Practical office strategies for weight management of the obese diabetic individual

Obesity is a key component of the insulin-resistance syndrome of type 2 diabetes, and intensifies comorbidities underlying the increased cardiovascular risk of individuals with type 2 diabetes. Weight loss leads to dramatic beneficial effects, with reductions in blood glucose levels and improvements in lipid profiles and blood pressure that often necessitate reductions in medications. Successful long-term weight loss is difficult to achieve in patients with diabetes, as standard dietary approaches often have minimal long-term impact, and intensive management strategies designed to improve glycemic control often contribute to further weight gain in these patients. This article offers a review of newer strategies for enhancing lifestyle change and weight loss in the obese diabetic individual. Use of meal replacements provides structure with portion control, and increased intake of fruits and vegetables promotes a healthier eating style for these patients. Encouraging physical activity such as walking, stair climbing, and gardening can significantly improve cardiorespiratory fitness and glycemic control, and helps patients maintain weight loss. Self-monitoring through lifestyle diaries can reinforce the healthy behaviors necessary for long-term management of obesity. Adjunctive antiobesity medication, medically-supervised intensive weight loss programs, and minimally invasive gastric bypass procedures are important options for patients unable to make significant progress with behavioral changes.