Dear Ms. Deen:

Now that the dust has settled and the world knows you’ve had type 2 diabetes for a few years I want to offer you (and millions like you new to type 2 diabetes) a dose of support and words of wisdom as a diabetes educator and dietitian who, shall we say, has a few years under her belt. 

First, let me encourage you to close your ears to all the advice (and criticism) you’ve received, free of charge, since coming out about your type 2. These “advisors” clearly don’t know much about YOUR diabetes, YOUR medical situation or, to be downright honest, much about type 2 diabetes and today’s treatments.

Second, let me offer you a virtual hug and pat on the back. Thank you for letting the world know about your type 2 diabetes. Too many people deny they have type 2 and remain in denial during the precious years in which taking action to slow down the disease progression is SO critical (more about that below). 

Yes, it’s that time of year again where we reflect on the past and move into the future with goals to better ourselves in the year ahead. In my bailiwick the focus is squarely on eating healthier and being more physically active.

I’ve posted my resolutions here, along with a handful of global wishes. It is said that if you state your goals, actually say them out loud, you’re more likely to see them through. I figure putting them out in the blogosphere for all to see is one step better. I’ll report back on these at the end of 2012.

I’ve got five, what I’ll call local resolutions. Actions I want to take close to home, my backyard and kitchen table to be precise.

Here’s my run-down:
1. Prepare and stock homemade salad dressings, ditch the bottles: For several years I’ve wanted to rid our fridge of bottled salad dressings. But I eat a lot of salads and they’re, well, just so easy to open and drizzle. However, because I eat at least one salad a day, they’re a good place to target to taper fat grams, calories and particularly sodium milligrams, to make a significant dent in our daily intake. Homemade dressings will also limit our intake of unneeded additives and preservatives. Got any recipes for healthy salad dressings I can blend up in volume and stash in the fridge?

A few facts are crystal clear:

• Myriad adults would improve their health status and potential longevity by losing a few pounds. Five percent seems to be the magic number to reap health benfits.
• Two thirds of adult Americans are overweight or obese, including many Medicare beneficiaries.
• Losing weight, even a few pounds, and keeping those pounds off is tough work which requires tenacity.
• Primary care providers (PCPs), including general and family practice physicians, nurse practitioners, physicians assistants and others; aren’t known for addressing or spending the time it takes with clients to counsel them on weight control. (In all fairness, they haven’t been allotted the time until now.)
• Susan Yanovski, MD, in her 11/24/11 New England Journal of Medicine editorial Obesity Treatment in Primary Care – Are We There Yet? (abstract), stated: “less than 50% of PCPs report consistently providing weight-control advice to adults and less than 25% report regularly referring people to other providers who may help them with weight control.”
• It’s well known that PCPs receive a minimumof nutritional science in training and it’s highly unlikely that many have obtained the skills known to be effective in weight management counseling from studies on long term weight management.

Yet despite these facts, on November 29th, Medicare (Centers for Medicare and Medicaid Services) announced in their Decision on Intensive Behavioral Counseling for Obesity that it will start to cover obesity counseling services when provided by PCPs (as defined by CMS).

In the past couple of weeks I’ve had the opportunity to learn more about just what the Partnership for A Healthier America is up to. For being in existence barely a year, their strides and accomplishments are tremendously exciting. PHA’s efforts to date make me hopeful that perhaps we will reach PHA’s and the First Lady’s related, but independent, Let’s Move campaign’s, overarching goal: to end childhood obesity within the next generation. Yes, a lofty goal, but one that seems in sight with these important movers and shakers around the table.

Briefly PHA, a nonpartisan nonprofit organization, came together in 2010. Their mission is to “bring together public, private and nonprofit leaders to broker meaningful commitments and develop strategies to end childhood obesity.”

• Are you or a loved one at risk of having diabetes during pregnancy?
• Have you or a loved one had gestational diabetes?
• Are you overweight, thinking of becoming pregnant and have a family history of type 2 diabetes?

Gestational diabetes (diabetes that occurs during pregnancy) is on a steep uptick. CDC estimates that a rapid climb is about to occur from about 7% of pregnancies to about 18% - or one in seven pregnancies (1).

Why is GDM, as it’s often referred, on such a rapid rise?

Let's kick this off with THE TRUTHS about how challenging it is to keep lost pounds, just that, lost. It’s a tough job, in fact tougher than taking off those unwanted pounds in the first place.

Research shows that the most weight people lose, even with pretty constant expert support, is about 6 to 10% from your starting weight. Example: 200 pounds that's 12 to 20 pounds. Doesn’t sound like much compared to those triple digit losses touted on Biggest Loser or from for-profit diet plans. Research also shows people lose these pounds by about 6 months to 1 year max. It’s simply tough to lose more weight.  For sure there are exceptions. Read Weight Loss, Control: Expectations vs. Research-based Realities.

With the increasing conversation about prediabetes and type 2 diabetes you’ve likely heard the terms insulin resistance and it’s opposite insulin sensitivity. Another term that’s entered our lexicon with the epidemics of obesity and type 2 diabetes is metabolic syndrome…a group of symptoms which at its core is insulin resistance.

Think of metabolic syndrome, prediabetes, and type 2 diabetes as a continuum.

What follows are simple explanations of insulin resistance and metabolic syndrome along with action steps to put them in reverse or at least slow their progression over time. 

Insulin Resistance Defined
Insulin resistance most often occurs in people who are overweight. It’s particularly common in people who carry excess weight around their middle – waist line. An apple-shaped figure is often associated with insulin resistance. The medical term is central adiposity.

Recently I vacationed in Morocco. Ah!!!

We’ve got friends living in a smallish town about an hour south of Casablanca. One of them is an engineer with a U.S. based company assisting the Moroccans to build another phosphate processing plant. Yes, phosphate used to make fertilizer and more, is a large natural resource in Morocco.

Gaining a bit of knowledge about how phosphate is mined, processed and shipped throughout the world as well as smelling, tasting and seeing the foods and dishes of this culture were just a few of the treats of travel in Morocco. 


What I love about travel is the opportunity to see, observe, learn…oh yes, and eat. And eat our way through Morocco we did. From Marrakesh to Essaroura to El Jidata and beyond.

Here’s a few snapshots of the sites, tastes and aromas of Morocco:

In late June I attended the 2011 American Diabetes Association's Scientific Sessions (meeting). As usual, a fascinating learning experience. Over the years this meeting has become one that attracts scientists and health care providers from all over the world. Many stimulating and thought provoking meetings go on as well as an opportunity to explore new products and resources in a chock-full exhibit hall.

Rather than recreating additional recaps of this meeting, I'm pointing you to two detailed debriefs I've wrote for PRESENTdiabetes.com, the online continuing education community for healthcare professionals for which I'm the nutrition section editor:

This is one in a series of book reviews. You may find these books beneficial if you: manage prediabetes or diabetes, follow a diabetes meal plan and/or try to eat healthy to live well. These book reviews also appear on amazon.com. The books I’ve reviewed here can be found in my amazon a-store. Please check them out and consider a purchase.

Go unDiet – a catchy, succinct title. But what’s inside this book, which on the cover promises 50 Small Actions for Lasting Weight Loss? Cut to the chase, easy-to-digest, common-sense tips to get away from “dieting” and on to slowly changing your eating habits towards healthy – once and for all. The author, Gloria Tsang, RD is a well respected dietitian, Founder and Editor-in-Chief of the popular online nutrition website HealthCastle.com.

Tsang and I agree on a lot, particularly unDiet’s basic premises, she says: