Eat less

Watch the weight
Most people with type 2 diabetes are overweight or obese (Figure 2). For many people, even the thought of trying to lose weight is overwhelming. However, it is important to emphasise to patients that even a small loss of weight can largely influence health. Even a modest weight reduction of approximately 10% of body weight improves glycaemic control, lipids, blood pressure and quality of life.

Rather than focussing on an unrealistic ‘ideal’ weight that falls within a body mass index (BMI) of 20–25, set small but specific weight loss goals with the patient. For example, an overall weight loss goal of 12 kg could be broken down into smaller monthly goals of one kg per month for 12 months.

Discourage patients from weighing too frequently, as losing weight is a slow process. For most people, weighing on a weekly basis is adequate. Weight should be checked on the same day each week, preferably in the morning. Light clothing and shoes should be worn. Monitoring waist measurements is an effective way of monitoring change in body shape. Change in body shape often decreases more quickly in response to lifestyle change and shifts the focus from the dreaded scales. Generally an individual’s healthy weight(kg) is approximately height (cm) minus 100.

Cut the calories
Suggest patients keep a diet diary to track what they eat. Patients commonly under report their food intake to themselves and may tell GPs and health workers what they want to hear. Recommend moderate energy restriction together with increased physical activity. Tips to reduce calorie intake are shown in Table 1 on the next page.

Figure 1. Unhealthy vs recommended eating patterns