-- Successful long-term weight loss in Type II diabetics Patricia Phillips SRD Dietitian

R Park MBMRCP Medical Registrar*

S D Slater MD FRCP Consultant Physician

Medical Division, Victoria Infirmary, Glasgow *Presently Medica l Registrar, Royal Infirmary, Glasgow

Correspondence D r S D Slater, Consultant Physician, Medical Division, Victoria Infirmary, Glasgow, G42 9TL

Abstract Weight changes were examined in 200 Type I1 diabetics who had had the

disorder for an average of 10 years and were on conventional carbohydrate restricted diets. At diagnosis, 30.5% were overweight, 49% of average weight, 6.5% at ideal weight and 14% were underweight. The corresponding figures at review were 14%, 56.5%, 9% and 20.5% respectively. Nearly all (88%) of the overweight patients lost weight, amounting to 10% or more of their original weight in 43% of them. Conventional dietary advice may be more effective in achieving long-term weight loss than is generally believed.

Introduction dependent (Type 11) diabetics, treated by Diabetics have a poor record of conventional carbohydrate restricted

adherence t o dietary advice a n d diets. successful long-range weight reduction in obese diabetics is generally regarded as Patients and methods unusual (Ref 1). We have reviewed long- Weight changes were analysed in 200 term weight changes in non-insulin- consecutive Type I1 diabetics attending a

Figure. Distribution of weight at diagnosis and at review in all subjects

diabetic clinic who had had the disorder for at least three years. There were 82 men and 1 18 women, aged 4 1 to 94 years (mean 68.2), with diabetes for 3 to 45 years (mean 9.7). All patients had been interviewed by a dietitian at diagnosis and, especially in obese patients, periodically reviewed thereafter. All were on conventional diets containing 40% of total calories as carbohydrate. Many patients were also receiving oral anti- diabetic drugs: a sulphonylurea in 46.576, metformin in 1496, and both types of drug in 9%. Smokingand drinking habits were also ascertained.

Weight changes were based on the Tables of Average Weights according to

Number of patients

30

20

10 I 0 50

Wight at diagnosis

0 Weight at review

%of tabkd average weight

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age and height in the Build and Blood Pressure Study of the Society of Actuaries (Ref 2). Weight categories were defined by us as follows:

Overweight: weight 10% ormore above the Tabled Average Weight. Average weight: weight between Ideal weight and Overweight. Ia'ed weight: weight in the range from midway between the Tabled Average Weights as for ages 17-19 and 20-24 years to midway between the Tabled Average Weights as for ages 20-24 and 25-29 years. Underweight: weight below Ideal weight.

Results The distribution of weights at

diagnosis and at review in all subjects is shown in the Figure. At diagnosis, 61 patients (30.5%) were overweight, 98 (49%) of average weight; 13 (6.5%) at ideal weight, and 28 (14%) were underweight.

Of the overweight patients, 49% attained and maintained average weight, 5% ideal weight and only 10% were heavier. Altogether, 88% of the overweight patients had maintained some weight reduction since diagnosis, amounting to 10% or more of their

Successful long-term weight loss in Type II diabetics

original weight in nearly half of them (43%). Men lost more than women.

Of the average weight patients at diagnosis, 75% remained so, 8% achieved ideal weight, 16% fell underweight, and only 1% became overweight. There was little change in the original ideal weight group and most underweight patients stayed so.

In total, conventional dietary advice was associated with the long-term achievement or maintenance of average weight in 56.5% of patients and of ideal weight in 9%, while 14% of patients remained overweight and 20.5% remained or became underweight.

Only 16% of patients smoked cigarettes and 15% took alcohol regularly. These habits had no significant bearing upon the weight-changes observed.

Discussion Weight-loss in the overweight patients

was greater than that reported elsewhere (Ref I). Conversely, the quite substantial number of underweight patients was of some concern, although there was no evidence to indicate that some of them might not have been at their own personal ideal weight. In only a few (7 of 41), has their low weight continued and

been due to uncontrolled diabetes from secondary oral drug failure needing insulin. Likewise, a few patients (6 of 131) of average or ideal weight have ultimately required insulin.

We would suggest that emphasis on difficult obese patients has possibly led to an underestimate of the eficacy of conventional dietary advice in achieving long-term weight loss and avoiding obesity. It may also be that, by concent- rating on carbohydrate restriction, a reduction in total calorie intake is more readily assured than will prove to be the case with the more generous carbo- hydrate intakes now being recom- mended.

Acknowledgements We acknowledge the help given by

Miss J M Inglis, Senior Dietitian, and the Department of Nutrition and Dietetics, Victoria Infirmary, Glasgow.

References (1) West K M.

Diet therapy of diabetes: an analysis of failure. Ann Int Med, 1973; 79: 425-34.

(2) Dacumenta Geigy Scientific Tables, 7th ed. Bade, J R Geigy S A, 1970; 711.

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