Weight loss for diabetics

It’s harder to lose weight with Type 2 diabetes

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Dear Dr. Roach: I am a 67-year-old woman with Type 2 diabetes. I take 1,000 milligrams of metformin twice a day. My last A1C was 8.1. I desperately want to lose weight to get rid of the diabetes or at least lower the A1C, and am cutting down on carbs, but I am told it is very difficult to lose weight on diabetes meds. Can you explain why, and offer any wight-loss advice?

R.P.

Dear R.P.: It can be harder to lose weight with Type 2 diabetes. The underlying defect is resistance to insulin, so blood insulin levels usually are high. Insulin is a growth hormone, a signal in the body that there is plenty of sugar and that the body should store energy as fat.

Medications for Type 2 diabetes that increase insulin levels tend to make it even more difficult to lose weight. Insulin itself, and medications that tell the pancreas to make more insulin, such as glyburide, tend to promote weight gain.

On the other hand, medicines that reduce insulin levels tend to promote weight loss. Metformin works mostly by preventing the liver from making sugar, so the body’s own insulin can work more effectively on the sugar we take in through food. Another medicine, exenatide (Byetta), promotes weight loss in some people. Other medications for Type 2 diabetes have variable effects on weight.

Of course, controlling total calorie intake, especially carbohydrate intake, has a powerful effect on weight, both directly and indirectly. Similarly, exercise makes insulin work better, so modest changes in diet and exercise, along with careful attention to the choice of diabetes medication, can help promote weight loss. I have found that exercising a half-hour or so after eating seems to work well.

Dear Dr. Roach: My son is 53, and three years ago he had three stents put in due to clogged arteries. His cardiologist put him on Lipitor at 80 mg. I don’t know if this is necessary.

J.K.

Dear J.K.: In people with blockages in the arteries in their hearts, there is really no doubt that medications like atorvastatin (Lipitor), a statin drug, reduce the risk of heart attack. Although they can have side effects, for most people the benefit far outweighs the risks.

It’s important to recall that even a powerful medication like a statin can’t optimally treat people if they don’t treat themselves right. Years ago, I had a patient who was doing well after his bypass surgery and was taking a statin with good results. Walking through the hospital cafeteria, I saw him eating a triple cheeseburger (why the cafeteria even sold such a thing is a separate question), and he sheepishly argued that he was taking his statin. A statin can’t beat a triple cheeseburger.

Good cardiac health requires a good diet of mostly plants, with whole grains, nuts, fruits and fish included for people who choose it. Exercise an important part of the treatment, and walking is nearly as good as any exercise. Medication is just a small part of a healthy lifestyle and preventing heart disease, which, although rates are decreasing, is still the leading cause of death in industrialized countries.

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If you have type 2 diabetes (T2D), there’s a good chance you are overweight or obese. It’s also likely your doctor has told you that you need to lose weight in order to regulate your blood sugar. But no matter how hard you try, the pounds don’t budge.

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Your diabetes medication may be the problem.

“I hate to give my patients these medications. I tell them to lose weight, and then I write a prescription that increases their appetite or makes them gain weight. It’s like shooting them in the foot,” says endocrinologist Betul Hatipoglu, MD.

Tips to help you lose weight

If you take a diabetes medication and find it hard to lose weight with diet and exercise, here are some things you might want to try:

Make changes gradually. Overhauling your lifestyle is an overwhelming task that can be made easier by doing it gradually. For example, stop eating bread or drinking sugary sodas. Start eating a healthy breakfast. Exercise 10 minutes a day.

“Adopt a healthy behavior you can live with, and add more changes as you are able,” Dr. Hatipoglu advises.

Try a low-carb diet. Insulin resistance makes your body think it’s starving, so it won’t let go of fat. A low-carb diet can break your body’s obsession with fat. When you stop eating carbs, your body will draw down its fat stores. You won’t need to give up carbs forever. Once you start losing weight, you can reintroduce whole grains gradually to see how many carbs you can eat without gaining weight.

Move it. Move as much as you can. Exercise of any kind speeds up the metabolism and accelerates weight loss.

Seek support. If your doctor is associated with a medical center, find out if there is a diabetes management or weight-loss program you can tap into. If not, check the website of the pharmaceutical company that makes your diabetes drug, since many companies have patient support programs.

