HEALTH FIRSTDiabetes, Obesity, & Mortality:

A Patient’s PerspectiveSteve Hirsch, MD

Obesity: What are the risks?• Overweight/Obese Patients:

What diseases are they at risk for?

• Pre-Diabetes, Type 2 Diabetes

• Heart Disease, High Blood Pressure, Stroke

• High Cholesterol

• Osteoarthritis, leading to hip/knee replacement

• Cancers (Esophageal, Pancreatic, Colon & Rectal, Kidney, Gall Bladder, Thyroid, Breast, Uterine)

• Dementia related to Diabetes

Diabetes and Pre DiabetesPrevalence Diabetes• 20.1 million Americans (20 & older)

Prevalence Pre Diabetes• 86 million Americans (20 & older)

Deaths• 7th leading cause of death

American Diabetes Association, 2012

Diabetes

Complications

• Hypertension: 71%

• High Cholesterol: 65%

• Heart Attack: 1.8 times the risk

• Stroke: 1.5 times the risk

• Diabetic Retinopathy that can lead to Blindness: 21% (of those age 40+)

American Diabetes Association, 2012

So much of the focus is on INCIDENCE of Diabetes…..

And not enough onPREVENTION!!!

Studies show that….

• A healthy weight reduces the risk of diabetes by 90%

“Apart from Lung Cancer, Diabetes is the only other disease that can almost be eliminated with a simple lifestyle change.”

Walter Willett, Professor, Harvard School of Public Health

So many fad diets that don’t work over the long term…

• Popular due to promise of instant gratification, but not sustainable

3 Day Diet

• Not sustainable, but continues to fall in and out of favourCabbage Soup Diet

• Ingesting tape worms is not only extreme, it’s dangerousTape Worm Diet

Diabetes/Pre Diabetes: How do you decrease the risk?

• Weight Loss

• Making healthier choices

• Exercise It’s all about Lifestyle!!!

Mindfulness: Making Conscious Choices• Think before you eat

• Stick to your budget

• Try to avoid mindless and emotional eating

Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgementally.

Jon Kabat-Zinn, Mindfulness for Beginners

Mr. G65 year old male, non-smoker….initial visit July 2013Weight 240 lbsHeight 5’11”BMI 33.5 (BMI: 30-34.9 = Class 1 Obesity)Blood Sugar 131 mg/dl (7.3 mmol/l)

(Diabetes: >126 (7.0))Blood Pressure 130/85Total Cholesterol 225 mg/dl (5.82 mmol/l)

LDL (bad) cholesterol

141 mg/dl (3.65 mmol/l)

HDL (good) cholesterol

48.7 mg/dl (1.26 mmol/l)

Your turn….

After 5 months on the HEALTH FIRST Program™

BaselineJuly 26, 2013

November 8, 2013(at 4 months, 35 lb

loss)Weight 240 205

BMI 33.5 28.6

Blood Sugar 131 (7.3) 90 (5.0)

Total Cholesterol 225 (5.82) 175 (4.53)

LDL (bad) cholesterol

141 (3.65) 92.8 (2.4)

HDL (good) cholesterol

48.7 (1.26) 55.6 (1.44)

55 lb Weight Loss!

Your turn again….

The Key to Success: A Program that Works

• HEALTH FIRST Program™: As effective as it is simple• Choose healthier foods• Control portion size• Budget food groups

• Keep It Simple: It Works!• Don’t let yourself get hungry: Hunger always wins!• Never skip meals: 3 /day• 4 healthy snacks/day

Health First Food Groups• Starches

• Meat

• Poultry

• Vegetables

• Fruit

• Dairy

• Cheese

• Eggs

• Legumes

Starches (Cereal, Bread, Rice, Potatoes, Pasta ,Crackers, Couscous)

16

• Must be whole grain, or whole wheat, or brown rice. No white bread, white flour or white rice.

• 1 portion (size of your palm)• 3 portions/day (female)• 4 portions/day (male)

CerealWhole grain only• HINT: Add real fruit to sweeten

naturally• WARNING: Read box labels. Select

brands that are low in sugar

Starches (Cereal, Bread, Rice, Potatoes, Pasta, Crackers, Couscous)

BreadWhole grain only

• CAUTION: A standard slice of bread is 4” x 4.5” x ¾” thick….many slices are double this size!

RiceBrown or Wild Rice only

• 1 portion = size of your palm (about ½ cup)

Starches (Cereal, Bread, Rice, Potatoes, Pasta, Crackers, Couscous)

Potatoes• Enjoy white or sweet

potatoes

Pasta• Whole wheat pasta only• Remember…1 portion = size

of your palm (about ½ cup)

Meat: (Beef, lamb, veal, all pork products)

• 3 portions of meat / week• 1 portion = 6 oz (170 g)

• AVOID all processed meats such as sausage, bacon, smoked meat, corned beef, ham, pepperoni, salami, bologna, hot dogs

Poultry: (Chicken, turkey)

• Unlimited portions of unprocessed, skinless chicken & turkey per week

• Favour white meat over dark, always skinless

• Avoid fried poultry

Fish and Shellfish• 3 portions / week• 1 portion = 6 oz (170 g)• Avoid fried fish• Shellfish may be 1 of 3 fish portions per week

Vegetables• Unlimited – as much as you can eat• Seek lots of variety• Remember…Potatoes are a starch

