Weight-management conversations need to happen
The Centers for Disease Control and Prevention reports that more than 100 million U.S. adults are living with diabetes or pre-diabetes, which often leads to diabetes within five years. Of those diagnosed with diabetes, 90-95 percent are Type 2 diabetics, as opposed to those with Type 1 diabetes or gestational diabetes.
The road to remission
Diabetes has traditionally been thought of as a chronic, long-term disease that people must live with for life. While not a cure, recent research has begun to indicate that with weight loss and intensive long-term lifestyle modifications, some people with Type 2 diabetes can experience remission. Health practitioners with a thorough understanding of the disease and the most effective dietary and behavioral treatments are positioned to positively influence this trend and those they serve who have Type 2 diabetes or pre-diabetes. In addition, with two-thirds of the American population designated as overweight, such treatments can also benefit the overweight patients you likely serve in your chiropractic practice every day.
It has long been understood that people diagnosed with diabetes either don’t produce enough insulin or don’t properly use the insulin their bodies produce. Insulin is one of the most powerful hormones produced by the body, in the pancreas. It is an important part of metabolism. Insulin is responsible for converting glucose from ingested macronutrients and stored fat into energy, then distributing this energy to body cells. Insulin also helps the liver, fat and muscle cells store glucose that is not immediately required by the body for later use.
Insulin is a hormone that can be controlled, for most, through their nutritional intake and other specific behaviors. Dietary recommendations over the years have varied and often confused the lay population. However, a recent analysis by Nita G. Forouhl and colleagues indicates that common ground on dietary approaches for the prevention, management and potential remission of Type 2 diabetes can be found.
Integrated weight management
This common ground includes the understanding that weight loss and weight management are critical for metabolic health. Additionally, dietary quality such as avoiding processed foods, refined grains and foods high in sugar, while increasing intake of quality protein sources and vegetables as well as considering personal, cultural and social factors, is preferred.
Integrating weight management and supportive treatment for Type 2 diabetes can be a great fit within any chiropractic practice. Such integration supports overall patient health, low-back pain treatment, improving or eliminating inflammation and brain fog, and effectiveness of adjustments, among other benefits.
Based upon research and experience working with thousands of patients, here are three ways you can positively impact your patients with Type 2 diabetes and those who are overweight:
1. Don’t avoid the weight management conversation. Your patients know, like and trust you and rely on you for quality advice that positively impacts their holistic health. Provide them with information that will help them with their weight management efforts and support the treatment plan for those suffering from Type 2 diabetes. Any weight management conversation should include the following components at a minimum:
a. Nutrition: Recommend a nutrition plan that will lower their insulin requirements and result in controlled insulin levels. This generally includes a diet low in carbohydrates and refined foods that includes quality sources of lean protein. Do your own research as well regarding nutrition and Type 2 diabetes and be open to what you find. There is a great deal of evidence that diets lower in carbohydrates that include adequate amounts of quality protein are beneficial. In fact, prior to the development of exogenous insulin as a treatment for diabetes in 1921, the treatment was dietary management including a diet containing 5 percent carbohydrates, 20 percent protein and 75 percent of calories from fat. Many variations of this exist today, as well as much research and support for intermittent fasting.
b. Lowering stress levels: When people with Type 2 diabetes are under emotional or physical stress, their blood sugar levels can rise, which results in the need for more insulin. Controlling stress can help avoid such glucose swings and improve insulin-level stability.
c. Exercise: Physical fitness has been shown to lower blood sugar levels, improve overall health, avoid complications through improved blood flow and glucose utilization, and improve mental outlook. Start with small goals and increase from there. Begin by having your patients track their steps and increase up to 10,000 per day. Then integrate resistance training for an increase in lean body mass. Improving lean body mass throughout the weight-loss journey is important for supporting patients’ metabolism, which is critical for long-term weight-loss success.
d. Quality sleep: Research has found that insufficient sleep (specifically duration and quality) increases risk for development of Type 2 diabetes. Insufficient sleep, like stress, can cause cortisol levels to rise. The result is higher levels of glucose in the blood, an increase in appetite and a craving for high-calorie foods. In addition, lack of sleep adversely affects the desire to exercise for many people. The recommended amount of sleep for adults is at least seven hours. Poor-quality sleep can be evidenced by not feeling rested or repeatedly waking up throughout the night.
2. Consider offering a quality weight-loss program within your practice. Any successful medical weight-loss program must include specific, easy-to-follow nutritional instruction, patient engagement and accountability, and ongoing support and integration of the behaviors that support long-term weight management. These can be created in-house and offered on-site with supporting online patient interaction for convenience, or integrated through a turn-key program offered through a reputable third party.
3. Partner with bariatric specialists as appropriate. Overweight patients need your services. Reach out to bariatricians and/or bariatric surgeons and investigate ways to partner, or at the very least, refer patients to each other for optimal holistic care. You could even consider offering a satellite weight-loss program within your office that includes a shared revenue model. Integration of high-quality protein products can also add an additional revenue stream. It is critical to make sure whatever products you select taste great, are not offered at “big box” retailers, and can be combined into a program that enhances patient weight-loss efforts.
Greater health, greater revenue
Integrating one or more of these strategies can not only improve the health of your patients but add additional revenue streams to your practice. The key to success is keeping patients’ needs top of mind, practicing what you teach and enjoying your journey along the way.
Karol Clark, MSN, RN, is the best-selling author of How to Add Medical Weight Loss to Your Practice: 7 Steps to an Enjoyable Business, Healthier Patients and Increased Profitability and owner of Weight Loss Practice Builder. She partners with Nutritional Resources (d/b/a HealthWise) for creation of educational programs/articles for weight-loss practitioners and can be reached at healthwisenri.com.
3 Forouhi, N.G., Misra, A., Mohan, V., Taylor, R., Yancy, W. (2018). Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018;361:K2234.
5 Fung MD, J. & Moore, J. (2016) The Complete Guide to Fasting: Heal your body through intermittent, alternate-day and extended fasting. Victory Belt Publishing, Las Vegas.
6 Knutson KL, Ryden AM, Mander VA, Van Cauter E. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 2006;166:1768–1764.