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HEALTH FIRST Diabetes, Obesity, & Mortality: A Patient’s Perspective Steve Hirsch, MD.

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Presentation on theme: "HEALTH FIRST Diabetes, Obesity, & Mortality: A Patient’s Perspective Steve Hirsch, MD."— Presentation transcript:

1 HEALTH FIRST Diabetes, Obesity, & Mortality: A Patient’s Perspective Steve Hirsch, MD

2 Obesity: What are the risks? Overweight/Obese Patients: What diseases are they at risk for? Pre-Diabetes, Type 2 Diabetes Heart Disease, High Blood Pressure, Stroke High Cholesterol Osteoarthritis, leading to hip/knee replacement Cancers (Esophageal, Pancreatic, Colon & Rectal, Kidney, Gall Bladder, Thyroid, Breast, Uterine) Dementia related to Diabetes

3 Diabetes and Pre Diabetes Prevalence Diabetes 20.1 million Americans (20 & older) Prevalence Pre Diabetes 86 million Americans (20 & older) Deaths 7 th leading cause of death American Diabetes Association, 2012

4 Diabetes Complications Hypertension: 71% High Cholesterol: 65% Heart Attack: 1.8 times the risk Stroke: 1.5 times the risk Diabetic Retinopathy that can lead to Blindness: 21% (of those age 40+) American Diabetes Association, 2012

5 So much of the focus is on INCIDENCE of Diabetes….. And not enough on PREVENTION!!!

6 Studies show that…. A healthy weight reduces the risk of diabetes by 90% “Apart from Lung Cancer, Diabetes is the only other disease that can almost be eliminated with a simple lifestyle change.” Walter Willett, Professor, Harvard School of Public Health

7 So many fad diets that don’t work over the long term… Popular due to promise of instant gratification, but not sustainable 3 Day Diet Not sustainable, but continues to fall in and out of favour Cabbage Soup Diet Ingesting tape worms is not only extreme, it’s dangerous Tape Worm Diet

8 Diabetes/Pre Diabetes: How do you decrease the risk? Weight Loss Making healthier choices Exercise

9 Mindfulness: Making Conscious Choices Think before you eat Stick to your budget Try to avoid mindless and emotional eating

10 Mr. G 65 year old male, non-smoker….initial visit July 2013 Weight240 lbs Height5’11” BMI33.5 (BMI: 30-34.9 = Class 1 Obesity) Blood Sugar131 mg/dl (7.3 mmol/l) (Diabetes: >126 (7.0) ) Blood Pressure130/85 Total Cholesterol225 mg/dl (5.82 mmol/l) LDL (bad) cholesterol 141 mg/dl (3.65 mmol/l) HDL (good) cholesterol 48.7 mg/dl (1.26 mmol/l)

11 Your turn….

12 After 5 months on the HEALTH FIRST Program™ Baseline July 26, 2013 November 8, 2013 (at 4 months, 35 lb loss) Weight 240205 BMI 33.528.6 Blood Sugar 131 (7.3)90 (5.0) Total Cholesterol 225 (5.82)175 (4.53) LDL (bad) cholesterol 141 (3.65)92.8 (2.4) HDL (good) cholesterol 48.7 (1.26) 55.6 (1.44) 55 lb Weight Loss!

13 Your turn again….

14 The Key to Success: A Program that Works

15 Health First Food Groups

16 Starches (Cereal, Bread, Rice, Potatoes, Pasta,Crackers, Couscous) 16 Must be whole grain, or whole wheat, or brown rice. No white bread, white flour or white rice. 1 portion (size of your palm) 3 portions/day (female) 4 portions/day (male) Cereal Whole grain only HINT: Add real fruit to sweeten naturally WARNING: Read box labels. Select brands that are low in sugar

17 Starches (Cereal, Bread, Rice, Potatoes, Pasta, Crackers, Couscous) Bread Whole grain only CAUTION: A standard slice of bread is 4” x 4.5” x ¾” thick….many slices are double this size! Rice Brown or Wild Rice only 1 portion = size of your palm (about ½ cup)

18 Starches (Cereal, Bread, Rice, Potatoes, Pasta, Crackers, Couscous) Potatoes Enjoy white or sweet potatoes Pasta Whole wheat pasta only Remember…1 portion = size of your palm (about ½ cup)

19 3 portions of meat / week 1 portion = 6 oz (170 g) AVOID all processed meats such as sausage, bacon, smoked meat, corned beef, ham, pepperoni, salami, bologna, hot dogs