Fruit

• 1 portion = palm size

• 4 portions per day

• Seek out a wide variety

• Avoid fruit juices

• No syrup, sugar or sweeteners added

• Use fruit strategically

Milk, Yogurt & Milk Alternatives

• 3 portions per day• 1 portion of milk = 8 oz (250 mls)• 1 portion of yogurt = ¾ cup (190 ml)

Yogurt, plain, 1% or 0% fatMilk, 1% or 0% fatSubstitute soy or almond milk, as desired

Cheese

• 3 portions per week

• 1 portion = 1.5 0z (42.5 g)

• Count cheese included in other dishes

Eggs

•4 whole eggs a week

•Count eggs in dishes and baked goods

Legumes(Beans, peas, lentils, soybeans)

•Up to 1 cup per day

Healthy Snacking: 4 x per day• Vegetables: “Tons”

• Fruit: but only 4 portions per day

• Nuts & Olives: a handful daily

• Seeds: a handful daily

• Cheese: 1 of your 3 weekly portions

Recommended Snack Times

Breakfast Lunch Dinner

1st SnackMid-

morning

2nd SnackMid-

afternoon

3rd Snack½ hour before

dinner

4th SnackEvening

Alcohol: Yes, but not too much!• Females: Up to 4 drinks/week

•Males: Up to 7 drinks/week

• 1 drink

= 1.5 oz of liquor

= 12 oz of beer

= 5 oz of wine

The Table of 3’s and 4’s

3 Portions per week

4 Portions per week

3 Portions per day

4 Portions per day

Unlimited Servings

Meat EggsMilk, Yogurt,

Milk Alternatives

Fruit Vegetables

Fish Starch(Females)

Starch(Males)

Poultry

Cheese

The App

Patient Story: Enjoying ComplimentsSal, a 36 year old, school teacher who came with complaint of feeling sluggish

• BMI of 33 (Class 1 Obesity), Waist Circumference of 44”, High Blood Pressure (150/100), LDL elevated

• Discussed options: wanted lifestyle program rather than meds to lower blood pressure and cholesterol

Your turn….

RESULT:• Lost 40 lbs, rate of 2 lbs /week • Blood pressure - 120/80• Cholesterol returned to normal

Patient Story: Enjoying Compliments

Sal, a 36 year old, school teacher who came with complaint of feeling sluggish

“This program is so easy to follow: I never feel like I am on a diet, and I am

never hungry. I’m very focused on what I eat and drink. I quickly realized that I

was drinking too much alcohol, and eating way too many starches. Since I’ve lost the 40 lbs, I no longer feel sluggish, I

have tons of energy, and I also like the compliments that I’m getting about how

great I look. Keeping the weight off is also easy with the maintenance

program that I now follow. Physical activity and exercise is now just a part

of my life.”

Sugars: More Sinister Than You Think

The average American (& Canadians are not that far behind) consumes 90 lbs of sugar per year.

How do you limit your sugar consumption?

• Read labels

• Avoid soft drinks

• Avoid fruit juices, even the unsweetened varieties

• Avoid yogurt with added fruit

• Avoid sugary breakfast cereals

• Avoid processed and packaged foods; pastries, cookies, buns, pies, ice cream

Reading Labels:Sugar: Bottle of Cola

Remember: 4 grams of sugar = 1 teaspoon

How much sugar is that???

17.5

Reading Labels:Sugar: Green Tea

Commercially available Green Tea can be a real sugar trap!

9

99 Teaspoons of Sugar

Reading Labels:Sugar: Cereal

Many cereal boxes state: “Protein and fibre, all natural”

• Label: • Sugar: 13 grams of sugar per serving• Serving size: ¾ bowl

• So….in a full bowl:• 16.25 grams of sugar = 4 teaspoons of sugar!

The Power of Moving: Physical Activity & Exercise

• 80:20 Rule

• Critical Separation: Never link physical activity & exercise to calorie burning

Physical Fitness is not only one of the most important keys to a healthy

body, it is the basis of dynamic and creative intellectual activity.”

John F. Kennedy

The Power of Moving: Physical Activity & Exercise

Physical Activity: Work up to 10,000 Steps/Day How can you increase your steps/day?

• Stairs, not escalators

• Don’t use a drive-thru

• Park far from stores

• Get off subway at an earlier stop

• Go for a walk at lunch

The Power of Moving: Physical Activity & Exercise

Exercise: • What kind?• How often?• How much?• What intensity?

The Power of Moving: Physical Activity & ExerciseType• Cardio:• Power walking• Running• Gym machines: elliptical, rowing, • stationary bike • Classes: spinning, step, Zumba• Swimming• Team sports: basketball, hockey, squash/racket ball, soccer, tennis

The Power of Moving: Physical Activity & Exercise

Amount

• Minimum: 30 min, 3X/week• Ideal: 45 min, 4X/week

• Work up to moderate intensity• Huff & puff, or check heart rate• (220 – your age)…start at 60% of that, work up to 85%

The Power of Moving: Physical Activity & Exercise• Barrier to Exercise: “Not enough time”

• Appointment Making and Showing Up: “Just Book It” & “Do It”!

Keys to Remember

• Weigh yourself every Monday morning• Ideal weight loss is 2 lbs/week; 1 lb is OK…

• Be positive

• Be mindful

• Review the diet components every day

• Practice good eating habits always

• Physical activity (10,000 steps)

• Cardio exercise: 3-4x/wk, 30-45 min

In Conclusion…

• HEALTH FIRST Program™….reduces your risk for many diseases

• Portion size matters!

• Smaller is healthier, bigger is not better

Life is not a dress rehearsal….better health and

wellness is achievable!!!

Thank you for staying awake!