| Issue Date: November 17, 2002
HEALTH HOUSECALLS
Keep moving toward the lite
Mom has a health problem. And that affects the whole family. Our medical expert gives advice for all of us on diabetes, dieting and caring for those you love.
By Tedd Mitchell, M.D.
Brenda Tutt of Augusta, Ga., reminds me a lot of my mother.
The Tutts of Augusta, Ga.
Brenda Tutt, 55
Health: Diabetes Type 2, hypertension, osteoarthritis.
Job: Retired language arts and science teacher.
Distinction: Volunteers with abused children at Augusta Child Advocates; reads Bible daily for positive attitude; joined a diabetes support group at Doctors Hospital.
Spare time: Walks; recently began cardio and strength training at a local gym; uses treadmill at home.
Godin E. Tutt, 57
Health: Mild hypertension, trying to quit smoking.
Job: Retired from Westinghouse, works full-time at a funeral home.
Spare time: Walks; uses a Bowflex weight machine.
Jennifer Tutt, 21
Health: Good.
Job: Junior psychology major at University of South Carolina at Aiken.
Spare time: Takes 2 aerobics classes; is a licensed apprentice at a funeral home.
|
A retired language arts and science teacher, she runs her household, volunteers with abused children and brims with Southern charm. Unfortunately, she also has some of the same illnesses my mother had -- high cholesterol, high blood pressure, increased weight and chronic knee pain. A few years ago, Brenda noticed she was urinating a lot and felt especially weary. She knew being African American put her at an increased risk for diabetes, and her doctor confirmed her self-diagnosis.
These problems may seem daunting, but 55-year-old Brenda and her supportive husband Godin and daughter Jennifer are doing a lot right to make sure she lives to a healthy old age.
Brenda wants to avoid medication for diabetes, so she's controlling her blood sugar through portion control and diet.
Brenda knows that to improve her health risks, she needs to lose weight.
To lose weight she needs to exercise.
But exercise causes knee pain.
And knee pain prevents exercise.
Less exercise means more weight gain.
And more weight gain means worse health risks.
Sound familiar? For millions and millions of us, this is an all-too familiar tune!
The chance to help lots of people overcome these multiple hurdles is why I chose this family as the fifth in my year-long "House Call" series.
OUR DIABETES EPIDEMIC
Let's talk about diabetes. Sugar diabetes (diabetes mellitus) occurs when the body does not produce insulin in sufficient amounts or does not properly use the insulin it is producing. Insulin, a hormone made by the pancreas, is required for the body to "burn" sugar for energy. Although many things can cause changes in the way we metabolize sugar, the two major types of diabetes are what we'll discuss. They are:
Type 1 diabetes, formerly called "insulin dependent" or "juvenile-onset" diabetes. This occurs when the body's pancreas produces no insulin. If these diabetics do not receive insulin (in injections), their bodies cannot burn glucose for fuel. They produce energy in other ways, the byproducts of which create acids that lead to death. This is not a disease to mess with. The diagnosis usually is made when someone is acutely ill, and the follow-up is necessarily intense.
Type 2 diabetes, formerly called "non-insulin dependent" or "adult-onset" diabetes. This is a much more common illness and is what Brenda and 17 million other Americans have. Their problem: The body is resistant to the effects of insulin. For most of them, this increased insulin resistance is caused by increased weight! In fact, the vast majority of people with Type 2 diabetes are overweight. Treatments include a variety of oral medications but, from my perspective, the most important part of therapy is an appropriate lifestyle. Good nutrition, regular activity and weight control have a tremendous impact.
This illness hits many parts of the body. The heart and blood vessels experience an accelerated form of hardening of the arteries. Eyes become affected, eventually leading to blindness. Nerves become damaged, causing numbness in the hands and feet as well as problems in the stomach, intestines and bladder. Erectile dysfunction (impotence) in men with diabetes is extremely common. And, last but not least, the kidneys become destroyed, resulting in a loss of function that places people on dialysis.
The really bad news -- yes, it gets worse -- is this damage occurs slowly, over a protracted period. Many are unaware their systems are failing until it's too late.
As the country's demographics have changed, so has the prevalence of diabetes. The problem seems more common in Native Americans, African Americans, Hispanic Americans, Asian Americans and Pacific Islanders. But just because you are not in one of these groups doesn't mean you're immune. Aging is also a risk, so none of us is exempt.
