A holistic approach to weight management is essential. Individualized strategies may include nutrition and exercise interventions, behavioral counseling, pharmacotherapy, and metabolic surgery.
In people with type 2 diabetes and overweight or obesity, weight management should represent a primary goal of treatment along with glycemic management.
Weight management is crucial because it:
Delays progression from prediabetes to type 2 diabetes
Is highly beneficial in treating type 2 diabetes
Improves glycemia and reduces the need for glucose-lowering medications
Reduces cardiovascular risk factors, lowering long-term cardiovascular and mortality risks
Reduces other obesity-related health risks
When addressing weight management:
Use person-centered, nonjudgmental, person-first language (e.g., “person with obesity” rather than “obese person” and “person with diabetes” rather than “diabetic person”).
Calculate BMI and measure body fat distribution (e.g., waist circumference, waist-to-hip ratio, and/or waist-to-height ratio) if BMI is indeterminant. Monitor these parameters at least annually.
Identify and overcome any implicit and explicit weight-based attitudes to improve care for people with obesity.
Person-Centered Treatment Options for Overweight and Obesity in Type 2 Diabetes
| BMI (kg/m2) | |||
|---|---|---|---|
| 25.0–26.9 (or 23.0–24.9*) | 27.0–29.9 (or 25.0–27.4*) | ≥30.0 (or ≥27.5*) | |
| Intensive behavioral counseling | | | |
| Weight management pharmacotherapy | | | |
| Metabolic surgery | | ||
| BMI (kg/m2) | |||
|---|---|---|---|
| 25.0–26.9 (or 23.0–24.9*) | 27.0–29.9 (or 25.0–27.4*) | ≥30.0 (or ≥27.5*) | |
| Intensive behavioral counseling | | | |
| Weight management pharmacotherapy | | | |
| Metabolic surgery | | ||
*Recommended cut points for Asian American individuals.
Nutrition, Physical Activity, and Behavioral Therapy for People With Overweight and Obesity
| Recommendations | |
|---|---|
| Nutrition, physical activity, and behavioral therapy are recommended for people with type 2 diabetes and overweight or obesity to achieve both weight and health outcome goals. |
| Frequent counseling (≥16 sessions in 6 months) focusing on nutrition, exercise, and behavioral strategies to achieve a 500–750 kcal/day energy deficit, is beneficial for weight loss and recommended if available. |
| Long-term (≥1 year) weight maintenance programs are advised for those meeting weight loss goals, offering monthly support, at least weekly body weight monitoring, self-monitoring strategies, and regular physical activity (200–300 min/week). |
| Short-term, structured very-low-calorie diets (800–1,000 kcal/day) should be reserved for carefully selected individuals, be prescribed by trained practitioners in medical settings with close monitoring, and include counseling for long-term weight maintenance. |
| When developing a care plan, consider systemic, structural, cultural, and socioeconomic factors that may affect nutrition patterns and food choices, such as food insecurity and hunger, access to healthful food options, and other social determinants of health. |
| Recommendations | |
|---|---|
| Nutrition, physical activity, and behavioral therapy are recommended for people with type 2 diabetes and overweight or obesity to achieve both weight and health outcome goals. |
| Frequent counseling (≥16 sessions in 6 months) focusing on nutrition, exercise, and behavioral strategies to achieve a 500–750 kcal/day energy deficit, is beneficial for weight loss and recommended if available. |
| Long-term (≥1 year) weight maintenance programs are advised for those meeting weight loss goals, offering monthly support, at least weekly body weight monitoring, self-monitoring strategies, and regular physical activity (200–300 min/week). |
| Short-term, structured very-low-calorie diets (800–1,000 kcal/day) should be reserved for carefully selected individuals, be prescribed by trained practitioners in medical settings with close monitoring, and include counseling for long-term weight maintenance. |
| When developing a care plan, consider systemic, structural, cultural, and socioeconomic factors that may affect nutrition patterns and food choices, such as food insecurity and hunger, access to healthful food options, and other social determinants of health. |
Weight Management Pharmacotherapy
*Medications approved for long-term use should be continued as indicated beyond reaching weight loss goals. ER, extended release.
*Medications approved for long-term use should be continued as indicated beyond reaching weight loss goals. ER, extended release.
Weight Loss Efficacy of Glucose-Lowering Medications
Glucose-Lowering Medications
Consider weight when choosing glucose-lowering medications for individuals with type 2 diabetes and overweight or obesity.
When possible, avoid prescribing medications that cause weight gain to treat comorbid conditions.
Weight management pharmacotherapy should be considered for people with diabetes and overweight or obesity along with lifestyle changes. Potential benefits and risks must be considered.
Continue weight management pharmacotherapy if it is effective (>5% weight loss after 3 months).
Consider changing or stopping treatment if weight loss is <5% after 3 months or if significant safety/tolerability issues arise.
