MNT for diabetes includes assessment of the patient's nutritional status and the collaborative development and implementation of an individualized diabetes self-management plan. The ADA also recommends "a registered dietitian, knowledgeable and skilled in MNT, should serve as an inpatient team member. The dietitian is responsible for integrating information about the patient's clinical condition, eating, and lifestyle habits and for establishing treatment goals in order to determine a realistic plan for nutrition therapy". In the outpatient setting the Registered Dietician assists the patient to determine nutritional needs based upon desired weight, lifestyle, medication, and comorbidities, such as hypercholesterolemia, hypertension, renal or liver disease, etc. The diabetes nurse educator can assist the patient to incorporate knowledge and behaviors into daily diabetes self-care.
Standards of Medical Care in Diabetes—2014 (excerpts)
Accessed at, http://care.diabetesjournals.org/content/37/Supplement_1/S14.full
(A) = Supported by clear evidence from well-conducted, generalizable, randomized controlled trials that are adequately powered.
(B) = Supportive evidence from well-conducted cohort studies.
MNT General Recommendations
- Nutrition therapy is recommended for all people with type 1 and type 2 diabetes as an effective component of the overall treatment plan. (A)
- Individuals who have prediabetes or diabetes should receive individualized MNT as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT. (A)
- Diabetes nutrition therapy can result in cost savings (B) and improved outcomes such as reduction in A1C (A).
Energy balance, overweight, and obesity
- For overweight or obese adults with type 2 diabetes or at risk for diabetes, reducing energy intake while maintaining a healthful eating pattern is recommended to promote weight loss (A)
- Modest weight loss may provide clinical benefits (improved glycemia, blood pressure, and/or lipids) in some individuals with diabetes, especially those early in the disease process. To achieve modest weight loss, intensive lifestyle interventions (counseling about nutrition therapy, physical activity, and behavior change) with ongoing support are recommended. (A)
- Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes (B)
Primary prevention of diabetes
- Among individuals at high risk for developing type 2 diabetes, structured programs that emphasize lifestyle changes that include moderate weight loss (7% of body weight) and regular physical activity (150 min/week), with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes and are therefore recommended. (A)
- Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake). (B)
Dietary fat intake in diabetes management
- In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern. (B)
- As recommended for the general public, an increase in foods containing long-chain n-3 fatty acids (EPA and DHA) (from fatty fish) and n-3 linolenic acid (ALA) is recommended for individuals with diabetes because of their beneficial effects on lipoproteins, prevention of heart disease, and associations with positive health outcomes in observational studies.(B)
Carbohydrate intake in diabetes management
- While substituting sucrose-containing foods for isocaloric amounts of other carbohydrates may have similar blood glucose effects, consumption should be minimized to avoid displacing nutrient-dense food choices. (A)
- For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium. (B)
- For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone. (B)
- People with diabetes and those at risk for diabetes should limit or avoid intake of sugar-sweetened beverages (from any caloric sweetener including high-fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiometabolic risk profile. (B)
Other nutrition recommendations
- Evidence does not support recommending n-3 (EPA and DHA) supplements for people with diabetes for the prevention or treatment of cardiovascular events. (A)
- Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. (A)