Obesity & diabetes: the new epidemics.

Described as the "twin epidemics" by the Centers for Disease Control and Prevention (CDC), obesity and diabetes now affect more than 39 and 16 million Americans, respectively. Obesity--having an excessively high amount of body fat in relation to lean body mass--increases the risk of developing type 2 diabetes, high blood pressure, heart disease, stroke, gall bladder disease, and cancer. Type 2 diabetes--the body's inability to produce enough insulin or use it properly--can lead to blindness, kidney failure, neurological conditions, and amputations.

Recent studies show that physical activity can help prevent--and help control--both obesity and diabetes. But individuals who haven't exercised on a regular basis can put themselves at risk for injury by starting a program without professional advice. Physical therapists (PTs), with their expertise in body mechanics, can develop appropriate exercise programs for people at risk of developing obesity and diabetes or for those who already have the disease(s).

Safe Regimens

"As with all exercise programs designed to prevent illness, it's important that at-risk individuals work with professionals who can help them design a safe and thorough regimen that meets individual needs and circumstances," says Michael Mueller, PT, PhD, associate professor of physical therapy at Washington University School of Medicine.

"People who are overweight are at high risk for physical injury from an improper exercise regimen," says Mueller. "Range of motion, mobility, and flexibility often are greatly reduced in people who are overweight or obese, thereby increasing their chances for serious injury."

High-impact activity, such as running, puts a strain on joints and, therefore, may not be appropriate for people who are overweight. Instead, safe and appropriate low-impact exercise is a better choice.

Therese McNerney, PT, owner of Precision Health and Fitness, in Bethesda, Maryland, manages people who are overweight and people who are obese through a 12-week program that she customizes to each individual's needs. "You have to determine what the individual can do safely. People who are overweight often have joint problems associated with osteoarthritis. And because they have not been exercising, it hurts when they start," says McNerney, who determines how the patient can exercise without overexerting.

Once a person loses weight, he or she can begin a maintenance program under McNerney's supervision. She says her clients, like most Americans, cite the usual reasons for inactivity and weight gain, such as driving rather than walking, sitting for hours in front of computers at work and home, and not making the time for exercise. As most people who have lost weight know, maintaining a healthful weight requires a life-long commitment. "This is a lifestyle choice, not a fad," McNerney says.

PTs also know that it's important to recognize that overweight or obese individuals may have experienced past failures with exercise. "The guidance of a physical therapist who understands the difficulties that individuals may be encountering, who monitors their progress closely, and who encourages them to persevere can often mean the difference between success and failure," Mueller explains.

Lifestyle Changes

A landmark study recently conducted by the National Institutes of Health (NIH) found that people at risk for type 2 diabetes could reduce the likelihood of developing the disease by 58% through 30 minutes of moderate daily exercise, weight reduction, and by eating a low-fat, low-carbohydrate diet. The NIH study demonstrated that lifestyle interventions actually can prevent the disease.

Terry Michel, PT, MS, CCS, clinical associate professor of physical therapy at MGH Institute of Health Professions, Boston, who contributed to the study, says that PTs can play a vital role in helping people develop safe exercise programs. "Overweight or obese individuals must follow an appropriate exercise program that includes aerobic conditioning and avoidance of exercises that can lead to injury," says Michel. Safe and appropriate exercises may include swimming, stationary cycling, and walking.

Michel says that PTs can design a low-impact form of weight training by using low-weight, high-repetition exercise bands. This type of exercise helps to avoid joint stress and prevent stress fractures while providing stimulus for bone growth and osteoporosis prevention. "Modified yoga stretches and Tai Chi are also good exercises for promoting flexibility and relaxation. Many people enjoy doing these exercises in groups," she says.

Sandra Levi, PT, PhD, professor of physical therapy at the University of Illinois at Chicago, agrees that people enjoy the social aspect of exercising. Levi developed an exercise program for people with diabetes in the university's community. The program--which incorporates stretching, strengthening primarily using exercise bands, and aerobic exercises--is held in a group setting. "For clients who are newly diagnosed, we stress the social aspect of the group. We exercise with the clients. We eat with them. And they're encouraged to bring a spouse, child, or other family member with them for support. It's been proven that shared experiences are much more likely to be lasting."

Getting people with diabetes to attend an exercise class regularly can be difficult. "It's easier to change behavior when a patient experiences an acute injury. It's more difficult with a condition such as diabetes," Levi says.

For some people, getting started is the hardest part. But once they've made the decision to do it, they remain committed to their new routine. "Almost everyone who starts the program finishes it. And we can notice a difference in the patients," Levi says. "The program is designed so patients can continue to exercise at home, even in a small apartment," she adds.

Children at Risk

With the super-sizing of fast food, video games that keep children in front of televisions and computers, and cuts in physical education classes, it's not difficult to understand why obesity and type 2 diabetes are affecting children as well as adults.

The CDC in May reported "a disturbing increase" in the hospital costs related to childhood obesity. According to the CDC, hospital stays for youths with obesity-related conditions have more than tripled in the past 20 years, reaching $127 million. And the discharges of youths with diabetes nearly doubled. Inactivity also is taking its toll on America's children.

Children with--or at risk for--obesity and diabetes also can benefit from a PT's expertise. Physical therapists remind parents that, in addition to weight management and helping to prevent type 2 diabetes, physical activity is critical to children achieving cardiovascular fitness. Physical activity also helps build bone mass and strength, an important factor in preventing or minimizing the effects of osteoporosis later in life. Therese McNerney's practice isn't limited to adults; she also develops programs for children. And she's managed a mother-and-daughter team through a weight loss program. When it comes to healthy lifestyles, Americans should make regular exercise a family affair.

Who's at Risk for Diabetes?

People who are obese, have a family history of diabetes or prior history of gestational diabetes, have "pre-diabetes" (formerly termed impaired glucose tolerance), or are inactive are at risk for developing type 2 diabetes. Some ethnic groups, such as African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders, are at particularly high risk for type 2 diabetes.

In March, the American Diabetes Association issued new guidelines that urge most middle-age people to get a screening for pre-diabetes. According to the guidelines, individuals age 45 and older should consider being screened. Everyone age 45 or older who is overweight should be screened. Physicians should consider screening younger adults if they are significantly overweight and have another risk. Other risks include: having high levels of bad cholesterol, high blood pressure, or diabetes during pregnancy; having given birth to a baby bigger than 9 lbs; or being a member of a racial or ethnic minority group. If the test is normal, it should be repeated every 3 years.

How Obesity Is Measured

An individual is considered overweight when he or she weighs 10% more than his or her ideal body weight and obese if he or she weighs 20% more, according to the US surgeon general's height to weight index. If you are overweight or obese, losing just 10% of your body weight can improve your health.

To find out if you are at a healthful weight, go to www.surgeongeneral.gov/topics/obesity/calltoaction/fact_advice.htm.