Losing Weight for Heart Health

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Q: I watch what I eat and I exercise, but I can't seem to knock off the pounds. Is there some other connection between being overweight and having diabetes? I have had type 2 diabetes for at least 15 years and take insulin and rosiglitazone (Avandia).

A: Statistics show that at least 80 percent of those with type 2 diabetes are obese. How are diabetes, obesity, and cardiovascular disease connected?

The amount of weight gained varies greatly from person to person and is dependent, to a large degree, on the choices people make regarding the food they eat and the amount of exercise they get. However, insulin therapy in type 2 diabetes may be associated with weight gain, probably due in part to the effect excess insulin has on turning glucose into glycogen and fat.

Drugs such as rosiglitazone (Avandia) or pioglitazone (Actos) are associated with weight gain. They interact with a receptor on fibrous tissue that may convert it into fat cells, though how this occurs is not yet well understood.

Improved CV Function

At the same time, this class of drugs has demonstrated highly positive effects on our cardiovascular health. Despite the weight gain, rosiglitazone and pioglitazone also cause metabolic changes that are associated with improved cardiovascular function. These beneficial changes include lower blood pressure and a more favorable blood lipid (cholesterol and triglycerides) profile. It is generally accepted that the use of metformin with insulin may lessen weight gain.

Among people with type 1 diabetes, weight gain is greatest among those who use insulin as a "carbohydrate credit card," instead of balancing carbohydrate intake with exercise. Most studies of "tight control" in type 1 diabetes have shown metabolic changes associated with improved cardiovascular function, despite varying degrees of weight gain.

The major immediate goal of diabetes care is to control blood glucose, and then to deal with any associated weight gain. But how can you tell if you've gained too much weight?

The Waist Test

Just measure your waist. A value greater than 40 inches in men or 35 inches in women is associated with a substantially increased risk of health complications related to obesity.

How should one deal with weight gain, whether due to eating too much and lack of exercise, or to vigorous attempts at tight control? A diet that is low in simple carbohydrates and saturated fats with adequate fiber, along with regular physical exercise, will help control weight gain and the risk factors for cardiovascular disease.

The most important thing when it comes to managing obesity and diabetes is to start taking control through diet and exercise and to follow the health care regimen recommended by your health care team. Focus on the things you can control with food and exercise and on achieving the best overall health regimen for your diabetes today.

Sheldon H. Gottlieb, MD, FACC, is a cardiologist at Johns Hopkins Bayview Medical Center, Department of Cardiology, in Baltimore, Md. He also directs the Diabetes-Heart Failure Program at Johns Hopkins HealthCare, LLC.