In this groundbreaking book, diabetes and weight management expert Osama Hamdy, M.D., Ph.D., reveals how you can reverse the course of your type 2 diabetes, lose weight for good and finally reclaim your healthin just 12 weeks!
Dr. Hamdy is at the forefront of cutting-edge clinical research conducted at Joslin Diabetes Center, an affiliate of Harvard Medical School. For the first time, he shares those scientific breakthroughs in a usable and doable step-by-step 12-week plan based on the successful Why WAIT (Weight Achievement and Intensive Treatment) program he conducts at Joslin. And with the professionally formulated exercise plans fine-tuned by Dr. Sheri Colberg, an exercise physiologist and renowned diabetes fitness expert, you'll not only get results but keep them.
With the Why WAIT program, Dr. Hamdy and his Joslin team have helped hundreds of patients:
• Break free from the pill bottle. It is possible to cut your medications by 50-60%or even stop them altogether!
• Stop fearing the scale. Learn how to safely loseand keep offthose 10, 20 or even 50 plus pounds that are holding you back from a healthy life.
• Never dread exercise again. Tailor your exercise plan to the way you really live and work, so you can get results without being a slave to the gym.
• Make it easy. The dozens of checklists, goal worksheets and real-life success stories in this book will keep you motivated to make smart decisions, even on the busiest days.
So don't settle for a diabetes diagnosis.
Shed the pounds, toss the medications and conquer your diabetes, once and for all.
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Read an Excerpt
Why WAIT? Lose Weight Now
Who would ever have imagined that the often relentless progression of a chronic disease like type 2 diabetes can be stopped or reversed? Or that you can reduce your diabetes medications even if you've been taking multiple ones for a long time, including insulin? The good news for you-and the rapidly expanding number of people with type 2 diabetes worldwide-is that it is finally imaginable and definitely possible and the program outlined in this book is the key to making it happen.
Maybe your doctor just told you that you have a "touch" of the sugar. Is that a reason to worry that you have diabetes? If truth be told, even if you only have a condition called prediabetes (which develops before type 2 diabetes), now is the time to get motivated and take action to improve your health and prevent it from turning into full-blown diabetes. Even in the early stages, diabetes can be a treacherous disease, one that may be damaging your blood vessels, eyes and nerves when you don't know you have it and while you're still feeling just fine. Once it has finally been diagnosed, your health may already be starting to suffer.
So what can you do? Luckily, diabetes is a controllable condition if you lose weight and follow a healthy lifestyle plan. You may have already heard that advice from your doctor, but you may not know how to accomplish these goals. Healthy lifestyle changes, like changing what you eat and exercising more, are critical for controlling diabetes at any stage of the disease, but they're particularly important in the early stages. Improving your lifestyle is also the key to losing enough weight to reverse the course of diabetes and avoid its negative impact on your health and well-being. All you need is the right guide on your path toward conquering it for good. The scientifically proven program you'll ind in this book is especially designed to help you do just that.
A HOME-BASED VERSION OF THE WHY WAIT PROGRAM FOR YOU
Dr. Hamdy and his team designed a medically managed weight loss program for people with diabetes called "Why WAIT" (Weight Achievement and Intensive Treatment), which is offered on-site through the Joslin Diabetes Center in Boston and affiliated with Harvard Medical School. This program has resulted in unsurpassed success for its participants-in fact, it's the only clinical program to show long-term successful weight loss for people with diabetes. Even though you'll be doing this home-based version of the Joslin Why WAIT program called the Diabetes Breakthrough on your own, it will help you lose and keep the weight off if you follow the program as closely as you possibly can.
We've known for a while that improving your lifestyle to help you lose as little as 10 or 15 pounds can prevent type 2 diabetes in the first place. But Dr. Hamdy and his colleagues at the Joslin Diabetes Center were the first to show that losing a similar amount of weight (around 7 percent of your total body weight) can rev up your insulin action and frequently reverse type 2 diabetes or prevent the development of health problems associated with it. Participants who went through the 12-week Why WAIT program at Joslin were able to cut their medications by an average of 50 to 60 percent and many of them were able to go off medications entirely, all while keeping their diabetes in great control.
It's time you joined them on the path to better health, a lesser chance of drug side effects and more money in your pocket as a result of paying for fewer expensive medications. Even if you don't reach your goal weight or completely eliminate your medications, how would you like to live a longer and healthier life without carrying around all those extra pounds? Our results at Joslin show it's possible and in this book you will learn how to make it happen for you.
What makes this program so unique? Here are ten innovations that make it a true breakthrough for weight loss and health management for anyone with diabetes or prediabetes:
1. This program progresses over 12 weeks like no other, with doable increases in your exercise plan, efective ways to change your bad habits and transitions in your diet from replacing some of your meals with meal shakes to eating just regular foods.
2. It's not just about reducing your calories by a set amount or eating only a certain amount of fat to lose weight; instead, you will be assigned a specific calorie level regardless of your current daily calories and you will follow a unique dietary plan that includes eating more protein and carbohydrates that cause smaller glucose spikes.