OBESITY 'R' US
Brenda Tutt, who wants to lose 75 pounds, is in a growing category of Americans. Almost 65% of American adults weigh too much. Fully 30.5% of adult Americans are obese, weighing 20% more than their ideal body weight.
Let me clarify: I don't mean that 30% of us are "pleasantly plump" or just need to lose a few pounds. I mean that 30% are gordo. Fat.
Back in the early '60s, 13% of the adult population was obese. That figure stayed pretty constant through 1980. But for the past 20 years, each time the researchers update the info, more people join the ranks of the obese. The most recent National Health and Nutrition Examination Survey (NHANES), published in the Oct. 9 Journal of the American Medical Association, indicates the hinges have come off the wagon. Or should I say the zippers have popped off the jeans?
Women have fared worse than men; ethnic groups worse than Caucasians. One of the groups hardest hit is black women. Today, 80% of black women are overweight, and more than 50% are obese.
In all fairness, this is not just an American phenomenon. Other industrialized nations show the same trends. Even underdeveloped countries have more obesity as they gain affluence.
Medically speaking, the consequences are dire. Diabetes, heart disease, stroke, high cholesterol, high blood pressure, arthritis and even some forms of cancer are associated with obesity. Addressing this topic now couldn't be more timely and important.
I'd love to say that those of us in the medical community have done a bang-up job treating obesity. However, that would be, as we say in Texas, "a dang lie." Public health measures to educate people about appropriate lifestyles for weight control have been minimal. Most programs have been directed toward individuals, and success has been limited at best.
I know, I know. Some of you will swear by a particular program you started six months ago that made you lose weight. That's not what I'm talking about. What I'm talking about is long-term success. There is a phrase in Latin -- "Res ipsa loquitur" -- that means, "The thing speaks for itself." The sheer numbers of Americans getting fatter speak volumes about the long-term effectiveness of most weight-loss plans.
THE BEST WEIGHT-LOSS PROGRAM
I'm frequently asked my opinion about which diet is best. Should I go low-fat and high-carbohydrate? How about high-fat and low-carb? What about high-protein? The grapefruit diet? The water diet? The rice diet? It's enough to make your head spin.
Because it's an area of interest, and because so many people ask about them, whenever I'm in bookstores I usually head over to the health section to peruse the latest and greatest weight-loss advice.
I was doing that in preparation for this article when it struck me: There's a way to combine all weight-loss plans into a guaranteed success! No fuss, no gimmicks, no kidding!
To implement my ground-breaking new program, take two medium-size cloth tote bags and a good school backpack to your local bookstore. Head for the health/nutrition section.
Grab the first five weight-loss books you see and place them in tote bag No. 1 (it doesn't matter which books they are, just grab them and put them in).
Next, grab five more and put them in tote bag No. 2.
Finally, get the next eight on the shelf and put them in the backpack.
"Weight is all about behavior, a very complicated thing. Our impulses, reactions and habits are based on myriad things not easily understood or changed."
|
Pay for the books and go home.
Here's the plan: Wear the backpack throughout the day, every day. At the end of each day, do calisthenic exercises holding one tote bag in each hand.
Voilà! You'll improve your fitness, strength and energy, and you'll very likely lose some weight.
My point? Diet program after diet program offer easy outs, claiming that you can enjoy eating while taking it easy.
Don't count on it. Physiologically, increased weight invariably reflects an imbalance between energy intake (how much we eat) and energy expenditure (how active we are). When intake is more than output, we gain weight. When output is more than intake, we lose weight. Period.
But at a deeper level, weight is all about behavior, a very complicated thing. Human impulses, reactions and habits are based on myriad things not easily understood or changed. Among factors blamed -- but not proven -- to make individuals fat, JAMA cites "advances in technology, changes in work life, the advent of computers, trends in eating out vs. food preparation at home, time pressures, fear of crime, decreases in tobacco use." In other words, modern life.
CONTROL YOUR DESTINY
Losing weight and keeping it off is not easy, but it is do-able. Studies have shown that lifestyle changes, when implemented consistently, can result in long-term weight control.
Additionally, there are benefits that have nothing to do with weight loss. As a member of The President's Council on Physical Fitness and Sports, I attended a celebration at The White House in June, during which time President Bush spoke of the need to maintain healthful habits. It was refreshing to hear him emphasize lifestyle as a means to control your health destiny. Keep in mind that the president's call to action was not for people to "get skinny," but rather to behave correctly.
