“We empower [participants] to focus on a weight that’s obtainable and maintainable,” she says.
The first eight weeks of the UAMS program focus on behavior modification, including psychological aspects, Day says. The second eight weeks are “nutrition 101,” during which participants learn about carbohydrates, proteins, micronutrients, and macronutrients, as well as the importance of physical activity, she says.
The UAMS clinic provides Health One meal replacements through its program, which are also used by nine other similar clinics across the country, Day says. For the first six weeks, participants eat only the meal replacements. This is to help them avoid worrying about cooking or shopping and instead focus on appropriate portions and calorie intake. After that, fruits, vegetables, and lean meats are gradually added, she says.
Ultimately, the appropriate amounts of carbohydrates, proteins, and fats vary for each individual, and total caloric intake must be individualized to achieve specific weight-loss goals. This is why a team approach that includes a registered dietitian is so useful in ensuring the weight-loss success of individuals with diabetes.
Participants in the UAMS program are encouraged to keep food journals both during the program and after it ends, Day says, because it “puts them back to problem solving, and they have to take ownership.” Weekly weigh-ins also encourage accountability, she says. “There’s no shame, but it keeps them mindful and accountable.”
At the end of the program, most participants have not yet reached their weight-loss goal, Day says. So program staff work with participants to establish an individualized plan to continue on their journeys.
“They have to get out of their comfort zones and get involved with what they eat versus going through a drive-thru window,” Day says.
While about 40% of those in the UAMS program have diabetes, it is open to anyone seeking weight loss, Day says.
Though he did not start the UAMS weight-loss program with a “numeric goal” in mind, Terry Sharp says he hoped to reduce his medicines and lead a healthier life. He learned to make lifestyle changes and lost nearly 50 pounds. He had been taking the insulins glargine (brand name Lantus) and glulisine (Apidra), and, once he lost weight, was able to drastically reduce the amount he used, going from “four shots a day to one,” he says.
Reducing the amount or number of medicines one takes is a “success that you can’t quantify,” Day says.
Agarwal says making lifestyle changes can dramatically improve the quality of life for people with diabetes. After weight loss, many people are able to stop taking or reduce insulin and/or oral hypertensive (high blood pressure) drugs, she says. She says many people, like Sharp, can go from three or four injections a day to only one after making small dietary and lifestyle changes, and losing only 5% to 10% of their body weight.
That amount of weight loss has also been shown to prevent or delay the onset of Type 2 diabetes in people considered to be at risk of developing it. In the Diabetes Prevention Program (DPP), a major multicenter clinical research study reported on in 2002, participants who set a goal of losing 7% of their body weight by adopting a healthy diet low in calories and fat and increasing moderate-intensity physical activity, such as brisk walking, to a minimum of 150 minutes per week were dramatically less likely to develop Type 2 diabetes.
The format of the DPP has now been adopted by YMCAs throughout the United States to help more people avoid developing Type 2 diabetes. In the YMCA Diabetes Prevention Program, a trained lifestyle coach educates participants about nutrition, stress reduction, being more physically active, and staying motivated. The course starts with 16 one-hour sessions, followed by monthly meetings for up to a year.