In the case of both OW/OB and type 2 diabetes, prevention is by far the best approach, requiring significantly less expense and effort than therapeutic interventions. Compared to individuals with a BMI of 18.5 to 24.9, persons with a BMI > 35 are 20 times as likely to develop diabetes (2, 11). As little as a 5 percent weight loss has been shown in clinical trials to prevent obese subjects with glucose intolerance from developing type 2 diabetes (6). Unfortunately, in the face of affluent lifestyles and copious amounts of readily accessible and highly palatable foods, the motivation for preventing obesity is often absent, as evidenced by current trends toward more rather than less OW/OB in the U.S. population (12). Without the presence of discernable health impairments, many individuals lack the motivation to incorporate diet and exercise regimens into their daily routines. Labor-saving devices and time constraints that favor a sedentary lifestyle also contribute to the prevalence of positive energy balance. For ready-to-change individuals (13), however, preventive nutrition measures offer dramatically beneficial effects. Results from the Diabetes Prevention Program (14) indicated a reduced four-year incidence of type 2 diabetes in men and women with glucose intolerance in response to weight reduction (7 percent loss in year one) and increased physical activity (150 minutes brisk walking/week). Tuomilehto et al. (15) followed 522 OW/OB subjects randomly assigned to a control group or a diet/physical activity intervention and reported reductions in the incidence of diabetes directly commensurate with lifestyle changes.
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