3. You'll learn how to combine eating healthy foods and meal replacement shakes, both with speciic proportions of carbohydrates, protein and fat to better manage your blood glucose levels and body weight.
4. On this program, you'll be able to eat many of your regular foods following our special menus that were developed from commonly used foods (instead of making you eat new foods you may not like or follow strange and unusual menus).
5. Your activity plan has a greater emphasis on strength exercise to build muscle, not just cardio workouts like most weight loss plans.
6. Unlike most plans, you'll work up to doing about 300 minutes of weekly exercise that its into your daily lifestyle (in comparison to more common recommendations of only 150 minutes of weekly cardio exercise).
7. Through this book, your health care providers will have access to algorithms that ofer guidelines for precisely changing your diabetes medications to enhance weight loss, especially to avoid hypoglycemia (low blood glucose levels).
8. You'll also learn why you should consult with your health care team about revisiting the dosages and types of diabetes medications you take as you lose weight and you'll ind out why it's important to continue to monitor your blood glucose levels.
9. You'll learn a lot about how to change your habits and the behaviors that caused you to gain wait in the irst place.
10. In addition to learning about how to lose weight safely, this program also teaches you everything you need to know about managing your diabetes more efectively.
COULD THIS BE YOUR STORY?
We'd like you to meet Linda, a graduate of the revolutionary Joslin Why WAIT program. Her story is that she started out at a normal weight when she was a young adult, but over the next four decades she steadily gained about a pound a year, gaining over 40 pounds total and developing type 2 diabetes in the process. She had a family history of diabetes, but it was her weight gain that led her to fully develop type 2 diabetes.
Naturally, she tried to lose the weight after she got the bad news, especially since her doctor kept emphasizing the need to lose weight to control her blood glucose levels. Linda knew how to lose weight on a diet; in fact, she repeatedly dieted and exercised over a decade when her weight gain had become embarrassing to her, but without any lasting success. She was worried that this time wouldn't be any different. Basically, despite what she had heard about the program, she expected to lose some weight and then eventually gain it back again like she always had in the past-only now she also had diabetes to contend with and that wasn't going away.
WHAT ARE YOU THINKING?
How does Linda's story relate to your own? Have you been gaining weight slowly over the years? How many times have you lost weight on a diet, only to gain it all back-and maybe some extra-not long after? Do you dread the holidays every year since you know you'll gain more weight? How much weight had you gained by the time you found out that you now have type 2 diabetes to deal with, as well?
Let's find out what you're thinking. How many of the following statements describe something you've said or thought at one time or another?
• "I weigh more than I want to."
• "I know I need to lose some weight."
• "My doctor told me I have to lose some weight."
• "I'm on a diet (or I was recently)."
• "I felt better both physically and mentally after I lost weight."
• "I weigh more now than when I started my irst diet."
• "I'm totally discouraged about keeping the weight off and I think it's impossible."
• "I really don't know what I should be eating anymore."
• "I don't know which diet to try next."
• "I'm depressed about how much I weigh."
• "I hate the way my body looks."
• "I think about food and eating all the time."
• "I don't get enough exercise."
• "I know I need to be more active."
• "My doctor told me I need to exercise more."
• "I already broke my New Year's resolution to exercise more."
• "I may have to have surgery to lose weight."
• "My doctor keeps increasing my diabetes pills."
• "I'm taking more insulin than ever before, but my blood glucose is still high."
If even one of these comments applies to you, then this diabetes breakthrough program is your tool to achieve what you've been dreaming of for yourself. How do we know this? Because almost all of these statements applied to Linda when she joined the Why WAIT program.
THE REAL PROBLEM WITH DIETS
You may already know from experience that losing weight on a diet may not be enjoyable, but it is usually possible. With everyone dieting, why are people around the world generally getting heavier instead of thinner? The real dieting dilemma is that fad diets have no scientific basis. New diet books come out all the time and you can walk into any bookstore and find dozens of different ones to choose from. If you search an online bookseller, you'll find hundreds of options. This abundance of unproven dieting methods makes an incredibly important topic extremely confusing for everyone trying to sort out fact from iction related to dieting.
A major problem with many of these fad diets that promote rapid weight loss by severely cutting calories is that they can lead to a medically dangerous condition called starvation ketosis, which occurs when your body ineffectively attempts to burn fat when your carbohydrate or calorie intake is very low and is speciically harmful for people with diabetes. What's more, most very low-fat diets lead you to eat less protein than you need and cause you to lose too much muscle mass in the process.
Another major issue with fad diets is that they are usually too extreme-for example, many eliminate entire food groups like grains and other carbohydrates-for people to actually be able to continue on them for long. A study done at Tufts Medical Center comparing these diets found that at the end of a year, dieters' average weight loss is not more than three pounds since most people can't stay on these diets for more than a few weeks.