20 Unlimited portions of unprocessed, skinless chicken & turkey per week Favour white meat over dark, always skinless Avoid fried poultry

21 Fish and Shellfish 3 portions / week 1 portion = 6 oz (170 g) Avoid fried fish Shellfish may be 1 of 3 fish portions per week

22 Vegetables Unlimited – as much as you can eat Seek lots of variety Remember…Potatoes are a starch

23 Fruit 1 portion = palm size 4 portions per day Seek out a wide variety Avoid fruit juices No syrup, sugar or sweeteners added Use fruit strategically

24 Milk, Yogurt & Milk Alternatives 3 portions per day 1 portion of milk = 8 oz (250 mls) 1 portion of yogurt = ¾ cup (190 ml) Yogurt, plain, 1% or 0% fat Milk, 1% or 0% fat Substitute soy or almond milk, as desired

25 Cheese 3 portions per week 1 portion = 1.5 0z (42.5 g) Count cheese included in other dishes

26 Eggs 4 whole eggs a week Count eggs in dishes and baked goods

27 Legumes (Beans, peas, lentils, soybeans) Up to 1 cup per day

28 Healthy Snacking: 4 x per day Vegetables: “Tons” Fruit: but only 4 portions per day Nuts & Olives: a handful daily Seeds: a handful daily Cheese: 1 of your 3 weekly portions

29 Recommended Snack Times Breakfast Lunch Dinner 1 st Snack Mid- morning 2 nd Snack Mid- afternoon 3 rd Snack ½ hour before dinner 4 th Snack Evening

30 Alcohol: Yes, but not too much! Females: Up to 4 drinks/week Males: Up to 7 drinks/week 1 drink = 1.5 oz of liquor = 12 oz of beer = 5 oz of wine

31 The Table of 3’s and 4’s 3 Portions per week 4 Portions per week 3 Portions per day 4 Portions per day Unlimited Servings MeatEggs Milk, Yogurt, Milk Alternatives FruitVegetables FishStarch (Females) Starch (Males) Poultry Cheese

32 The App

33 Patient Story: Enjoying Compliments Sal, a 36 year old, school teacher who came with complaint of feeling sluggish BMI of 33 (Class 1 Obesity), Waist Circumference of 44”, High Blood Pressure (150/100), LDL elevated Discussed options: wanted lifestyle program rather than meds to lower blood pressure and cholesterol

34 Your turn….

35 Patient Story: Enjoying Compliments Sal, a 36 year old, school teacher who came with complaint of feeling sluggish

36 “This program is so easy to follow: I never feel like I am on a diet, and I am never hungry. I’m very focused on what I eat and drink. I quickly realized that I was drinking too much alcohol, and eating way too many starches. Since I’ve lost the 40 lbs, I no longer feel sluggish, I have tons of energy, and I also like the compliments that I’m getting about how great I look. Keeping the weight off is also easy with the maintenance program that I now follow. Physical activity and exercise is now just a part of my life.”

37 Sugars: More Sinister Than You Think The average American (& Canadians are not that far behind) consumes 90 lbs of sugar per year. How do you limit your sugar consumption? Read labels Avoid soft drinks Avoid fruit juices, even the unsweetened varieties Avoid yogurt with added fruit Avoid sugary breakfast cereals Avoid processed and packaged foods; pastries, cookies, buns, pies, ice cream

38 Reading Labels: Sugar: Bottle of Cola 17.5

39 Reading Labels: Sugar: Green Tea Commercially available Green Tea can be a real sugar trap! 99 Teaspoons of Sugar

40 Reading Labels: Sugar: Cereal Many cereal boxes state: “Protein and fibre, all natural” Label: Sugar: 13 grams of sugar per serving Serving size: ¾ bowl So….in a full bowl: 16.25 grams of sugar = 4 teaspoons of sugar!

41 The Power of Moving: Physical Activity & Exercise

42 Stairs, not escalators Don’t use a drive-thru Park far from stores Get off subway at an earlier stop Go for a walk at lunch

43 The Power of Moving: Physical Activity & Exercise




47 Keys to Remember Weigh yourself every Monday morning Ideal weight loss is 2 lbs/week; 1 lb is OK… Be positive Be mindful Review the diet components every day Practice good eating habits always Physical activity (10,000 steps) Cardio exercise: 3-4x/wk, 30-45 min

48 In Conclusion… HEALTH FIRST Program™….reduces your risk for many diseases Portion size matters! Smaller is healthier, bigger is not better Life is not a dress rehearsal….better health and wellness is achievable!!!

49 Thank you for staying awake!

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