Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies
A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
- Samuel Klein, MD1,
- Nancy F. Sheard, SCD, RD2,
- Xavier Pi-Sunyer, MD, MPH3,
- Anne Daly, MS, RD, BC-ADM, CDE4,
- Judith Wylie-Rosett, EDD, RD5,
- Karmeen Kulkarni, MS, RD, BC-ADM, CDE6 and
- Nathaniel G. Clark, MD, MS, RD7
- 1Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri
- 2Department of Family Practice, University of Vermont, Burlington, Vermont
- 3Division of Endocrinology, Diabetes and Nutrition, St. Luke’s–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
- 4Springfield Diabetes & Endocrine Center, Springfield, Illinois
- 5Division of Health, Behavior and Nutrition, Albert Einstein College of Medicine, Bronx, New York
- 6St. Mark’s Diabetes Center, Salt Lake City, Utah
- 7American Diabetes Association, Alexandria, Virginia
- Address correspondence and reprint requests to Nathaniel G. Clark, MD, MS, RD, American Diabetes Association, 1701 N. Beauregard St., Alexandria, VA 22311. E-mail: nclark{at}diabetes.org
The prevalence of diabetes in the U.S. continues to rise by epidemic proportions. This increase parallels the rising rates of obesity and overweight observed over the past decade (1,2). Indeed, as BMI increases, the risk of developing type 2 diabetes increases in a “dose-dependent” manner (3,4). The prevalence of type 2 diabetes is 3–7 times higher in obese than in normal-weight adults, and those with a BMI >35 kg/m2 are 20 times more likely to develop diabetes than those with a BMI between 18.5 and 24.9 kg/m2 (5,6). In addition, weight gain during adulthood is also directly correlated with an increased risk of type 2 diabetes (3,7–9).
Obesity also complicates the management of type 2 diabetes by increasing insulin resistance and blood glucose concentrations (10). It is an independent risk factor for dyslipidemia, hypertension, and cardiovascular disease (6,11–14) and, thus, increases the risk of cardiovascular complications and cardiovascular mortality in patients with type 2 diabetes (15).
The purpose of this statement is to review the important role of weight management in the prevention and management of type 2 diabetes and to describe strategies for achieving and maintaining a healthy body weight through lifestyle modification. The use of weight loss medications and bariatric surgery in the management of obesity will not be discussed in this document. Pharmacotherapy can be a useful adjunct to lifestyle modification in the long-term management of obesity in selected patients (16). Weight loss medications may be considered for those with a BMI ≥30 or those with a BMI ≥27 plus obesity-related comorbid conditions. Weight loss surgery may be a therapeutic alternative for patients with a BMI ≥40 or a BMI ≥35 plus comorbid conditions (16). Comprehensive review articles that …
