This year’s report revealed that twenty-nine percent of people in North Carolina are obese, which means that one has a body-mass index of 30 or more; 29.9 percent of South Carolinians are considered obese.

Embarrassing to us southerners, all but one of the 10 fattest states are in the South, with Michigan as the only exception. It tied with North Carolina for 10th place. Also of great concern is the fact that almost 19 percent of N.C. children and 15 percent of S.C. children are obese. Obesity rates have risen in 27 states, including North Carolina. It seems to be more common in poor people, blacks Hispanics and women.

At least 20 diseases are caused or aided by obesity. The two main diseases induced by obesity are diabetes and cardiovascular disease.

The Good Health Club Physician Toolkit presents messages from the “Good Health Club, ” which is a group of friendly animal characters that motivates children to:

* Eat 5 servings of fruits and vegetables each day

* Curb screen time to 2 hours or less each day

* Exercise at least 1 hour each day

* Eliminate sweetened drinks

Dr. Don Bradley, senior vice president and chief medical officer at BCBSNC, and Dr. Edie Bernosky, Chapel Hill pediatrician, are both pleased and optimistic about the new program.

In the last 20 years, type 2 diabetes (formerly called adult-onset diabetes) has been reported among U.S. children and adolescents with increasing incidence, according to the Centers for Disease Control and Prevention (CDC). One in three U.S. children born in 2000 could get diabetes during their lifetime and the pervasiveness of obesity in children aged 6 to 11 has more than doubled in the past 20 years, rising from 6.5 percent in 1980 to an astounding 17 percent in 2006.

Since 1999, Blue Cross and Blue Shield of North Carolina has developed an assortment of programs in our community that focus on healthy lifestyles. The lifestyle modification program, called Health Lifestyle Choices, gave customers the support and instruments they needed to reach and maintain a healthy weight. In 2005, BCBSNC converted into one of the very first insurers to label obesity as a medical condition and cover nutritionist visits. Since 2007, they have augmented model tool-kits to assist families in getting routine exercise and taking control of managing their health and well-being.

To take a look at the Good Health Club Physician Toolkit and to get more information about what the Blue Cross and Blue Shield companies are accomplishing in their communities to fight childhood obesity and diabetes, please visit www.bcbs.com/goodhealthclub.

Soda, juices and most flavored waters are full of unwanted sugar, carbohydrates and calories. Water is usually recommended as the healthiest drink choice, but people often become tired and bored from the lack of taste.

One option is a drink that is thirst-quenching and healthy with no artificial sweeteners or preservatives. It has absolutely no sugar or calories either. It’s called hint and is made in San Francisco, California. It is just as healthy as drinking regular water, but it has some added natural flavor with a refreshing taste.

For more information or to purchase hint, go to (www.drinkhint.com).,

A new book called “The Skinny”, by Louis J. Aronne, the veteran director of the Comprehensive Weight Loss Program at New York Presbyterian Hospital/Weill Cornell Medical Center,  explains this theory. In the book, he talks about how what you eat and when you eat can make a huge difference in your appetitie, satisfaction and willpower.

Dr. Aronne has treated patients for 23 years. He has come to believe that refined carbohydrates and high sugar foods encourage what he calls “fullness resistance.” He says that they seems to tamper with the elaborate hormonal messages the body normally sends to the brain to cue that it’s time to stop eating. Instead, people actually can fell hungrier. This happens when refined carbohydrates cause blood sugar levels to rise, making insulin increase and pushing blood sugar down again, which causes rebound hunger. This insulin surge also has a blocking impact on leptin, the hormone that is secreted by fat cells that usually tells the body to stop eating. Obese people have plenty of leptin, but sometimes it doesn’t reach the brain or the brain gets resistant to it. Dr. Arboone writes that “this is not a failure of willpower, it’s a physical mechanism.” This opens the door for diabetes, because the body becomes resistant to insulin. Other researchers have claimed that refined foods with a lot of  sugar and carbohydrates can be as addictive as alcohol and tobacco.

The good news is that eating foods that are high in protein, vegetables, fiber and water have the opposite effect according to Dr. Aronne. In his plan, he suggests changing what you eat, one meal at a time, to bring back your sense of fullness.

For breakfast, he says to load up on lean protein, preferably from egg whites or a protein shake. When you eat this way in the morning, it can reduce hunger throughout the day. 

As for lunch, many dieters like to skip this meal, but going for more than 5 hours without food makes hunger hormones increase and fullness hormones drop, sending more of the calories eaten at dinner right to the fat cells. Dr. Aronne suggests beginning lunch with a salad; at least 2 cups of lettuce. After this, have more vegetables and then a lean protein. Try to eliminate the cheese, croutons, bacon and creamy dressings, he says. He claims that using vinegar by itself will decrease your appetite and slow blood sugar spikes.