Consider bariatric surgery. If you continue to struggle with your weight, consider consulting a bariatric surgeon. A weight-loss surgical procedure might be your ticket to success. “There is good evidence that the loss of weight patients experience from these procedures can not only reverse their diabetes, but reduce their risk from its complications,” says Dr. Hatipoglu.

Good news for some

Some newer diabetes medications don’t cause weight gain — or will at least allow patients to lose weight. These drugs — liraglutide (Victoza®) and empagliflozin (Jardiance®) — are also beneficial to the heart.

If you are taking a different diabetes medication and struggling to lose weight, ask your doctor if one of these might be right for you. Be sure to check with your insurance plan to ensure the cost will be covered.

According to Dr. Hatipoglu, some patients find that even when they take one of these newer diabetes medications, they need an extra push to jump start the weight loss process. In these cases, she is not opposed to prescribing weight-loss drugs for short-term use. “They don’t replace diet and exercise, but they offer the little push that many patients need to lose weight,” she says.

Why losing weight matters

Obesity is a major risk factor for the development of insulin resistance, which can lead to type 2 diabetes. People ages 51 to 61 with diabetes have a mortality rate 2.6 times higher than their peers without diabetes. Add obesity to the mix, and the mortality rate jumps to 7 times normal.

Obesity is also a major obstacle to achieving long-term glycemic control. But weight loss can bring about major changes. In fact, losing only 10 percent of your excess pounds can make diabetes disappear.

This article originally appeared in Cleveland Clinic Heart Advisor.

The Outsmart Diabetes Diet is based on new research that found four specific nutrients—fiber, vitamin D, omega-3s, and calcium—work together to help balance blood sugar and encourage weight loss. Build your daily diabetic diet meal plan by choosing one breakfast, one lunch and one dinner, plus two snacks—any combination gets you approximately 1,400 calories a day and a healthy dose of the “Fat-Fighting 4.” Remember to eat about every 3 hours and practice portion control.

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Follow this mix and match diabetic diet meal plan—adapted from The Outsmart Diabetes Diet—for the next five weeks to help fight fat, maintain healthy blood sugar levels, boost energy, and reduce your diabetes risk.

BREAKFAST

Fruity bagel breakfast: Spread 1 Tbsp light cream cheese and 1 tsp 100% fruit spread on ½ of a whole grain bagel. Serve with 1 c fat-free milk.

Crunchy yogurt: Combine 6 oz fat-free light yogurt, ¼ c granola cereal, 1 Tbsp ground flax seed, and 1 Tbsp chopped nuts. Add ground cinnamon and/or sugar substitute to taste.

Eggs and English muffin: Scramble 1 egg in a pan coated with 1 tsp canola or olive oil; top with ¼ c chopped tomato, onion, and chile salsa. Serve with toasted 100% whole grain English muffin, spread with 2 Tbsp low-fat (1%) cottage cheese, and 1 c fat-free milk.

Instead of scrambled eggs, try poaching an egg:

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Good Morning Blend: Stir together 6 ounces fat-free yogurt, 2 Tbsp dried mixed fruit, 2 Tbsp ground flax seed and 2 Tbsp chopped almonds, walnuts, or pecans.

Nutty Oatmeal: Top ½ c cooked oatmeal with ¼ c walnuts or other nuts; add ground cinnamon and/or sugar substitute to taste. Serve with 1 c fat-free milk or calcium-enriched soy or rice beverage.

Bagel and cream cheese: Spread ½ 100% whole grain bagel with 1 Tbsp low fat cream cheese. Serve with 1 c fat-free milk or calcium-enriched soy or rice beverage.

Veggie omelet: Cook 1 egg white in a pan with 2 tsp canola, peanut or olive oil. Add ½ c spinach leaves, ½ c mushrooms, onions, garlic, and herbs as desired; and top with 2 Tbsp reduced fat cheese. Serve with 1 slice 100% whole grain toast spread with 1 tsp canola-oil margarine and 1 c fat-free milk or calcium-enriched soy or rice beverage.