And that takes us right back to the whole diabetes thing. The American Diabetes Association has a wonderful Web site (diabetes.org) that can walk you through an approach to healthy living. The site has information on an appropriate nutritional program, exercise regimen and stress management, as well as tips on hygiene. Brenda Tutt gets regular eye and foot exams; these are vulnerable areas for diabetics. With diabetes, it's important to lower your risk for developing infections by keeping your mouth, teeth, nails and skin in good shape.
Regular checkups with your physician are part of the program, too. New medications have been developed for treating diabetes. These include not only medications to treat blood sugar itself but also medications that help "protect" the heart, the kidneys and other organs from adverse effects of the illness. These medications are prescription only, so see your doctor; he's got to be part of the "regimen" as well.
3 EXERCISE PLANS
Brenda Tutt is lucky to have live-in coaches on her path to better Health: her husband, Godin, and her daughter, Jennifer. Godin frequently suggests a family walk, and Jennifer opted to live at home and commute about 30 minutes to the University of South Carolina at Aiken so she could help her mom. Support like this family offers can't be underestimated. Brenda also attends a diabetes support group.
The best exercise routine for Brenda is the one she will stick to over the long haul. According to the American College of Sports Medicine, because of her diabetes she needs to work out at least three non-consecutive days each week (and I would actually recommend five sessions per week for better weight control). Single bouts of exercise can lower the blood sugar for up to several days, and by exercising five days a week, she gets the benefit of day-to-day improved blood sugar control as well as the long-term weight reduction and blood sugar control -- a double whammy!
Because of her arthritis and knee pain, she should start slowly! Ten to 15 minutes per session of low-impact activity at a comfortable pace would be just fine. Each week she can increase the length of time by a few minutes, until she finally gets to sessions lasting 30 to 45 minutes. Only then should she crank up the intensity (by then her muscles and body will be preconditioned for more intense activity).
Her long-term goal for aerobic exercise should be working out at an intensity she considers "somewhat difficult"; that is, enough to make her sweat and breathe a little heavily, but not so intense that she can't carry on a conversation in short sentences with an exercise buddy. I've got all the confidence in the world that she can do it!
Husband Godin and daughter Jennifer can help by following an exercise program and cleaning up their own dietary habits. Nothing helps more than a family that tackles the problem together. It's terribly difficult to be the only one in the house trying to behave, especially when you continually see others misbehaving.
Godin's situation is different, but the same, as Brenda's. Losing weight isn't his bottom-line goal, but he does need to control his blood pressure. So he also needs an exercise program he can do five times per week. That will provide him with a more even blood pressure profile over the short term and (by improving his conditioning) better long-term blood pressure. Think of it like this: He needs to exercise regularly to keep his wife motivated, and by following a very similar routine he stands to significantly improve specific health concerns of his own. And who said marriage isn't good for you!? Godin's target for cardio is the same as Brenda's.
Godin also needs to ditch the butts. He's trying to cut back on his cigarettes and is down to half a pack a day, but the long-term goal is to not smoke at all. No amount of smoking is safe. Help is available in over-the-counter nicotine delivery systems, support groups, counselors and prescription medicines.
Jennifer doesn't have the specific health concerns her parents have, so for her the battle is to make exercise a habit she can maintain. Several studies, including some conducted at our own Cooper Clinic, have shown that by being active she'll reduce her chance of developing diabetes, high blood pressure and high cholesterol. She needs exercise for general fitness and longevity.
This is pretty simple: three sessions each week of an aerobic routine at a moderate intensity for at least 30 minutes. It establishes a pattern of behavior that is very beneficial and not overbearing.
After the Tutts firmly establish the habit of exercising, all three of them should incorporate light strength training into their programs. Because Godin has some equipment already available at home, that should be fairly easy. At least two days each week each family member should spend time challenging their muscles with resistance training. Result: muscles that will be lean, dense and burn calories.
The Tutts, like everyone starting a diet and exercise overhaul, should keep this motto in mind: Simple things done consistently is the way to go.
Brenda has a lot going for her: a vibrant family, a successful career, fulfilling volunteer work. I hope this general advice on her health can help keep her going strong for many years to come. Because she reminds me of my mother, I'd really love to see her succeed. Deep down inside, I know my mom would love that, too.
Contributing: Patty Rhule
Photographs by Mark Anderson for USA WEEKEND
|
