Article by Suzanne Lambeth

Many people, both with and without diabetes, dread visits to the doctor. And it's not because of poking, prodding or other invasive procedures; it's about having to get on the scale. Even the subtlest mention of current health risks or the benefits of weight loss can feel like a lecture. Rather than have to face the scale, it's easy to postpone physician visits again and again.

As people age, the metabolic rate slows down. While a weight gain of 2-3 pounds a year doesn't sound like much, over the course of 10-20 years, it becomes significant. Central obesity, where the excess weight is carried around the middle of the body, is most closely associated with diabetes, heart disease and other illnesses. This central obesity decreases the body's sensitivity to insulin. The pancreas responds to this resistance by releasing additional insulin, but over time may be unable to keep up with the demand. This causes the blood glucose levels to rise and Type 2 diabetes to develop.

The importance of weight loss to overall health cannot be overstated. A weight loss of 5 -10% of total body weight can significantly decrease insulin resistance, improve blood glucose levels and perhaps allow for the decrease or elimination of diabetes medication. It can decrease blood pressure, improve cholesterol levels and decrease the pressure on arthritic hips, ankles and knees.

Weight loss programs and fad diets abound, but if you're serious about losing weight, ask your physician for a referral to a registered dietitian. A dietitian who is also a certified diabetes educator is your best choice. She understands the unique issues and medications related to weight loss and diabetes. Take in a 3-day food diary to your appointment. Not a food diary of what you think you should be eating - one that reflects what you actually are eating. You and the dietitian should work together to develop a meal plan that suits you. Don't be afraid to speak up and tell the dietitian what's realistic and what's not. You're the one who will have to follow this meal plan - make sure it's something you can live with.

For successful long-term weight loss, exercise is essential. Exercise is also one the best "medications" available for controlling Type 2 diabetes. It utilizes blood glucose, decreases insulin resistance and strengthens the heart, lungs and circulatory system. It is low or no cost and has no negative side effects. And it burns calories, critically important for weight loss.

If you have not exercised for a while, start slowly and increase gradually. Exercise does not have to be intense or painful; any increase in activity is beneficial. If you can only exercise for 5 minutes at a time, try to exercise 3 times per day. Gradually increase your time until you are exercising a total of 30-60 minutes daily. Your exercise program should include something aerobic (walking, running, swimming, biking, etc) and also some strength training (pushups, sit-ups, weight lifting). Strength training maintains and increases muscle mass. This prevents a slow down in your metabolism and helps reverse the age-related weight gain.

Talk to your physician before starting an exercise and weight loss program. An underactive thyroid is associated with weight gain and is very common in people with diabetes. You may need a thyroid test. Make sure to notify your physician if you experience chest pain, leg cramps, episodes of low blood sugar or any other discomfort during exercise.

Weight loss is typically a very slow process and it's easy to get discouraged. It's important to be realistic. Set small goals for yourself (5 - 10 pounds) and celebrate those successes. Don't give up when you reach a plateau. Maintaining the weight loss you've achieved is as important as continuing to lose.

Suzanne Lambeth is a certified diabetes educator at Pullman Family Medicine and author of the book "The Diabetes Experience." For more information or to schedule an appointment with Suzanne call (509) 332-3548.