The current dietary principles recommended by ADA are the same as those of the American Heart Association (AHA). The caloric content should be that which will permit a patient with type 2 diabetes to attain a body mass index (BMI) of 25 kg/m2. With gender, height, weight, and age known, the basal daily caloric requirement and the desired weight can be obtained from standard online calculators. A simpler method, for patients with routine and not intensely physical activities, is to estimate the daily caloric expenditure by multiplying the ideal weight in kilograms by 30 calories/kg. Weight loss can be safely achieved if the patient is taught how to reduce caloric intake by 100 calories per day for each 10 pounds of desired weight loss over 1 year. National Institutes of Health guidelines advocate that weight changes be methodically accomplished over long periods. This will preclude acute energy shifts that could cause gallstones, gout, and depression and have 95% likelihood of recidivism. The guidelines suggest a weight loss goal of 7%, usually rounded to 10%, per year until the patient attains ideal BMI. For example, for a patient with type 2 diabetes weighing 200 pounds, the advice should be to lose 20 pounds in 1 year by reducing dietary caloric intake by 200 calories per day and/or increasing energy expenditure by that amount.
If a new and reduced weight set point is achieved in the central nervous system, longitudinal studies have shown a reduction in the progression of prediabetes, which confirms widespread clinical experience that the weight loss has a reversal effect on type 2 diabetes.
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