LUNCH

Tuna melt: Top 1 toasted whole grain English muffin with ¼ c tuna mixed with 1 tsp mayonnaise (or 1 Tbsp light mayonnaise), 1 Tbsp minced dill pickle and/or chopped celery and 1 oz reduced-fat cheese. Place in pre-heated oven (450ºF) for 5 to 10 minutes (or microwave for 30 seconds until cheese melts). Serve with 8 baby carrots with 2 Tbsp reduced fat ranch dressing, and 1 c fat-free milk or calcium-enriched soy beverage.

Lean-body salad: Toss 2 c mixed dark greens, ½ c canned garbanzo beans (rinsed well), 1 oz reduced-fat Mozzarella shredded cheese and 2 Tbsp light Italian dressing. Serve with 1 fresh peach or ½ c canned peaches (in juice or water).

Chicken salad: Combine 2 c mixed dark greens, 2 stalks chopped celery, and ¼ c sliced green or red grapes. Top with 2 oz cooked chicken breast, and drizzle with 2 Tbsp light honey mustard dressing (such as Newman’s Own). Serve with 1 slice reduced-calorie 100% whole grain toast, spread with 1 tsp canola oil soft tub margarine.

Roast-beef sandwich: Layer 2 oz lean roast beef, ½ c chopped romaine lettuce and ½ sliced tomato on 2 slices reduced calorie 100% whole grain bread, spread with 1 tsp mayonnaise and/or mustard.

Pesto pizza: Split and toast a 100% whole grain English muffin. Top each half with 1 Tbsp pesto basil sauce, 1 slice tomato or ½ c canned tomatoes, and ½ slice reduced-fat cheese. Broil or bake in oven until cheese melts.

Bean tostada: Bake 1 corn tortilla in 400-degree oven until crisp. Spread with ½ c cooked or canned pinto beans (rinsed) and 2 Tbsp shredded reduced-fat Mexican blend cheese. Return to oven for 5 to 10 minutes until cheese melts. Top with ¼ c salsa. Serve with a cabbage salad (1 c shredded cabbage and 1 chopped tomato with 2 Tbsp reduced-fat dressing).

Tuna salad: Mix 3 oz water-packed tuna with 2 stalks chopped celery, 4 chopped green olives, and 1 tsp regular (or1 T reduced-fat mayonnaise). Add 1 Tbsp seasoned rice vinegar, if desired. Scoop tuna onto 2 c mixed dark greens, and top with 1 Tbsp chopped almonds. Serve with 1 oz 100% whole grain crackers.

SNACK OPTIONS #1

1 medium orange or tangerine and 2 T dry roasted almonds (no added salt)
1 c fresh strawberries and ¼ c unsalted nuts
1 c seasonal melon and 6 oz fat-free light yogurt
4 dried apricot halves (or 3 dried plums) and 7 walnut halves
2 fresh or dried figs and ¼ c unsalted nuts
1 kiwi and 12 whole almonds
1 medium apple, sliced, with 2 Tbsp all-natural peanut butter

MORE: See 14 Snacks That Power Up Weight Loss

DINNER

Barbecue chicken: Grill or roast 3 oz chicken and top with 2 Tbsp barbecue sauce. Serve with 1 slice garlic sourdough toast, spread with1 tsp olive oil and garlic, and colorful coleslaw (mix 1 c shredded red and green cabbage and carrots with 1 Tbsp regular coleslaw dressing or 2 Tbsp reduced-fat dressing).

Roast beef and rice: 3 oz lean roast beef, sliced, with ⅔ c cooked brown rice and 1 c cooked spinach, seasoned with 1 tsp olive oil and 1 tsp balsamic vinegar.

Halibut and potatoes: 3 oz foil-baked halibut or other fish with 1 c green peppers and onions. Serve with ½ c red potatoes, roasted in 1 Tbsp olive oil and seasoned with herbs and spices.

Pasta with meatballs: Toss 1 c cooked whole grain pasta in garlic and 1 Tbsp olive oil and garlic. Top with 3-oz lean meat balls (made with turkey, chicken or soy) and 1 tsp grated Parmesan cheese. Serve with cucumber salad (toss 1 c mixed greens, 1 c cucumber slices, 10 halved cherry tomatoes, ¼ c chopped red onions and 2 Tbsp reduced-fat Italian dressing).

