1. Weight loss is recommended for all those with type 2 diabetes mellitus whose BMI exceeds 25
kg/m2; the intervention strategy should include a reduced calorie intake and increased physical activity.
2. The target BMI for this population is 25 kg/m2 or less; but even a modest weight loss of 5
percent to 10 percent of initial body mass will help prevent the development of diabetes and enhance metabolic control for those in whom the disease is already established.
pharmacologic treatments, including insulin (20), as discussed in the chpater by Lien and Feinglos in Section II of this book. In patients with longstanding disease or pronounced pancreatic P-cell dysfunction, moderate weight loss may not be sufficient to achieve satisfactory glycemic control. There may be a need for more intensive, ongoing intervention, including an escalation of calorie restriction to a very low-calorie diet, e.g., 800 Kcal/day or less (4, 55). In this event, a routine vitamin/mineral supplement and routine nutritional monitoring should be employed, and indications of medical complications, including gallstones (56), should be monitored. Weight-loss-promoting medications may need to be considered in some cases when calorie reduction and exercise do not result in sufficient weight loss, i.e., BMI > 30 or BMI > 27 plus OW/OB-related comorbid conditions. Bariatric surgery may be considered with a BMI > 40 or BMI > 35 plus comorbid conditions (47).
Achieving a healthy body weight can be a daunting task for OW/OB individuals with type 2 diabetes, requiring encouragement and guidance from the health-care team and strong social support from family and friends. Invariably, the potential benefits are nothing short of remarkable, having few negative side effects and providing a number of indirect benefits (improved self-esteem, sense of control) in addition to wide-ranging improvements in health and mortality. Even if pharmaco-logic agents are needed to achieve full glycemic control, lifestyle interventions can help minimize necessary doses and maximize health benefits.
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