This is the current release of the guideline.

Overweight and obesity are strongly linked to the development of type 2 diabetes and can complicate its management. Obesity is also an independent risk factor for hypertension and dyslipidemia as well as cardiovascular disease, which is the major cause of death in those with diabetes. Moderate weight loss improves glycemic control, reduces cardiovascular disease risk, and can prevent the development of type 2 diabetes in those with pre-diabetes. Therefore, weight loss is an important therapeutic strategy in all overweight or obese persons who have type 2 diabetes or are at risk for developing diabetes.

Specific Recommendations

• Weight loss is recommended for all overweight (body mass index [BMI] 25.0-29.9 kilograms per meter squared [kg/m²]) or obese (BMI >30.0 kg/m²) adults who have, or who are at risk for developing, type 2 diabetes.
• The primary approach for achieving weight loss is therapeutic lifestyle change, which includes a reduction in energy intake and an increase in physical activity.
• A moderate decrease in caloric intake (500-1,000 kilocalories per day [kcal/day]) will result in a slow but progressive weight loss (1-2 pounds per week). For most patients, weight loss diets should supply at least 1,000-1,200 kcal/day for women and 1,200-1,600 kcal/day for men.
• Overweight or obese patients with diabetes are encouraged to adopt the dietary recommendations known to reduce the risk of coronary heart disease (outlined in Tables 3 and 4 of the original guideline document). In conjunction with a moderate reduction in caloric intake (500-1,000 kcal/day), this diet is likely to result in moderate weight loss as well as improvement in cardiovascular risk factors. Dietary guidance should be tailored to each person, allowing for individual food preferences and approaches to reducing caloric intake.
• Physical activity is an important component of a comprehensive weight management program. Regular, moderate-intensity physical activity enhances long-term weight maintenance. Regular activity also improves insulin sensitivity, glycemic control, and selected risk factors for cardiovascular disease (i.e., hypertension and dyslipidemia), and increased aerobic fitness decreases the risk of coronary heart disease.
• Initial physical activity recommendations should be modest, based on the patient's willingness and ability, gradually increasing the duration and frequency to 30 to 45 minutes of moderate aerobic activity, 3 to 5 days per week, when possible. Greater activity levels of at least 1 hour per day of moderate (walking) or 30 minutes per day of vigorous (jogging) activity may be needed to achieve successful long-term weight loss.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Not applicable: The guideline was not adapted from another source.

2004 Aug

American Diabetes Association - Professional Association
American Society for Clinical Nutrition - Professional Association
North American Association for the Study of Obesity - Professional Association

American Diabetes Association (ADA)

Not stated

Primary Authors: Samuel Klein, MD, Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri; Nancy F. Sheard, SCD, RD, Department of Family Practice, University of Vermont, Burlington, Vermont; Xavier Pi-Sunyer, MD, MPH, Division of Endocrinology, Diabetes and Nutrition, St. Luke's—Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York New York; Anne Daly, MS, RD, BC-ADM, CDE, Springfield Diabetes & Endocrine Center, Springfield, Illinois; Judith Wylie-Rosett, EDD, RD, Division of Health, Behavior and Nutrition, Albert Einstein College of Medicine, Bronx, New York; Karmeen Kulkarni, MS, RD, BC-ADM, CDE, St Mark's Diabetes Center, Salt Lake City, Utah; Nathaniel G. Clark, MD, MS, RD, American Diabetes Association, Alexandria, Virginia

Samuel Klein, MD is a member of the Obesity and Diabetes Educational Council, which is funded by an unrestricted educational grant provided by Roche Laboratories, is on the Enteromedics Medical Advisory Board, has received honoraria from Merck, and has received research support from Transneuronix.

Judith Wylie-Rosett, EDD, RD has received research funding from the Dr. Robert C. Atkins Foundation.

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on April 18, 2005.