Management of Obesity in Diabetes Key Messages An estimated 80 to 90% of persons with type 2 diabetes are overweight or obese. A modest weight loss of 5 to 10% of initial body weight can substantially improve insulin sensitivity and glycemic, blood pressure and lipid control.

Management of Obesity in Diabetes Key Messages A comprehensive healthy lifestyle intervention program should be implemented in overweight and obese people with diabetes to achieve and maintain a healthy body weight. The addition of a pharmacologic agent should be considered for appropriate overweight or obese adults who are unable to attain clinically important weight loss with lifestyle modification. Adults with severe obesity may be considered for bariatric surgery when other interventions fail to result in achieving weight goals.

Management of Obesity in Diabetes 2008 CPG Recommendations 1. A comprehensive healthy lifestyle intervention program (including a hypocaloric, nutritionally balanced diet, regular physical activity or exercise, and behavioural modification techniques) for overweight and obese people with, or at risk for diabetes, should be implemented to achieve and maintain a healthy body weight [Grade D, Consensus]. Members of the healthcare team should consider using a structured approach to providing advice and feedback on physical activity, healthy eating habits and weight loss [Grade C, Level 3 (31-34)].

Management of Obesity in Diabetes 2008 CPG Recommendations 2. In overweight or obese adults with type 2 diabetes, a pharmacologic agent such as orlistat [Grade A, Level 1A (26)] or sibutramine [Grade B, Level 2 (37)] should be considered as an adjunct to lifestyle modifications to facilitate weight loss and improve glycemic control. 3. Adults with class III obesity (BMI ≥ 40.0 kg/m 2 ) or class II obesity (BMI 35.0 to 39.9 kg/m 2 ) with other comorbidities may be considered for bariatric surgery when other lifestyle interventions are inadequate in achieving weight goals [Grade C, Level 3 (43)].