Lifestyle interventions for "diabesity": the state of the science

Lifestyle is an expression of individual choices and their interaction with the environment and is closely associated with risks for obesity, diabetes, and cardiovascular disorders. If taken cumulatively this syndrome may be referred to as "diabesity." The escalating prevalence of obesity among both children and adults is one modifiable dominant risk factor in this triad. An increase in body weight of approximately 2.2 pounds (1 kg) has been shown to increase risk for diabetes by 4.5%. Alternatively, a 5% to 10% decrease in body weight improves diabetes control. The metabolic syndrome of diabetes has been described as a consortium of conditions including dyslipidemia, hypertension, and abdominal obesity. In randomized controlled clinical trials, dietary and physical activity interventions have been shown to be effective in decreasing risk for, as well as delaying conversion to, these disorders. Since 1977, 4 hallmark multisite clinical trials have been conducted in the United States, the United Kingdom, and Finland confirming that improved glycemic and hypertensive control of patients through lifestyle interventions can have positive effects on associated complications and longitudinal outcomes. A fifth robust and well-controlled study is currently being conducted in multiple sites in the United States. Dietary behaviors are modulating factors not only in these metabolic and systemic conditions but also in risk for oral diseases such as dental caries. The association between obesity, diabetes, cardiovascular diseases, and oral health status may be linked by these lifestyle behaviors. Promotion of weight management involves approaches that include diet, physical activity, and behavior modification. Established effective guidelines within these domains may be applicable to current practice and future studies designed to examine the associations between diabesity and oral health status.