Shrimp salad bowl: Mix ⅓ c cooked brown rice and 2 Tbsp crumbled feta cheese. Scoop onto 2 c mixed greens, and top with 3 oz grilled or sautéed shrimp and 2 Tbsp reduced-fat dressing. Serve with 2 whole grain rye crispbread crackers, spread with 2 Tbsp low-fat ricotta or cottage cheese.

Oven fried chicken: Toss 4 oz raw chicken breast in 1 Tbsp reduced-fat Italian dressing, coat with 2 Tbsp seasoned bread crumb and spray lightly with canola oil. Place on lightly oiled cookie sheet. Bake at 350ºF for 30 minutes or until browned and no longer pink inside. Serve with 3-bean salad (toss ½ c green beans, ¼ c garbanzo beans, ¼ c red beans, 2 Tbsp chopped onion and 2 Tbsp reduced-fat Italian dressing)

Tofu stir fry: Stir-fry 3 oz tofu and 2 c mixed vegetables (broccoli, cauliflower, green beans, onions) in 2 Tbsp reduced sodium stir fry sauce and 1 Tbsp olive oil. Serve over ⅔ c cooked brown rice.

SNACK OPTIONS #2

2 graham crackers spread with 1 Tbsp all natural peanut butter
3 c light popcorn and 16 oz light lemonade
¼ c cashews, almonds, walnuts or other nuts
4 vanilla wafers and 1 c fat-free milk or calcium-enriched soy or rice beverage
6 oz fat-free light yogurt and ¾ cup blueberries, raspberries or blackberries
½ c light ice cream (choose ice cream with no more than 2 grams saturated fat and 20 grams total carbohydrates)
Stir 1 Tbsp chopped dried fruit and 1 Tbsp chopped nuts into 6 oz fat-free light yogurt.

MORE: 30-Minute Dinners for Diabetics

Ask the experts

I have a friend that is 35 and has diabetes. For the past eight years, his weight has always been in check and if anything he may have been a little overweight. Just recently, he has lost a lot of weight and he told me that he weighs less than he did in high school. I think he looks too thin and I am concerned about his health with him being a diabetic. Should there be a concern and what kind of advice can you give me to pass on to him.

Doctor’s response

We often assume weight loss is good and healthy. A slow steady intentional weight loss using nutritional change and exercise is associated with beneficial effects on the heart, blood pressure, and cholesterol levels. In addition, weight loss can reduce “insulin resistance” and make muscles and fat tissues more sensitive to circulating insulin levels in the blood.

What type of diabetes causes weight loss?

A reduction in insulin resistance is problematic because insulin is needed to help glucose enter these tissues to be metabolized. If these tissues are resistant to insulin, higher than normal levels are needed for this process to occur. This is often the case in Type 2 diabetes. As a result, a vicious cycle occurs, the higher the insulin levels are, the harder it is to lose weight (insulin is anabolic, and is a hormone that likes to store fat). On the other hand, the heavier a person is, the more likely they are to have higher insulin levels. As you can see, the cycle is often hard to break.

What causes unintentional weight loss in diabetes?

While intentional weight loss in people with diabetes is usually a good thing, unintentional weight loss is not. If blood sugars are very high, patients with diabetes tend to urinate a lot, and this results in dehydration as a possible cause of weight loss. Also, muscle breakdown can occur if sugars are too high, causing an unhealthy weight loss. Actually, many patients with diabetes present for the first time to their doctor’s office because of unexplained loss of weight. In addition to diabetes, there are other concerning causes of unexpected weight loss which should be explored such as thyroid disease and cancers.

In summary, a supervised attempt to lose weight in people who can exercise without risk is usually of benefit. However in certain cases such as if blood sugars are too high or too low or if heart disease is present, it can be dangerous. This is why all exercise and weight loss programs should be started only after discussion with a physician. Any unexplained weight loss, in patients with or without known diabetes may be a sign of high blood sugars or another serious illness. It is absolutely necessary to see a physician and undergo a complete evaluation in these cases.

“It’s really encouraging. Losing weight may happen slowly, but getting healthy – getting rid of insulin resistance, getting your blood sugar down to healthy levels – can happen very, very quickly.”

Insulin resistance in remission

“Combating insulin resistance is incredibly important,” emphasizes Tom Rifai, MD, FACP, Regional Medical Director of Metabolic Health & Weight Management at Henry Ford Health System in Michigan, and member of the Pritikin Scientific Advisory Board.

