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Meal Plans: Which is Better?

Meal planning will help you get better blood glucose control. Which of the many meal planning tools is best for you?

A study done at Grady Health System Diabetes Clinic in Atlanta compared two meal planning systems: one based on exchanges, and one based on healthy food choices.

At Grady, patients are cared for by diabetes teams: nurses, dietitians, podiatrists, and endocrinologists. Patients with type 2 diabetes who do not have symptoms of high blood glucose (for example, thirst or frequent urination) stop taking or reduce their doses of diabetes pills for two months, to see how they do with a regimen of diet and exercise. Each patient is scheduled to see a dietitian at the first visit (for about an hour) and has return visits at 1, 2, and 3 weeks, and 2, 4, and 6 months (each lasting about 30 minutes).

For this study, 648 patients were recruited at their first visit. The average age was 52 years, 90 percent were African American, 65 percent were women, 78 percent were obese. Average A1C was 9.4 percent (goal is under 7 percent).

About half were assigned to the group that would learn exchanges, with an emphasis on weight loss. Those who were obese were given meal plans that were 500 calories less than what would maintain their weight.

The others were assigned to learn about healthy food choices, without an emphasis on weight loss. They used the Diabetes Food Pyramid. They were taught to limit fats, especially saturated fats, and sweets. Portion sizes were not discussed.

Results

Both groups showed similar improvement in blood glucose control. Average A1C dropped to 7.7 percent in the exchange group, and to 7.8 percent in the healthy food choices group.

At six months, 41 percent of the exchange group and 32 percent of the healthy food choices group had reached the goal of an A1C of under 7 percent.

About half of the obese people in each meal planning group lost weight. (Weight change was documented for the 275 people who were obese who returned for the 2-month follow-up, and the 155 of those who also returned for the 4- and 6-month follow-ups.)

Overall, counting obese and non-obese subjects, 60 percent of the exchange group and 45 percent of the healthy food choices group gained weight.

Easy

So it seems the two meal plans are running about even. But one pulls ahead when the researchers write: "...patients reported anecdotally that the healthy food choices meal plan was easy to understand...the dietitians reported anecdotally that the healthy food choices meal plan was easier to teach."

Easy to teach and learn...leads to better blood glucose control... The folks at Grady are convinced: "As a result of this study, providers in the Grady Diabetes Clinic continue to use the exchange meal plan for those patients who desire a focus on food exchanges and portion sizes as a strategy to lose weight, but instruction in healthy food choices without an emphasis on weight loss has become the standard approach to meal planning for all other patients."

Action Item:

If you've been taught a meal plan based on exchanges and find it confusing or too structured, or you've been taught some other meal planning tool that isn't working for you, ask your dietitian about other approaches.

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