Dear DOCTOR Owen:

I was recently diagnosed with diabetes mellitus. I am approximately 50 pounds overweight, and have elevated blood pressure and cholesterol. My doctor said that—if I lose weight—most of these problems will resolve themselves without medication. His nurse handed me book on a 1200 calories/day diet and then said, “Good luck.” I feel terrible that I cannot lose the weight or stick to the recommendations on the diet plan she handed me.

I am hungry all the time, and my family has been unwilling to help me. In fact, they just threw me a birthday party—with cake and ice cream as my only options! I don’t want to take pills and shots. What can I do? The doc told me that if I did not bring the weight down on my own, he would start me on medication, next visit.

Panicked Diabetic

Dear “Panicked”:

I will bet you everything I own that your caring, informed, and knowledgeable doctor or his nurse would not hand you a prescription for insulin or diabetic pills and then say, “Good luck” as happened with the diet. Unfortunately, too many physicians spend much of their educational time learning about new pills and shots and how to give insulin, but receive virtually no training in how to help patients manage their diets and their weight. Likewise, we doctors receive virtually no exercise education in our continuing education sessions (which are usually sponsored by drug companies).

There are many reasons for this. For one, nutrition and Diet Therapy are two separate issues. While physicians may have some training in nutrition, few if any of them have Diet Therapy training. Nutrition involves knowing what foods are proper for good health. Diet Therapy involves knowing how to balance and maintain the calories in those foods in the face of intense cultural, social, economic, biological, and psychological pressures to do otherwise.

I tell my patients that obesity and a lack of ability to control the diet are not character flaws! Yet, people feel like failures if they are unable to control their diets. Usually, they are on their own in accomplishing this major task, and receive little or no support from their loved ones and work colleagues. They are made to feel as if their obesity-related diseases result from a character flaw and that it is their own fault.

Weight loss is under your own control if you possess dietary management skills and knowledge. People are either taught about nutrition and dietary management or they learn about these things on their own. In addition, they find that weight loss and management are a constant dynamic process that involves people, places, and situations (as mentioned in your letter).

At the party, suppose you had taken your cake and ice cream plate and dumped it into the trash! Or, say, you’d told the guests: “I’m a diabetic and, therefore, can’t eat this. I wish you’d never bought it for me.” (Of course, you probably would never say that.) Seriously, though, what a dilemma you faced. At the very moment the plate was handed to you and you knew you shouldn’t eat the sweets, your elevated insulin levels were screaming out, “Eat,” because your cells were basically being starved of sugar. You knew that eating this food would be like eating arsenic—that sooner or later it would kill you.

Here are five suggestions for handling this situation at next year’s party:

• Get professional help from a dietitian, personal exercise instructors, or even reputable commercial plans such as Weight Watchers®, Jenny Craig®, Richard Simmons’, and so on. They offer basically good educational instruction, emotional and social support, and structure.
• Get your hands on as much diet and nutrition information as you possibly can, and read like a fanatic. Since it is possible to under-eat and over-exercise for diabetic control without medication, get books on this topic from your library or local bookstore, and search the Internet for data.
• If available in your area, check out a medically supervised Diet Therapy program until you have lost the weight needed. Then, enroll in the maintenance phase of the program. You may even consider rotating through all of the commercial Diet Therapy programs—especially for your weight maintenance.
• Prior to taking diabetic medications, consider agents that affect your diet, such as the new fat-blocker Xenical® (Orlistat). Also, Meridia® (Sibutramine) controls appetite and hunger. You might even wish to consider using both!
• Check out over-the-counter supplements such as chromium picolinate, vanadium, fish oil, and other herbal products.

Last resort: If you can control your diabetes without pills and shots, you will probably greatly reduce the chance of complications such as heart attack, stroke, blindness, kidney failure, and nerve damage.