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Simple things first

Dr Joe Kosterich thinks that the medical profession sometimes focuses too much on complex solutions - missing the simple answers just before their eyes. What should we really do to manage our diets and keep diabetes under control?

 Sometimes I genuinely despair for our medical profession. There is an increasing desire to find complicated solutions and ignore simple ones, which work. This mainly comes from academia, public health and those who devise guidelines rather than those who deal with patients.

 A consensus statement was endorsed by the Australian Diabetes Society calling for gastric band surgery to be the first line of treatment for people with type two diabetes (T2DM) and a body mass index (BMI) over 40. It also argued for those with a BMI over 30 to have surgery.

 What they are saying is to forget changing eating patterns, exercise, even medication, and go straight to surgery.

 The statement was endorsed by forty-five scientific and medical societies worldwide. Conflicts of interest were not declared. They must have missed the Danish study released the same week showing a near-doubling in use of psychiatric drugs after weight loss surgery. There is no suggestion that surgery causes psychiatric problems. When you consider the links between emotions, weight and mental health, clearly surgery is not the entire answer. And it is not without risk either!

 But let's put that to one side. There is a more fundamental issue here.

There are other simple things we can advise patients to do which will help them with weight management.

 There is a growing school of thought that the increase in obesity and T2DM we see has been to people following the low fat dietary advice promoted over the last four decades. The evidence for lower carbohydrate diets grows weekly.

 The British National Obesity Forum went as far as to call for an end to low fat diets. Rather than get engagement or start debate about this simple measure, they were dismissed as “irresponsible”.

 There are other simple things we can advise patients to do which will help them with weight management.

 The most basic one is eating more slowly. This enables the brain to keep up with what one is eating and to get the message when one is full. Eating while on a mobile or laptop or even watching TV also distracts the mind from this message.

 There is much work showing that eating at the table instead of on the couch also helps with weight. This particularly applies in children, where eating with the family has many other health benefits too.

 Another simple thing we can advise patients is to read labels on food. This will tell the sugar and calorie content. Changes by the FDA in the USA will mean that portion sizes will now be more realistis (a single muffin will not be 1.7 serves) and added sugars will be listed, Hopefully we will follow.

 And we can advise them to mainly eat foods which do not have (or need) labels, in other words, real food.

 Sure, not everyone will listen or follow through and they will need other measures.

 But with so many simple things that we can advise people to do, surgery is absolutely not the first step!

Jow KosterichDr Joe Kosterich MBBS
Doctor, speaker, author of three books, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.

He is a regular on Channel 9 and radio, writes for various medical and mainstream publications, as well as maintaining a website and blog providing health information. He is the health ambassador for locally grown fresh potatoes. Dr Joe also gives practical motivational health talks for the general public and organizations.