ADA Throws Its Weight Behind Obesity Issue in New Guidelines

LOS ANGELES — Primary prevention of diabetes begins with the prevention of obesity, as well as maintaining the ABCs of normal metabolism: hemoglobin A_1c, blood pressure, and cholesterol, according to new nutrition guidelines from the American Diabetes Association.

Judith Wylie-Rosett, Ed.D., offered a sneak preview of the new guidelines at the annual meeting of the American Association of Diabetes Educators.

The guidelines, which will be published in this month's issue of Diabetes Care, are intended to complement recent nutrition guidelines by the American Heart Association (Circulation 2006;114:82–96).

The guidelines share a focus on obesity, said Dr. Wylie-Rosett, professor of epidemiology and population health at the Albert Einstein College of Medicine in New York. Both guidelines stop short of offering advice on specific nutrients that are thought to prevent disease.

In the diabetes guidelines, available evidence is ranked according to whether it is backed up by well-conducted, generalizable, randomized or multicenter trials (level A evidence), by well-controlled cohort studies or metaanalyses (level B evidence), or, less powerfully, by supportive data (level C) or expert opinion (level D).

The strongest evidence (level A) was cited for the importance of monitoring carbohydrate intake as “a key strategy in achieving glycemic control,” and the fact that “sucrose-containing foods can be substituted for other carbohydrates in the meal plan, or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Fiber and protein are encouraged, but the guidelines note that evidence is lacking on whether people with diabetes need to modify the intake of these food sources beyond what is recommended for healthy adults.

In terms of structure, the diabetes guidelines break down into evidence addressing obesity, prediabetes, overt diabetes, and diabetes complications. For example, the guidelines cite level B evidence for the use of weight loss medications, which “may be useful in overweight/obese individuals with type 2 diabetes” for achieving a 5%–10% weight loss when combined with lifestyle change.

In general, the guidelines advise the limitation of food choices “only to the extent that we have evidence that it will be of benefit,” said Dr. Wylie-Rosett.

The guidelines also lend strong credence to the safety of sugar alcohols and nonnutritive sweeteners within Food and Drug Administration-recommended daily intake levels.

Dr. Wylie-Rosett said in an interview that the ADA is increasingly stressing the potential importance of the contribution of sugar, especially sugary beverages, to overall calorie intake. However, the new guidelines do not recommend low carbohydrate diets (less than 130 g).

“Although such diets produce short-term weight loss, maintenance of weight loss is similar to that from low-fat diets, and impact on cardiovascular disease risk is unknown,” they state, citing level B evidence.

LOS ANGELES — Primary prevention of diabetes begins with the prevention of obesity, as well as maintaining the ABCs of normal metabolism: hemoglobin A_1c, blood pressure, and cholesterol, according to new nutrition guidelines from the American Diabetes Association.

Judith Wylie-Rosett, Ed.D., offered a sneak preview of the new guidelines at the annual meeting of the American Association of Diabetes Educators.

The guidelines, which will be published in this month's issue of Diabetes Care, are intended to complement recent nutrition guidelines by the American Heart Association (Circulation 2006;114:82–96).

The guidelines share a focus on obesity, said Dr. Wylie-Rosett, professor of epidemiology and population health at the Albert Einstein College of Medicine in New York. Both guidelines stop short of offering advice on specific nutrients that are thought to prevent disease.

In the diabetes guidelines, available evidence is ranked according to whether it is backed up by well-conducted, generalizable, randomized or multicenter trials (level A evidence), by well-controlled cohort studies or metaanalyses (level B evidence), or, less powerfully, by supportive data (level C) or expert opinion (level D).

The strongest evidence (level A) was cited for the importance of monitoring carbohydrate intake as “a key strategy in achieving glycemic control,” and the fact that “sucrose-containing foods can be substituted for other carbohydrates in the meal plan, or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Fiber and protein are encouraged, but the guidelines note that evidence is lacking on whether people with diabetes need to modify the intake of these food sources beyond what is recommended for healthy adults.

In terms of structure, the diabetes guidelines break down into evidence addressing obesity, prediabetes, overt diabetes, and diabetes complications. For example, the guidelines cite level B evidence for the use of weight loss medications, which “may be useful in overweight/obese individuals with type 2 diabetes” for achieving a 5%–10% weight loss when combined with lifestyle change.

In general, the guidelines advise the limitation of food choices “only to the extent that we have evidence that it will be of benefit,” said Dr. Wylie-Rosett.

The guidelines also lend strong credence to the safety of sugar alcohols and nonnutritive sweeteners within Food and Drug Administration-recommended daily intake levels.

Dr. Wylie-Rosett said in an interview that the ADA is increasingly stressing the potential importance of the contribution of sugar, especially sugary beverages, to overall calorie intake. However, the new guidelines do not recommend low carbohydrate diets (less than 130 g).

“Although such diets produce short-term weight loss, maintenance of weight loss is similar to that from low-fat diets, and impact on cardiovascular disease risk is unknown,” they state, citing level B evidence.

LOS ANGELES — Primary prevention of diabetes begins with the prevention of obesity, as well as maintaining the ABCs of normal metabolism: hemoglobin A_1c, blood pressure, and cholesterol, according to new nutrition guidelines from the American Diabetes Association.

Judith Wylie-Rosett, Ed.D., offered a sneak preview of the new guidelines at the annual meeting of the American Association of Diabetes Educators.

The guidelines, which will be published in this month's issue of Diabetes Care, are intended to complement recent nutrition guidelines by the American Heart Association (Circulation 2006;114:82–96).

The guidelines share a focus on obesity, said Dr. Wylie-Rosett, professor of epidemiology and population health at the Albert Einstein College of Medicine in New York. Both guidelines stop short of offering advice on specific nutrients that are thought to prevent disease.

In the diabetes guidelines, available evidence is ranked according to whether it is backed up by well-conducted, generalizable, randomized or multicenter trials (level A evidence), by well-controlled cohort studies or metaanalyses (level B evidence), or, less powerfully, by supportive data (level C) or expert opinion (level D).

The strongest evidence (level A) was cited for the importance of monitoring carbohydrate intake as “a key strategy in achieving glycemic control,” and the fact that “sucrose-containing foods can be substituted for other carbohydrates in the meal plan, or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Fiber and protein are encouraged, but the guidelines note that evidence is lacking on whether people with diabetes need to modify the intake of these food sources beyond what is recommended for healthy adults.

In terms of structure, the diabetes guidelines break down into evidence addressing obesity, prediabetes, overt diabetes, and diabetes complications. For example, the guidelines cite level B evidence for the use of weight loss medications, which “may be useful in overweight/obese individuals with type 2 diabetes” for achieving a 5%–10% weight loss when combined with lifestyle change.

In general, the guidelines advise the limitation of food choices “only to the extent that we have evidence that it will be of benefit,” said Dr. Wylie-Rosett.

The guidelines also lend strong credence to the safety of sugar alcohols and nonnutritive sweeteners within Food and Drug Administration-recommended daily intake levels.

Dr. Wylie-Rosett said in an interview that the ADA is increasingly stressing the potential importance of the contribution of sugar, especially sugary beverages, to overall calorie intake. However, the new guidelines do not recommend low carbohydrate diets (less than 130 g).

“Although such diets produce short-term weight loss, maintenance of weight loss is similar to that from low-fat diets, and impact on cardiovascular disease risk is unknown,” they state, citing level B evidence.