Obese people eat usually eat more calories at dinner than slimmer people. For dinner, eat plenty of salads, clear soups or high-protein appetizers. In contrast to other diet programs, Dr. Aronne permits a half cup of grains or a small dessert at the end of the meal when you are still a little hungry. He also says that eating bread before dinner can make people lose their sense of fullness and actually cause them to eat more. He cautions that drinking alcohol can lower your resistance and promote fat storage.

When it comes to snacks, he believes that mid-morning and mid-afternoon snacks can be like appetite suppressants, because they prevent blood sugar from getting too low; just make sure your snacks are consistent with the plan.

As for beverages, we all know that juice and sweet soda can add lots of extra calories, and some studies have revealed that even artificial sweetened drinks can cause people to crave real sweets during the day. Try to cut back on all liquid calories and just drink water.

The weight-loss debates and theories will continue to be in the forefront of the news. Dr. Aronne says that because every one’s metabolism is not the same, and weight loss is a very complicated area, he suggests trying his plan for yourself. He says to experiment by having 200 calories of egg white or protein shake for breakfast and then have 200 calories of juice  on another day, and observe  your hunger hour by hour.

Even though diabetes has extensively increased in North Carolina and the U.S. over the last ten years, doctors are just now starting to figure out the mystery behind the intricate cycle of cellular occurrence that trigger the development of this persistent disease. Although a cure is not yet on the horizon, researchers are developing new targets for drug therapies.

Diabetes occurs when the body doesn’t make or successfully use insulin. Insulin is a hormone created in the pancreas which enables cells to convert sugars and starches for energy. People who are overweight have an increased chance of getting diabetes, because eating too much, and not exercising enough can exhaust the body’s capacity to use insulin. But important to mention is that not everyone who is heavy will develop the disease and not everyone with diabetes is overweight.

On April 7, a paper was published revealing that Duke University researchers have a new discovery that suggests that diabetes could be affected by protein and not sugary carbohydrates, which has long been thought of as the main culprit. The Duke researchers found that overweight people actually metabolize protein differently than leaner people, especially when it is part of a high-fat diet.

When too much protein and fat are eaten, the metabolic byproducts can not be totally absorbed, so they surge into the bloodstream. One of those byproducts is an enzyme that affects insulin sensitivity. A diet that is predominantly heavy in fat and protein causes the body to change to a different way of becoming insulin resistant.

Christopher Newgard, the director of the Sarah W. Stedman Nutrition and Metabolism Center at Duke and lead author of the study, said that protein is usually viewed as a good nutrient and it can be when people exercise and eat in moderation. The problem, she suggests, is the typical U.S. and Western society, where 65 percent are overweight due to a sedentary lifestyle and a diet that is too heavy in fat and protein.

This study looked at 132 obese adults. They all ate a diet that had the same daily calories and did 180 minutes a week of modestly intense exercise. Each day they also drank a drink that had 39 milligrams of caffeine, although one group drank green tea with 625 milligrams of catechins, which is an antioxidant and the main ingredient of green tea.

After just 12 weeks, the group that drank green tea had more success at losing weight-4.4 pounds. The control group dropped only a little over 2 pounds. Also, the green-tea group had more decreases in total abdominal fat, subcutaneous abdominal fat and triglycerides.

Just how green tea does this is not yet fully known, but scientists think that it revs up the speed at which fat is broken down in the body. Also, those affected by diabetes may also be interested to know that it might assist in the body’s sensitivity to insulin, which could lower the risk of diabetes.

On the positive side, a small study has shown that obesity surgery can reverse  diabetes in teens like it does in adults. There were 11 patients in the study who were aged 14 to 21 and all were severely obese, ranging from 250 to 403 pounds. They were taking diabetes pills and one was on insulin. They had gastric bypass surgery or stomach stapling at five different medical centers. At Cincinnati Children’s Hospital,they were compared to 67 teens who were mostly obese and had diabetes. Their blood sugar was being controlled with diet and medication.

After a year, those who had surgery had lost between 72 and 218 pounds, but none had reduced to a normal weight. Diabetes disappeared within a year for all but one of the 11 severely obese teens in the study, after under going weight- loss surgery, according to the researchers. The 11th patient still had diabetes, but was able to stop taking diabetes pills and needed much less insulin.

All of the teens who did not have surgery still had diabetes after a year and there was no change in their weight or their medication usage, but their blood sugar levels showed improvement.

The researchers said the reason wasn’t clear why diabetes wasn’t reversed in one patient who had been through the surgery, but they mentioned that his mother and a sibling had Type 2 diabetes. The teen still needed to take insulin but was no longer overweight three years after the surgery. Another reason could be that his diabetes was more advanced than the other teens in the study. Previous adult studies have found that the chances of reversing diabetes are better when the surgery is done soon after a being diagnosed. The others were most likely successful because their surgery was done while the patients were in the early stages of the disease.

