Obesity and Pre-diabetes
What is obesity and pre-diabetes?
Obesity is a chronic condition that affects over 35% of adults in the United States. It is a complex and multifactorial disease involving an excess amount of body fat. Obesity is a concern for patients because it increases the risk of type 2 diabetes, high blood pressure, heart disease, stroke, fatty liver disease, kidney disease, and other health issues.
Pre-diabetes is characterized by slightly higher blood sugar levels. Without significant lifestyle changes, the risk of progressing to type 2 diabetes, is significant. The 5 year risk of progression to type 2 diabetes is ∼15–30% (cdc.gov/diabetes)
RISK FACTORS AND DIAGNOSIS
Who is at risk for obesity and pre-diabetes?
Risk factors for obesity include age, unhealthy diet, liquid calories, inactivity, lack of sleep, stress, family history and genetics.
How do I know if I have obesity or pre-diabetes?
Obesity is calculated using the Body Mass Index (BMI). This is an indirect measure of the amount of relative body fat. The formula is BMI = kg/m2 where kg is a person's weight in kilograms and m2 is their height in meters squared. Overweight: BMI > 25; Obese: BMI ≥ 30.
Pre-diabetes if identified on routine blood work: Fasting blood glucose (FBG) = 100–125 mg/dL or HbA1c 5.7–6.4%
PREVENTION
What can I do to prevent obesity?
Perform physical activity for approximately 30 minutes or more, five to seven days a week. This will prevent weight gain and improve cardiovascular health. When used in conjunction with a calorie-restricted diet, patient achieve meaningful weight loss.
TREATMENT
Can obesity and pre-diabetes be treated with medications?
Medications are approved for patients who are unable to achieve weight goal with comprehensive lifestyle intervention alone. These medications are reserved for patients with BMI > 30, or a BMI of 27.0 to 29.9 with weight-related comorbidities, who have not lost at least 5% of total body weight at 3 to 6 months with comprehensive lifestyle intervention.
How will I know the treatment is working?
A weight loss of 5-10% of total body weight when combined with appropriate diet & 150 minutes of exercise a week can reduce your risk of developing diabetes by 58% over 3-year period (DPP, NEJM 2002;346:393). Various medications can also be prescribed to reduce your risk of progression to diabetes. We try to avoid weight goals or BMI goals, and instead focus on a waist circumference (around the bellybutton) of less than 40 cm (men) and 35 (for women).