“In fact, when we shed weight and get our blood sugar under control, it’s not really diabetes that’s in remission, it’s insulin resistance that’s in remission.”

Keeping diabetes at bay

The best way to keep insulin resistance and diabetes at bay is to keep the weight off.

The best way to keep the weight off is not by forcing yourself to live with chronic hunger day in and day out. “Chronic hunger is what happens with portion-control diets,” explains Kimberly Gomer, MS, RD, Director of Nutrition at Pritikin.

The problem with portion-control diets

“Portion-control diets often whittle down food to tiny, unsatisfying servings. Can anyone really stop at one skinny slice of pizza?” Eventually, nagging hunger overrides will power. Yes, the whole pizza disappears.

The solution

The best way to keep the weight off is with a program, like the Pritikin Eating Plan, that allows you to eat plenty of food throughout the day. It’s food that is low or moderately low in calorie density but high in stomach-filling satisfaction. It’s food like fruits, vegetables, bean-rich soups, potatoes, sweet potatoes, whole-grain pasta, and other plant-based, fiber-rich, unprocessed or minimally-processed foods. It’s food that fills you up on 10 to 20 calories per bite, not 100 calories per bite.

Concurs Dr. Tom Rifai: “It is far more likely that someone will maintain healthy weight reduction with these low- to medium-calorie-dense foods than with portion-control approaches that hyper-focus purely on calories. There’s another great bonus to these lower-calorie-dense foods. They’re often very high in nutrition.”

Getting off medication

“When you stick with a plan like Pritikin, you have a win-win situation. You’re not only losing the weight, you’re losing the medications,” adds Dr. Kenney.

“Here at the Pritikin Longevity Center, we’ve seen that most people with type 2 diabetes who have sufficient remaining beta-cell function are actually able to get off their diabetes meds.

“Bottom line: Insulin resistance is largely reversible with a healthy diet and exercise program provided it reduces calorie intake and leads to long-term weight control.”

Benefits of exercise

Getting into the habit of daily physical activity has also been found to reduce insulin resistance.

Of course, regular exercise also aids in the loss of body fat – and helps keep the weight off. In fact, one of the best predictors of long-term weight-loss success is a lifestyle that includes regular exercise.

Even if you regain the weight, keep trying

Yo-yoing? That’s okay. Keep at it.

“There is clear evidence that there is longer remission and better glucose control in people with type 2 diabetes who have lost weight and regained it compared to those who have never lost,” says Dr. Rifai.

“In short, it is better to have lost and regained than to have never lost at all.”

The sooner you get started, the better

In research3 on men and women with type 2 diabetes who came to the Pritikin Longevity Center, those who were most successful were those who arrived when they were first diagnosed with the disease, not those who waited till they’d had the disease for many years.

“The longer one continues treating type 2 diabetes with drugs while mostly ignoring what drives the disease process – excess body fat, excess calories, inactivity, and a lousy diet – the more rapidly the disease progresses. Beta cells are lost forever. It becomes more and more difficult to control blood glucose without drugs,” explains Dr. Kenney.

Beta cell burnout

To be sure, loss of beta cells happens to virtually everyone with type 2 diabetes. By the time people are diagnosed with the disease, many have already lost about half of their beta cells. It’s called beta cell burnout. Unfortunately, little evidence suggests that these burnt-out cells will ever function again.

“But with weight loss, you can maintain good functioning of the beta cells you still have,” encourages Dr. Kenney. “That’s why it’s so important to get started, now, with a healthy, weight-reducing program like Pritikin. Don’t wait.”

Summing Up | Can losing weight get rid of diabetes?

If you’ve been diagnosed with type 2 diabetes, there’s a good chance that adopting a program of low-calorie-dense eating and regular exercise, like the program taught at the Pritikin Longevity Center, will lower your blood sugar into healthy, normal ranges. That’s in large part due to the loss of insulin resistance.

When insulin resistance is in remission, blood sugar falls. When blood sugar falls, your need for medications falls.

In fact, research4 has shown that most people with type 2 diabetes who come to Pritikin on drugs for diabetes no longer need these drugs within 2 or 3 weeks, or their dosages have been dramatically reduced. Even some people who arrive using insulin shots no longer require them – or need less – upon their return home.

But always keep in mind that you’re susceptible to having your diabetes return.