One way to know if you have it for sure is to spend the night in a sleep lab. There you are hooked up to electrodes that evaluate your breathing. When people with sleep disorders snore, many physiological things take place. Blood pressure rises, oxygen and blood flow decrease, and heart irregularities are happen. Obviously, this is not a good night’s sleep. During the day, people having sleep apnea tend to have trouble with attentiveness and memory.

So what does all this have to do with diabetes? Diabetes and sleep apnea seem to be linked in certain ways. First of all, excess fat around the midriff is a risk for both diabetes and sleep apnea. People who have apple shapes or more fat cells in the upper body have different health effects than fat cells in the hips and thighs.

Then there is insulin resistance syndrome. It is a condition that is commonly found in people with diabetes as well as people with OSA. When breathing is too shallow, hormones are increased in the body causing blood sugar levels to raise and cause the body to not process excess blood sugar properly.

Another condition called neuropathy-nerve damage- frequently associated with diabetes, is also rampant in people with obstructive sleep apnea.

So what can you do to improve your odds of getting one of these problems or treat the ones you already have? Losing weight, avoid sleeping on your back, get at least 6 to 7 hours of sleep nightly, and avoid alcohol and other medications that may interfere with sleep are all ways that will help.

To summarize, sleep apnea may induce diabetes and vice versa. The good news is that the treatment of one may amend the aftermath of the other. As an example, a beneficial treatment for sleep apnea-Continuous Positive Airway Pressure, or CPAP-can also assist in controlling blood sugar levels by increasing more oxygen to the body.

Since high blood pressure and diabetes often go together, treating them both at the same time is the best solution. People with diabetes who control their blood pressure, cut their chances of having a heart attack, stroke or dying of heart disease in half. On the flip side, people with high blood pressure who control their blood sugar, can reduce the chances of losing their sight, losing feelings in the fingers or feet, losing a limb, and suffering kidney damage.

The American Diabetes Association recommends the fasting blood sugar test for diabetes testing. For this test, a small sample of blood is drawn in the morning before the patient has had anything to eat or drink. If the blood sugar reading is 126 milligrams per deciliter (mg/dL) or higher, and is confirmed by performing a second test a few days later, that person has diabetes. There are some doctors who check for diabetes by testing blood sugar two hours after a sugary beverage is provided or by checking the blood for the percentage of sugar-coated hemoglobin (known as hemoglobin A1c).

It is interesting to note that the word diabetes comes from ‘passing through’ and mellitus is ‘honey’. To put it simply and in a more sensible manner, the high levels of sugar in a person’s urine is pretty much like honey passing through. Adult Onset Diabetes or Type 2 Diabetes is characterized by the high levels of the glucose level in the bloodstream. This results to spilling over in the urine. It is also associated with an increase of carbohydrates in diets.

At the moment, adult onset diabetes is the 7th leading cause of death in the US., but there’s good news to this disappointing statistic. 90% of the diabetics who are non-insulin dependent can be cured as long as they achieve their ideal weight and by practicing a healthy lifestyle and having a balanced diet.

Other causes for insulin deficiency are toxic reaction to nitroso compounds, auto-immune disease and viral infection of the beta cells found in the pancreas. When not cured, risks include stroke, atherosclerosis, premature heart disease, blindness, pancreatic failure and gangrene of the limbs. Also, it runs in the family. If a family member has diabetes, chances are people in his blood line have more risk of getting it too if they do not watch what they eat.

A person’s diet is quite critical in regulating diabetes. Doctors recommend a healthy nutritional approach. In fact there are so many ways to regulate Diabetes Mellitus – from botanical medicine to traditional Chinese medicine, homeopathy and psychological approaches. Prevention is better than cure so the best way to control the disease is to simply regulate what you eat. If you have a sweet tooth the very minute you get up from bed, a grilled cheese sandwich might be a better breakfast as opposed to donuts and coffee.

Steer clear of pastry treats, cookies, pasta and soda-pop. You can have these but in moderation. If this is your diet day in and day out, expect the doctor to be diagnosing you with diabetes. You cannot change your diet overnight, but it can be done slowly and patiently with persistence. Since we are used to eating this and that, it’s hard to ignore the treats that we enjoyed before. But think of it this way, it is for your own good. This change in diet can be done. Plus, it puts you at less risk in getting diabetes.

Here’s a secret. Have a diet that does not contain sugar and high complex carbohydrates. Refined sugar is a carbohydrate that has been chemically altered through bleaching and processing. Examples of foods to ignore include cookies, candy, pastries, boxed cereal, alcohol, honey, soda pops, pizza and ice cream.

