Energy Balance And Body Weight

Obesity is recognised as a leading cause of insulin resistance (21). It therefore contributes to the development of Type 2 diabetes. This is particularly true for a central distribution of body fat, associated with a range of metabolic disturbances. Weight management is crucial in controlling blood glucose levels in people with Type 2 diabetes, although from UKPDS there is evidence that to normalise glucose tolerance usually requires major weight loss. Studies suggest that at least 80% of newly diagnosed patients with Type 2 diabetes are overweight and weight loss in people with Type 2 diabetes who are overweight increases life expectancy. Obesity is an additional risk factor for coronary heart disease and stroke. All cardiac risk factors (glycaemia, hypertension, lipids) are improved with weight management (22). This is true for individuals with Type 1 diabetes as well as Type 2 diabetes. However, it is also important to make sure that energy requirements are adequate in children and adolescents with Type 1 diabetes.

Dietary strategies for weight management should be based on realistic target weights. Assessment of target weights and the appropriate level of energy

Table 1.1

Age range (yr)

BMR (kcal/day)

Activity level

24-h Energy expenditure (kcal/day)

Men

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