The Pritikin Program protects you from that return. By sticking with a Pritikin lifestyle, you keep fat stores at bay, which keeps insulin resistance and diabetes at bay.

Living well

There’s more good news: With Pritikin living, you’re living well. You may never be able to say you’re completely rid of diabetes, but you sure feel as if you are.

Dr. William Pordy, a physician from New York City, knows that feeling. Several years ago, he arrived at Pritikin 60 pounds overweight and a type 2 diabetic. He shed that weight, and with it, his sky-high blood sugar numbers.

“Isn’t it terrific that at my age – I’m in my 60s – I actually turned my life around? Once you go to Pritikin, you learn, really learn, how to exercise and eat right. If I hadn’t gone to Pritikin, I wouldn’t have lost the weight, and I wouldn’t have gotten rid of my diabetes,” says Dr. Pordy.

“Oh sure, I’ll always be a type 2 diabetic, I’ll always need to live Pritikin-style to keep it under control, but that’s okay because I feel so good now. I’ve got energy. My brain functions better. My work functions better. Everything functions better. That’s why I can say I’ve gotten rid of my diabetes.

“I wouldn’t want to live any other way.”

Lose Weight at the Pritikin Weight-Loss Retreat

Take life to the next level, and be all that you can be. That’s what a vacation at Pritikin is all about. Live better. Look better. And best of all, feel better.

Sources

Losing Weight Can Have Big Impact on Those with Diabetes

December 14, 2012

Dear Mayo Clinic:

Can type 2 diabetes be cured just by losing weight?

Answer:

Losing weight can have a big impact on diabetes. Although it might not cure type 2 diabetes in every case, getting to a healthy body weight does have that potential for many people. Even if it doesn’t completely cure the disease, losing weight may make it possible for people with diabetes to take less medication. It often helps manage or prevent some of the health problems that can come with diabetes, too.

People who have diabetes have too much sugar in their blood. This happens because of a problem with the hormone called insulin. Insulin is made in the pancreas — a gland located just behind the stomach. When you eat, the pancreas releases insulin into your bloodstream. The insulin allows sugar to enter your cells, lowering the amount of sugar in your blood.

If you have type 2 diabetes, the pancreas does not make enough insulin or your body cannot use insulin as well as it should. So sugar cannot move into your cells. Instead, it builds up in your blood.

The reason why type 2 diabetes develops is not completely clear. But being overweight plays a role. In people who are overweight, the body sometimes needs as much as two to three times more insulin than it would if it was at a healthy weight. In those who develop diabetes, that is more insulin than the pancreas is able to produce.

When the pancreas tries to make that much insulin, it is pushed beyond its capacity and insulin-producing cells start to die. That makes the situation worse because the pancreas then has even fewer cells with which to make insulin. Compounding the problem, research also has shown that fat cells of people who are obese and who have more abdominal fat actually release molecules that can be harmful to the pancreas. So the more abdominal fat you have, the higher the risk of damage to your pancreas.

Getting to a lower weight reduces many of these problems. When you weigh less, your pancreas is better able to keep up with your body’s need for insulin. In some cases, weight loss is enough to restore blood sugar to a normal level, which eliminates diabetes. Even if it doesn’t get your blood sugar completely back to normal, it may lower your need for insulin therapy or other medications to control diabetes. It also lessens your risk for other serious complications of diabetes, including heart problems, kidney disease and nerve damage.

The benefits of healthy weight as it relates to diabetes continue over time, too. Many people mistakenly believe that a person’s risk for diabetes automatically goes up with age. In fact, your diabetes risk rises over time only if you gain weight and are less active as you age. For those who stay fit, the risk of developing diabetes remains the same or increases only slightly.

For those with a family history of diabetes, weight control is critical. Research has shown that people who have a family history of type 2 diabetes are more vulnerable to developing type 2 diabetes themselves. Staying at a healthy weight lowers their chances of getting the disease by about 70 to 90 percent.

In general, healthy weight is defined as a body mass index, or BMI, of 25 or lower. To get there, you don’t need to run marathons or do hours of workouts each day. But you do need to be active on a regular basis. If you are interested in losing weight, talk to your doctor about an exercise and diet program that best fits your needs.

— Robert Rizza, M.D., and Michael Jensen, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.

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