By Robert F. Kushner, MD, as told to Alexandra Benisek
In the WebMD webinar “Diabesity: When You Have Diabetes and Obesity,” Robert F. Kushner, MD, answered viewer questions about diabesity treatment and management.
He’s medical director of Northwestern Center for Lifestyle Medicine in Chicago and a professor of medicine and medical education at Northwestern University’s Feinberg School of Medicine. He’s also a founder of the American Board of Obesity Medicine.
Are there doctors trained and certified to treat diabesity, or is that something all diabetes specialists can treat? What’s the best way to find diabesity specialists?
Diabesity is a new concept that combines the treatment of diabetes and obesity. While all endocrinologists are trained to treat diabetes, they may not be comfortable with the treatment of obesity.
I suggest you ask your doctor upfront about their ability to treat both medical problems.
You can also look into a group of doctors called diplomates of the American Board of Obesity Medicine. They’re certified in the treatment of obesity and its complications. You can find them in your area through the website www.abom.org.
Do Medicare and other insurance plans cover costs for diabetes drugs that lead to weight loss? Do they cover costs for weight loss surgery?
While Medicare doesn’t cover any FDA-approved obesity medications, it does cover diabetes medications that might help with weight loss, such as liraglutide (Saxenda, Victoza).
Many private insurers cover both obesity medications and diabetes medications. It’s best to ask your insurance company what medications are covered before you see your doctor.
Medicare and most private insurance companies cover bariatric (weight loss) surgery if you meet the criteria for that operation.
There are two main procedures that you might get for weight loss. The most common is called the gastric sleeve. In this one, about 80% of your stomach is taken out. This leaves you with a smaller stomach.
The second most common surgery is called the Roux-en-Y gastric bypass. For this procedure, your upper intestine is moved so that your stomach directly connects to your upper jejunum (the second part of your small intestine).
Both of these procedures can help a lot for weight loss and the improvement of your diabetes.
Besides my diabetes specialist, what other health care providers should be on my overall health care team for diabesity?
Diabesity treatment is best managed by a team. This includes a medical professional and a registered dietitian or nutritionist. A behavioral health psychologist may also be helpful when emotional eating or behavior change is a problem.
Can medications cause diabetes?
There are several categories of medications that can cause weight gain. The most common are some anti-diabetes drugs, some medications used to treat depression and other mental health conditions, and corticosteroids.
Along with weight gain, many people taking these medications might also develop insulin resistance and have a higher risk for diabetes.
What are negative side effects of new drugs like metformin (Glucophage, Riomet, Glumetza), Wegovy, and Mounjaro?
The most common side effects of these drugs are gastrointestinal issues. This may include nausea, diarrhea, constipation, vomiting, and heartburn. These side effects are usually mild and only last a short period during the early months, when your dose is being increased.
What do you recommend for those with lung impairments, advanced age, mobility problems, and other challenges to exercising?
Work closely with your medical professional for a lifestyle program that’s tailored to you. None of these issues should stop you from following a healthier lifestyle program.
Do you recommend artificial sweeteners and sugar-free foods for those with diabesity?
According to the American Diabetes Association (ADA), nonnutritive sweeteners don’t seem to have a significant effect on diabetes control. They can reduce your overall calorie and carbohydrate intake, as long as you don’t also have extra calories from other food sources.
But there’s mixed data for nonnutritive sweetener use in terms of weight management.
Is intermittent fasting helpful or hurtful when you have diabesity?
Many people find that intermittent fasting (IF), which basically is time-restricted eating, sets up limits to troublesome nighttime eating.
There’s good data that shows IF can be beneficial for weight loss and improvement in blood sugar levels. But if you’re taking insulin, and your blood sugar levels need to be carefully monitored, it’s important to work with your health care professional.
Always talk to your doctor before you start a new eating pattern like IF.
Do you recommend supplements for preventing diabesity? What about those who have diabesity?
I don't know of any strong data that suggests everyone should take a specific supplement. Because of this, we don't really recommend a vitamin, mineral, or supplement universally, for all people.
We talk more about lifestyle changes – like the foods that you eat, how you move your body, how you sleep, and how you deal with stress.
I only suggest supplements for specific reasons. You may need to take a supplement for gastrointestinal issues, malabsorption, or a lack of (or deficiency of) vitamin D or vitamin B12.
It is worth noting that when it comes to diabetes, long-term metformin use can cause some people to have low levels of vitamin B12. Be sure to talk to your doctor about whether you should have your vitamin B12 measured.
Watch a replay of the webinar “Diabesity: When You Have Diabetes and Obesity.”
Watch other free WebMD webinars by leading experts on a variety of health topics.
