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From Research to Practice

Beyond “Just Eat Less, Exercise More”: Obesity Treatment in Patients With Type 2 Diabetes

  1. Scott Kahan
  1. Department of Health Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and George Washington University School of Medicine, Washington, DC
  1. Corresponding author: Scott Kahan, kahan{at}gwu.edu
Diabetes Spectrum 2017 Nov; 30(4): 234-235. https://doi.org/10.2337/ds17-0062
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Obesity and diabetes prevalence rates continue to rise nearly in parallel and are inextricably linked. Nearly 40% of American adults have obesity, and nearly 15% have diabetes.

Obesity is perhaps the strongest risk factor and contributor to type 2 diabetes. Approximately 90% of patients with type 2 diabetes have a BMI >25 kg/m2 (1). The risk of type 2 diabetes increases geometrically with increasing BMI, and patients with a BMI >35 kg/m2 have as much as a 93 times increased risk for developing diabetes (2). In addition to the increased risk for diabetes, weight gain and obesity increase the likelihood of developing microvascular, neuropathic, and cardiovascular complications of diabetes.

In turn, patients with type 2 diabetes consistently achieve less weight loss than those without diabetes, given the same weight loss intervention. Weight gain is also an important potential side effect of most common diabetes medications, including sulfonylureas and insulin, among others. Patients with type 2 diabetes are at risk of a vicious circle of increasing weight and worsening insulin resistance, requiring further intensification of glycemic treatment, resulting in additional weight gain. It is essential to address weight gain and obesity in patients with type 2 diabetes.

Fortunately, even extremely small weight losses improve glycemic control, and moderate weight loss often prevents or ameliorates type 2 diabetes (3). Weight loss of as little as 3–5% body weight begins to improve insulin action and glycemic control and reduces the need for diabetes medications. A 7% weight loss has been shown to decrease the risk for type 2 diabetes by 58%, even if much of the weight is regained (4). Obesity treatment with moderate-intensity lifestyle counseling and obesity pharmacotherapy can decrease the risk for diabetes by as much as 90% (5,6). Bariatric surgery for obesity can resolve type 2 diabetes virtually overnight in some cases, and it has been recommended as a primary diabetes treatment, even in the absence of significant obesity (7).

In this Diabetes Spectrum From Research to Practice section, we review the management of obesity in patients with type 2 diabetes, including information on epidemiology, pathophysiology, diagnostic considerations, treatment options, and team-based care. We include up-to-date reviews of obesity pharmacotherapy for patients with type 2 diabetes, recently approved medical devices for obesity, and bariatric and metabolic surgery for obesity and diabetes. We hope these articles will serve as valuable and practical teachings for health care providers who work with patients with obesity and diabetes.

  • © 2017 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0 for details.

References

  1. 1.↵
    1. World Health Organization
    . Obesity and overweight fact sheet. Available from http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf. Accessed 12 September 2017
  2. 2.↵
    1. Colditz GA,
    2. Willett WC,
    3. Rotnitzky A,
    4. Manson JE
    . Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481–486
    OpenUrlCrossRefPubMedWeb of Science
  3. 3.↵
    1. Jensen MD,
    2. Ryan DH,
    3. Apovian CM, et al
    .; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Take Force on Practice Guidelines and The Obesity Society. Circulation 2014;129(Suppl. 2):S102–S138
    OpenUrlFREE Full Text
  4. 4.↵
    1. Knowler WC,
    2. Barrett-Connor E,
    3. Fowler SE, et al
    .; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403
    OpenUrlCrossRefPubMedWeb of Science
  5. 5.↵
    1. Garvey WT,
    2. Ryan DH,
    3. Look M, et al
    . Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr 2012;95:297–308
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. le Roux CW,
    2. Astrup A,
    3. Fujioka K, et al
    .; SCALE Obesity Prediabetes NN8022-1839 Study Group. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet 2017;389:1399–1409
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Rubino F,
    2. Nathan DM,
    3. Eckel RH, et al
    .; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016;39:861–877
    OpenUrlAbstract/FREE Full Text
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Beyond “Just Eat Less, Exercise More”: Obesity Treatment in Patients With Type 2 Diabetes
Scott Kahan
Diabetes Spectrum Nov 2017, 30 (4) 234-235; DOI: 10.2337/ds17-0062

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Beyond “Just Eat Less, Exercise More”: Obesity Treatment in Patients With Type 2 Diabetes
Scott Kahan
Diabetes Spectrum Nov 2017, 30 (4) 234-235; DOI: 10.2337/ds17-0062
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© 2021 by the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353.