The symptoms of adult onset diabetes Type 2 include the following:

• frequent urination
• increased appetite
• increased thirst
• blurred vision
• fatigue
• slow-healing or frequent infections
• inability to have an erection

In order for the person to be sure that he has Type 2 Diabetes, the following examinations can be conducted:

• blood glucose level. If the level is above 126 mg/dL during two incidences, the diagnosis is possibly diabetes
• random blood glucose level testing – if the level is above 200 mg/dL and the person has the symptoms mentioned earlier, the diagnosis is possibly diabetes
• oral glucose test – if the level is above 200 mg/dL, the diagnosis is possibly diabetes.

People ask how to treat Type 2 diabetes. First, you have to eradicate the causes. You should also regulate the glucose level in the body. By continually doing this, the goal is achieved and a person with diabetes can have a longer life. The key to remember is that the main treatment for adult onset diabetes is diet and exercise.

Plan your meals and choose healthy foods. Eat the right amount and eat meals on schedule. In your free time, learn how much exactly fat, carbohydrates and protein you need in a balanced diet. Meal plans can be customized depending on your preferences and food habits.

Everybody’s advised to exercise regularly. This is a necessity if you’re diagnosed with diabetes because it controls the glucose level in your body. It also burns the extra calories and fat. That helps you mange your weight. In addition, it also helps you to cope with stress better. Adult onset diabetes may have these symptoms detailed here, but a consultation with a medical practicioner is the sensible path to take as soon as you suspect you may have diabetes.

What You Should Know: What are Treatment and Prevention Options?

Type 2 diabetes is a chronic condition that requires life-long treatment by changes in lifestyle AND by medications. Medication and lifestyle changes are not a cure for diabetes, but they can help reduce or eliminate organ damage due to diabetes. Both lifestyle changes and medication reduce the risk of the serious complications that can result from diabetes, such as heart, kidney, eye, and nerve damage.

Lifestyle
As with many other chronic conditions, in type 2 diabetes it is very important that you learn about the lifestyle changes and preventive approaches that will help you live with and manage your condition. Some of these are listed here – be sure to discuss them with your doctor.

Diabetes Education Classes are very important to help you learn the things you need to know to manage your diabetes and keep yourself as healthy as possible. There are professional educators including certified diabetes educators and dietitians that specialize in diabetes education. These classes are often covered by insurance. Be sure the classes have certification by the American Diabetes Association. Some of the things you will learn about in these classes are:

• Weight – This is extremely important in type 2 diabetes. By losing weight, you may be able to bring your type 2 diabetes under control. A structured weight-loss program that includes frequent meetings has been found to be the most helpful for people trying to lose weight.
• Diet – How much you eat, what you eat, and how often you eat are important to managing type 2 diabetes. Since this is an important and complex issue, guidelines recommend that patients be taught about proper diet by a registered dietitian. Eating a proper diet is critical, because this can help reduce glucose levels in your blood and maintain a healthy weight.
• Blood Sugar – You will learn how and when to test your blood sugar. If you need to use insulin injections, you will learn how to give yourself the injections.
• Exercise – Regular physical activity is very important to managing type 2 diabetes because it helps keep weight down. Diabetes is also easier to control when you exercise because it can lower blood sugar levels. However, you must first check with your doctor before starting any exercise program. Since cardiovascular problems are not uncommon, a cardiovascular evaluation is required before starting any exercise program.
• Smoking Cessation – It is very important that people with diabetes not smoke. Smoking increases your risk for complications. If you smoke, you will learn tips and resources for quitting smoking.

Drug Therapy
Here are the most common classes of drugs used to treat type 2 diabetes:

• Sulfonylureas – used to stimulate the pancreas to release insulin.
• Alpha-glucosidase inhibitors – used to reduce the amount of starch you body absorbs.
• Biguanides – used to reduce the amount of glucose produced and increase sensitivity to insulin.
• Meglitinides – used to stimulate the pancreas to release insulin with each meal.
• Thiazolidinediones – used to increase sensitivity to insulin.
• Synthetic hormones – use can vary for each.
• Insulin – used to replace insulin that is lacking.

All of these drugs are oral medications (pills) except for insulin and synthetic hormones, which are only available as injections at this time. An inhaled form of insulin has been approved by the FDA. An oral insulin preparation is also being tested.

Complication-Related Medications
You may also be prescribed other medications to treat other conditions you have because of your diabetes. Examples include ACE inhibitors or ARB’s to treat or prevent kidney complications, statins to lower risk of heart disease, and aspirin to lower the risk of heart attack and stroke.

Team Approach
Diabetes is a very complex disease. The American Diabetes Association’s standards indicate that diabetes is best controlled by a physician-coordinated team. As an example, the team can include physicians, nurses, dieticians, pharmacists, exercise physiologists, and mental health professionals. Other professionals can be included as well. Be sure to discuss this with your doctor. Feel free to request a referral to such multidisciplinary teams for education as well as treatment. The key to success is for the patient to be an active participant in his or her own care.