A common underlying philosophy of these diets is that if you take in fewer calories than you burn off, you'll lose weight. However, healthy weight loss is not that simple. If you diet by reducing calories using an unhealthy nutrition plan (such as the latest fad diet), you'll lose weight-and then you'll almost assuredly gain it back. Now not only are you heavier than ever, but you're also likely "fatter" than before you went on your irst diet, meaning that your percent body fat (the relative amount of fat compared to your total weight) is probably higher than ever. Why? It results from losing weight too rapidly using the wrong dietary balance without exercising and subsequently gaining the weight back, which 90 to 95 percent of dieters eventually do.
Following these fad diets, you're likely to lose 10 pounds or even more in the first week or two; however, most of it is water weight, which is why it's also so easy to gain that back when you start eating more normally again. If you continue losing weight at the recommended rate of one to two pounds per week after the first week or so, you'll likely be losing both fat and muscle. On the contrary, if you are eating enough protein and exercising regularly while dieting, you will shit the weight loss to losing mostly fat (which you want to lose) instead of muscle (which you deinitely want to keep).
KEEP THE MUSCLE-OR ELSE
Why is keeping your muscle when you lose weight so important? Although the weight lost on most diets is a combination of both fat and muscle, what you gain back afterward is usually just fat (with little or no muscle regain). Going through that cycle repeatedly can contribute to a poorer quality of life and a worsening of your blood glucose control due to loss of muscle. Everyone tends to lose some muscle mass just from getting older as well, so losing it for both reasons is a double whammy to your metabolism and glucose control since muscle is where you burn calories and store most of the extra carbohydrates that you eat.
Aging combined with diabetes is an even worse scenario. Most people who don't have diabetes lose around about half a pound of muscle a year as they age. However, if you have diabetes, you lose closer to three-quarters or a full pound of muscle with each passing year. If your diabetes is undiagnosed or poorly controlled, you may be losing more than a pound a year. Eventually, you won't have enough muscle left to move your body around, which will dramatically limit your activities. When you go on a typical weight loss diet, you will lose about three pounds of muscle for every ten pounds you drop. You definitely don't want to lose that much muscle because it's very difficult to get it back. For the best health outcomes, the muscle you lose should not exceed 10 to 15 percent of your total weight loss-or no more than one to one and a half pounds out of every 10-especially when you have diabetes.
The number one rule for being successful at losing weight and keeping it off and reversing or improving your diabetes course is that you absolutely have to lose the fat, but keep the muscle-which the dietary composition and the exercise component of this Diabetes Breakthrough program are designed to help you do. For example, in 2011 alone, over 400 Why WAIT program participants with diabetes lost an average of 25 pounds after only 12 weeks, while gaining muscle mass-not many other diets can do that. Our program incorporates the Joslin Nutrition Guidelines, which were initially developed in 2005 with just the right balance of carbohydrate, protein and fat to achieve proven beneits for body weight and diabetes control. If you attempt to lose body fat by simultaneously eating the right combination of foods, changing your behaviors, exercising regularly and modifying your medications, you'll be a lot less likely to regain the weight you lose.
Table of Contents
Foreword John L. Brooks III ix
Introduction: Why WAIT? Lose Weight Now xiii
Part I The Diabetes Solution
Diabetes Breakthrough Overview 3
Basics about Insulin, Blood Glucose, Calories, Exercise, Goal-Setting and More
Diabetes Breakthrough Week 1 29
Meal Plans, Logbooks, Exercise Barriers and Stretching
Diabetes Breakthrough Week 2 69
Medications and Weight Gain, Diabetes Pills, Serving Sizes and Cross Training
Diabetes Breakthrough Week 3 105
Portion Distortion, Resistance Training and Newer Diabetes Medications
Diabetes Breakthrough Week 4 133
Insulin Use, Circuit Training and Delay and Distraction Techniques
Diabetes Breakthrough Week 5 151
Blood Glucose Lows and Highs, Fitness Benefits and Interval Training
Diabetes Breakthrough Week 6 163
Diets and Dieting, Core Training, Yoga and Changing Your Negative Thoughts
Diabetes Breakthrough Week 7 187
Social Eating, Superset Training and Becoming an Active Exerciser
Diabetes Breakthrough Week 8 199
Body Core Exercises, Dining Out and Managing Urges and Cravings
Diabetes Breakthrough Week 9 211
Mental Stress, Deep Breathing and Relaxation Exercises
Diabetes Breakthrough Week 10 221
Mindful Eating, Sleep and Balance and Agility Exercises
Diabetes Breakthrough Week 11 229
Secrets of Successful Losers, the Importance of Exercise and Lapse and Relapse
Diabetes Breakthrough Week 12 239
Your Personal Weight Maintenance Plan and Survival Tips for Down the Road
Part II The Diabetes Life Plan
Diabetes Breakthrough to Lasting Weight Loss 247
Appendix A Breakfast Menu Choices and Examples 261
Appendix B Lunch Menu Exchanges and Recipes 265
Appendix C Dinner Menu Exchanges, Recipes and Acceptable Frozen Dinners 273
Appendix D Joslin Diabetes Center Nutritional Guidelines 299
Appendix E Medication Algorithms for Your Health Care Provider 305