A major battle that we seem to be losing in medicine is the fight against obesity. The rate of adult obesity was 30.5% in 2000, and by 2014 the rate had increased to 37.7%.1 This increase is a challenge that physicians face daily when treating patients.
Unfortunately, helping patients lose weight successfully can be difficult. Earlier this year, the nurse care manager in my office, also a diabetes educator, approached my colleagues and me and asked us to review some literature she found interesting on intermittent fasting and low carbohydrate dieting.
At first, I responded skeptically that If can’t get patients to eat less, then I didn’t think I would be able to get them to eat nothing. However, the concept of intermittent fasting made sense and was actually manageable for many of our patients. In conjunction with this, the nurse care manager asked if we could have some patients try a very low carbohydrate diet. We have noticed that patients with type 2 diabetes, particularly those who require insulin, generally struggle metabolically with weight loss.
Thus far, the results have been promising. Many of our patients who had been treated with insulin have had a significant decrease in their insulin requirement, and some patients were able to discontinue their insulin completely. Today I saw a patient whom I have been counseling for weight loss for many years without success. After treatment with some intermittent fasting and a low carbohydrate diet, his weight was reduced by 40 pounds, and he reports feeling much better. His energy level has improved significantly and he has become more active.
We plan to continue to monitor outcomes over time. For now, some of our patients, particularly those with metabolic syndrome, have improved success rates for weight loss significantly. I am convinced that our patients have lost more weight this year than in the last 5 years combined. Their HbA1c levels are lower, lipids are generally improved, and there is a reduction of comorbid conditions such as obstructive sleep apnea and hypertension.
An additional potential benefit may be a reduction in the use of insulin and some of the newer diabetes medications that could minimize the overall cost of diabetes treatment. Physicians who are practicing in an accountable care organization may also see an increase of shared savings for Medicare.
Although this is not consistent with the diet that the American Diabetes Association recommends, it does seem to hold merit. I am very impressed with the outcomes so far.
- Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;219:1-8.