If you are reading this article, I imagine you have recently been diagnosed with insulin resistance (IR), pre-diabetes, type 2 diabetes (T2D) or possibly told to lose weight. My name is Megan Roberts and as an Accredited Practising Dietitian what if I told you to forget about weight despite your recent diagnosis.

Weight is only one parameter that measures health. In a systematic review by Clifford et al. 2015 the “Non-diet interventions resulted in statistically significant improvements in disordered eating patterns, self-esteem, and depression. None of the interventions resulted in significant weight gain or worsening of blood pressure, blood glucose, or cholesterol, and in 2 studies biochemical measures improved significantly compared with the control or diet group.” Similarly, in a systematic literature review by Ulian et. al. 2018, ‘the HAES® interventions benefited both the psychological and physical activity outcomes, besides promoting behavioural and qualitative changes in eating habits.’ For those that do not know, HAES® Australia is an organisation aiming to ‘support people of all sizes to take care of their health and well-being, without weight stigma’ (HAES Australia, 2021). 

As per the above scientific analysis above, focusing on HAES® or Health at Every Size® is far more beneficial than a weight focused approach. After all I imagine if you are overweight, you know you are overweight, and you do not need someone like myself or society to tell you to lose weight. You have possibly tried a myriad of strategies that may or may not have worked, or they were unrealistic strategies and you regained the weight. So let us focus on sustainable strategies you can implement now that have nothing to do with weight 

Your diabetes or insulin resistance may have been led on by poor lifestyle choices and/or genetics. In regards to genetics, it is important to understand that you may or may not be able to reverse it, however you can work with your doctor, dietitian and diabetes educator to best manage your diabetes, minimising the negative health outcomes. 

Firstly, how does your body manage your blood sugar levels and insulin. When you consume foods containing carbohydrates or sugars, your body breaks this down into glucose. Glucose is then absorbed into the bloodstream and your blood sugar levels (BSL) rise. This rise in blood sugar is detected by the body resulting in the release of the hormone insulin from the pancreas. Insulin acts like a lock and key mechanism, allowing the sugar to move from the bloodstream into your cells and be used as energy. In insulin resistance (IR) the body is not responding normally to insulin and as a result your pancreas up regulates insulin production to compensate. Overtime BSLs rise as the body can no longer produce enough insulin to maintain BSLs, resulting in type 2 diabetes. 

Management of IR and T2D 

Medication, physical activity and nutrition can help you to manage your IR and T2D. 

Medication - Your doctor may or may not have prescribed medication at this point. If they have, be sure to take it. If you have pre-diabetes or IR and are unsure why you are on medication, speak to your doctor. They may have recommended diabetes medications to improve your insulin sensitivity as an example which will reduce how hard your pancreas works to maintain your blood sugar levels.

Physical Activity - Regarding physical activity we all know that movement improves our overall health. It helps to manage your weight, blood sugar levels, improve circulation, maintain muscle mass and strength, not to mention it helps improve your mental clarity. When I talk about increase your physical activity, I do not mean signing up to a gym. If you dislike gyms, find something that you will enjoy. If you choose an activity you enjoy, there is a greater chance you will keep it up. Here are a few ideas you may wish to try to increase your activity:

• Get your family involved - evening walks, taking the dog for a walk, throwing the football.
• Sign up to a sporting club or social games; mixed netball, touch football, surf lifesaving clubs
• Book in active catch ups with friends i.e., walk
• Park your car further away from your office
• Take the stairs

Nutrition - Healthy eating is not about crash dieting, counting calories or cutting things out. For someone with IR or diabetes it is just being mindful about carbohydrates as they are the only macronutrient to cause BSLs to rise. Food sources of fat and protein do not affect BSLs. 

What are carbohydrates: Carbohydrates come from wholegrains, breads and cereals, fruit and fruit juice (fructose), milk, yoghurt and some cheeses (lactose), legumes and lentils, and starchy vegetables. Then you have refined carbohydrates or sugars such as sugar (all types), honey, jam, lollies, biscuits, and cakes. By being mindful of the timing, quantity and quality of the carbohydrate will help your body regulate your blood sugar levels. Here are some strategies you can implement to improve the management of you BSLs: 

• Consume regular meals across the day - This will allow an even distribution of carbohydrates across the day, preventing large peaks and troughs in BSLs. A basic guideline to meal structure would be to consume three main meals (i.e. breakfast, lunch and dinner) and one to two snacks. Try not to get caught up in the finer details. Aim to get the basic foundations of regular eating first. It is the same as when you build a house.
• Choose high fibre carbohydrate options such as grainy breads, starchy vegetables and whole fruits. Fibre helps to slow the release of the carbohydrate into your bloodstream preventing spikes in BSLs. It also gives you consistent energy and sustained feeling of fullness.
• Quantity – it is not only the type of carbohydrates but the quantity that will cause your BSLs to go up and to what extent. When consuming a main meal, aim for a clenched fist portion of the carbohydrate, a hand size of the protein and have as much salad as you desire.
• Types of fluid – Water should be your main source of fluid. If you are someone who consumes soft drinks over water, consider changing to a diet or zero variety. Full strength soft drinks contain copious amounts of sugar that will cause your blood sugar levels to spike and your pancreas to work harder at producing insulin to pull that sugar into your cells. Simply switching to diet or zero varieties will help to cut out a large quantity of excessive refined sugar in your diet, improve your BSL and help with weight loss. 
• Omni-D Pre-meal supplements to reduce BSLs - For those with newly diagnosed T2D, you may wish to try Omni-D a pre-meal high protein, high fibre supplement that has shown to reduce blood sugar levels post meal by 36.5%. Available at your pharmacies, simply empty a sachet into 150mL of water, shake and consume 15-30 minutes before a main meal. This is an easy option to implement into your lifestyle especially during the holiday season without being a burden. 

References:

Clifford, Dawn, et al. "Impact of non-diet approaches on attitudes, behaviors, and health outcomes: A systematic review." Journal of Nutrition Education and Behavior 47.2 (2015): 143-155.

HAES Australia. 2021. HAES Australia is working for a just and compassionate community, where all bodies are respected and belong. Retrieved from https://haesaustraliainc.wildapricot.org.
Ulian, M. D., et al. "Effects of health at every size® interventions on health‐related outcomes of people with overweight and obesity: a systematic review." Obesity Reviews (2018).