It’s well known that obesity increases the risk of health complications for the more than 25 million Americans with diabetes. And Barbara Murray, a dietician and counselor at the IU Health Diabetes Center in Bloomington, knows it can be difficult for diabetics and prediabetics to lose weight. “High-calorie food is available so easily now,” she says. “It’s easy to go to a restaurant, but it takes time to buy and prepare fresh foods.”

Murray works with diabetic and prediabetic patients who are referred to the center by their physicians. At the first visit, she will take a history of what the patient eats “and what they are willing to change about their lifestyle” in four areas: food, exercise, stress management, and medications.

It’s important for patients “to do some form of tracking their intake of food,” Murray says. “That helps them see certain triggers and make changes.” It’s also important, she says, because “studies show that most people underestimate their calorie intake.”

“We look at the high-fat foods in the diet and work to bring down the fat content,” Murray says. She encourages her patients to eat regular meals, including breakfast. “Don’t skip it, or you will overeat later.” And she advocates a greater intake of high-fiber foods, which “help you feel fuller with fewer calories” and can help lower blood sugar levels.

Exercise is the other significant factor in weight loss. Murray emphasizes the importance of doing some form of physical movement to burn calories and work on blood pressure control. “Start an easy walking program and gradually bump it up,” she recommends.

It’s also important to have social support while losing weight, “to be around people who are eating healthily.” The Diabetes Center offers a monthly support group; Murray and Tammy Morrison, a registered nurse, conduct a diabetes clinic at the Bloomington office of Volunteers in Medicine; and Morrison teaches a diabetes prevention class at the center.

A new area of study, Murray says, is the effect that sleep has on weight. A lack of adequate sleep can make it harder to manage stress, which, in turn, can lead to overeating. She urges patients to consult a physician if they experience sleep problems.

Murray notes that it’s harder to keep weight off than to lose it, and easy to fall back into old habits, especially under stress. “Relapse is part of the process,” she says. “It’s going to happen, but don’t give up; don’t develop negative thinking.” Rather, “have a plan for getting back on the program.”