Aiming to be fit and thin (if possible)

As your body weight increases, so does your risk of dying from heart disease or developing type 2 diabetes. However, the more physically fit you are, the lower your risk of dying from any cause is — even if you’re overweight.

Although being fit and thin is still best for your health and life span, being fit and fat is healthier than being thin and unfit. In other words, you can gain extra fat and reduce your risk of developing health problems by being regularly active. Being overweight or obese and being physically unfit are stand-alone risk factors for heart disease, early death, and type 2 diabetes. So if you can’t lose weight, then get fit.

Recognizing that where you store your fat matters

When you store fat just in fat cells (particularly just under the skin, as subcutaneous fat), you aren’t likely to have as many health problems compared to when your body puts it in other places. If you store most of your fat in your hips (making you pear-shaped), you may be perfectly healthy, metabolically speaking. Being shaped more like an apple with fat around your middle, however, can be the indicator of many problems with your metabolism — and health issues in your future if you don’t do what you can to prevent them with changes in your lifestyle.

Preventing type 2 diabetes with activity

Regardless of how much weight you lose or don’t lose by being active, being regularly active can prevent you from developing type 2 diabetes in the first place or reverse prediabetes. Losing weight can also help manage diabetes in people, regardless of what type they have.

The Diabetes Prevention Program (a lifestyle management program designed to prevent type 2 diabetes) study found that weight loss is most directly associated with lower risk of getting type 2. But in the study, participants’ weight loss was predicted by how much exercise they did daily, and only the ones who continued to exercise around 60 minutes a day — most just by walking — after the study ended maintained their new, lower body weights. The rest who were sedentary gained most or all the weight back over time.

Choosing aerobic and resistance workouts

Remember, you can become more fit regardless of your body weight. You can also gain almost all the health benefits of having a higher fitness level without struggling to lose weight and keep it off. Both moderate aerobic exercise and resistance training help you lose belly (visceral) fat that dieting alone can’t. (I discuss these kinds of exercises in Chapters 10 and 11, respectively.)

Both aerobic and resistance training are more effective at helping you lose visceral fat than dieting alone. Research examined how improving lifestyle habits helped obese people with too much of this inside-the-belly fat. Though exercising helped them get rid of more of this bad fat, having a healthier diet also kept their insulin working better, showing that making both changes at once is beneficial. Another study showed that doing interval training while cutting back on carbohydrates and eating fewer calories for two weeks ensures that you lose the unhealthy visceral fat from inside your abdominal region while keeping more muscle.

Try to keep your muscle and gain more with resistance training to boost your metabolism, lower your blood glucose, and prevent gaining back the pounds you lost.

Giving your backside a break

How can you get more active when you’re sedentary and overweight? Most activities are possible, but ease into being more active by taking small steps in that direction. It’s not a race to the finish; you’re just trying to establish a lifetime habit of being more active.

• Stand up whenever possible. Burn calories by standing as much as you can every day. Stand up when talking on the phone at work or home. Have standing meetings at work. Get a standing desk. Encourage others to stand with you.
• Move more all day long. Make a habit of moving as much as you can throughout the day. Even if you find it challenging to fit in regular workouts at a gym or prolonged and continuous walks or other activities, you can get more fit and lose weight by staying as active as you can every day doing any physical movement. That includes standing, fidgeting, taking more daily steps, stretching, pacing in your office, walking the dog, and much more.
• Break up sedentary time. Even just getting up from a sitting activity at least once or twice an hour for a few minutes boosts your metabolism and prevents insulin resistance regardless of whether you have diabetes. Everyone needs to avoid sitting for long periods of time. What you do when you get up doesn’t have to be strenuous or prolonged; it just needs to occur frequently. Stand up, walk around at any speed, do a few leg bends, or stretch for two to five minutes before sitting back down.

Starting out slowly but steadily

Getting active with extra body weight is all about starting out slowly and progressing slowly for the best results. You want to get fit and possibly lose some weight along the way. It’s possible if you go about it the right way.

• Begin with lower impact activities. Do activities that don’t require you to carry around your full body weight, such as swimming, classes in a swimming pool, seated exercises, stationary cycling, stretching, and light resistance training. Extra fat stored under the skin acts to insulate you and keep you warmer in the pool, where you lose body heat faster than in air. Just walking or moving in the water is a good choice. Additionally, the water helps hide your figure, if that’s a concern for you, and may lower your resistance to exercising in public. Seated exercises or stationary cycling also reduce stress on your lower limb joints.
• Work your way up to doing more. One of the main reasons people drop out of exercise programs is that they start out working out too hard, which can cause injuries. Don’t push yourself as hard as a cast member on The Biggest Loser, or you’re likely to get sidelined by an injury or just lose interest. Do continue to move forward with what you’re doing, though, and progress to other activities and to doing them at a higher level to get more fit.

Picking activities you enjoy

As with all things, if you enjoy doing something, you’re more likely to continue doing it over time. This concept is critically important with physical activities and even more so if you’re trying to manage your weight. If you hate doing an activity, eventually you come up with one excuse or another to stop. When you’re packing some extra weight, doing any activity can feel harder than it might be when you’ve lost a few pounds.

Most people quit before they start enjoying an activity. Nothing is quite as important to establishing an active lifestyle as choosing activities to do that you find to be enjoyable or fun.

Join others to do physical activities with you as well to make them social events to enhance your enjoyment. You can help them all get thinner, too.

Working out with arthritic joints

Start with basic range-of-motion exercises (including stretching) to increase your joint mobility. Later you can include specific resistance exercises that strengthen the muscles surrounding your affected joints. Doing so also helps you maintain your leg strength, which is critical to basic movements like getting up out of a chair, climbing stairs, and walking.

Doing moderate aerobic activity that is weight-bearing (like walking) can reduce arthritis pain in hips and knees. If you have arthritic knees or hips and don’t enjoy walking because it’s too uncomfortable or painful, you can choose to do non-weight-bearing activities instead.

If you have arthritis in your lower extremities, also consider the following options:

• Easy or moderate workouts rather than vigorous ones
• Varied activities from day to day to avoid overstressing joints in the same way each time
• Warm-ups and cool-downs to keep joints more limber
• Some weight loss to take stress off your painful joints
• Activities that don’t make you carry your weight, such as swimming, aquatic exercises, cycling, and seated workouts

You may also want to seek out a physical therapist, athletic trainer, personal trainer, or other fitness professional to help you design an exercise program specific to your needs.

Your buoyancy in water takes the strain off painful joints so you can move them more fluidly. Swimming and aquatic classes (like water aerobics) in either shallow or deep water are both appropriate and challenging activities to improve joint mobility, overall strength, and aerobic fitness. You may also want to try walking in a pool (with or without a flotation belt around your waist).

Managing discomfort or pain

After exercising, you may want to apply ice to your joints (particularly your knees) for 15 to 20 minutes to reduce swelling and help prevent undue soreness. In addition, consider taking nonsteroidal anti-inflammatory medications (NSAIDs) like aspirin or ibuprofen to lessen any residual discomfort, but avoid taking them if your kidneys are not working well. Check with your doctor if your arthritis pain becomes worse over time, and avoid activities that feel like they make your joints more painful.

Avoiding other joint issues

Having diabetes increases your risk of experiencing joint-related injuries and overuse problems like tendinitis. Choosing a more moderate exercise like walking rather than jogging or running may be prudent to reduce the potential for joint trauma.

Diabetic frozen shoulder, trigger finger, and other acute joint problems can also come on with no warning and for no apparent reason, even if you exercise regularly and moderately, and they may recur more easily as well. You may benefit from the expert help of a physical therapist if you develop any of these issues.

The best defense against injuries is good blood glucose control, along with flexibility exercises (see Chapter 13) and doing cross-training (Chapter 14).

Losing some weight along the way

Going on a diet to lose weight isn’t the best long-term solution to managing your body weight or reducing your diabetes risk. Even though you can lose weight on a diet, dieting doesn’t work for most people. It becomes progressively harder to lose weight the longer you stay on a diet, which makes it harder for you to stay motivated to follow it. Consequently, many people give up after they’ve been on a diet for a while, and they fail to meet their target weight loss.

So how can you lose weight? The best way is slowly, over time, accomplished by doing physical activities and cutting back on your calories by a small amount. You won’t even realize that you’re “dieting” while you’re doing it. Just don’t diet or severely restrict your calories without being active, or you’ll lose too much of your muscle and likely eventually end up fatter than you were before. Consider consulting with a registered dietitian to set up an individualized, weight-reducing meal plan for you.

If you must choose between dieting and exercising to lose weight, always choose being active, even if that makes you lose weight more slowly.

Keep in mind that what you normally weigh can change gradually over your lifetime. But your body has a preferred weight, and when you try to change that quickly by dieting, your body resists the effort to keep it off. If you do daily physical activity while you’re losing weight and after, you’ll be less likely to gain fat back later because you keep more muscle.

Keeping the weight off

The biggest problem with dieting without exercise is that even if you do lose some weight, you’re not likely to keep off it. More than 90 percent of dieters who have successfully lost weight ultimately regain the pounds they struggled to lose. If you go back to eating the same foods that you ate prior to your weight loss, you are likely to return to your previous weight

Most people gain back even more than they lost, regardless of the diet they followed. And you may end up fatter than you started before you lose weight.

Regaining the weight is probably even worse for your health than never losing it in the first place. A greater percentage of the weight you gain back is fat (unless you’re exercising a whole lot and gaining muscle). In most cases, you end up with more total body fat than if you had never lost any weight, even if your weight only goes back to your pre-diet level. In other words, you ultimately end up even fatter from dieting.

Dodging weight gain from insulin use

Why is using insulin sometimes associated with weight gain? On insulin, your blood glucose is (usually) in a tighter range, and you stop losing some calories as glucose in your urine. You may also gain weight from having to eat extra to treat any lows caused by using insulin.

Lifestyle changes, such as cutting back on refined carbohydrates that require larger doses of insulin to cover them and exercising regularly, are likely your best bets to counteract any potential weight gain caused by insulin use.

Adjusting other diabetes medications to lose weight

Even when you begin exercising more, your non-insulin medications may be working against your ability to lose weight. Focus on reducing diabetes medications that contribute to weight gain and replacing them (if needed) with ones that are weight-friendly — that is, they don’t affect body weight, they help with weight loss, or they cause less weight gain. Table 15-2 shows both categories of medications; you can read more about each type of medication in Chapter 3.

To change any of your medications to more weight-friendly ones, consult directly with your health care provider for help with making appropriate adjustments.