Obesity and Type 2 Diabetes: What Can Be Unified and What Needs to Be Individualized?

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How effective is medical nutrition therapy in diabetes care? Collectively, these responses contribute to the pathogenesis of insulin resistance in the liver, skeletal muscle, and adipose tissue, and some e. Equally beneficial will be incorporating these ideas into a chronic disease model of care linking obesity management to diabetes care systems, including multidisciplinary approaches to patient care designed to prevent weight regain that is almost universal when therapy is stopped. While there are studies that show the health and medical benefits of weight loss, a study in of around Finns over an year period showed that weight loss from dieting can result in increased mortality, while those who maintained their weight fared the best. Mechanisms of obesity-associated insulin resistance The influence of obesity on type 2 diabetes risk is determined not only by the degree of obesity but also by where fat accumulates. The Daniel Fast resembles the vegan diet in that it excludes foods of animal origin. Obesity and Type 2 Diabetes:

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Metabolic surgery should be performed in high-volume centers with multidisciplinary teams that understand and are experienced in the management of diabetes and gastrointestinal surgery. Long-term lifestyle support and routine monitoring of micronutrient and nutritional status must be provided to patients after surgery, according to guidelines for postoperative management of metabolic surgery by national and international professional societies.

People presenting for metabolic surgery should receive a comprehensive mental health assessment. B Surgery should be postponed in patients with histories of alcohol or substance abuse, significant depression, suicidal ideation, or other mental health conditions until these conditions have been fully addressed. People who undergo metabolic surgery should be evaluated to assess the need for ongoing mental health services to help them adjust to medical and psychosocial changes after surgery.

Several gastrointestinal GI operations promote dramatic and durable improvement of type 2 diabetes. Improvements in micro- and macrovascular complications of diabetes, cardiovascular disease, and cancer have been observed only in nonrandomized observational studies 30 — Cohort studies attempting to match surgical and nonsurgical subjects suggest that the procedure may reduce longer-term mortality Available data suggest an erosion of diabetes remission over time: With or without diabetes relapse, the majority of patients who undergo surgery maintain substantial improvement of glycemic control from baseline for at least 5 44 to 15 31 , 32 , 43 , 45 — 47 years.

Younger age, shorter duration of diabetes e. Greater baseline visceral fat area may also help to predict better postoperative outcomes, especially among Asian American patients with type 2 diabetes, who typically have more visceral fat compared with Caucasians with diabetes of the same BMI Beyond improving glycemia, metabolic surgery has been shown to confer additional health benefits in randomized controlled trials, including greater reductions in cardiovascular disease risk factors 29 and enhancements in quality of life 44 , 48 , The safety of metabolic surgery has improved significantly over the past two decades, with continued refinement of minimally invasive approaches laparoscopic surgery , enhanced training and credentialing, and involvement of multidisciplinary teams.

Mortality rates with metabolic operations are typically 0. Morbidity has also dramatically declined with laparoscopic approaches. Empirical data suggest that proficiency of the operating surgeon is an important factor for determining mortality, complications, reoperations, and readmissions Although metabolic surgery has been shown to improve the metabolic profiles of morbidly obese patients with type 1 diabetes, establishing the role of metabolic surgery in such patients will require larger and longer studies Retrospective analyses and modeling studies suggest that metabolic surgery may be cost-effective or even cost-saving for patients with type 2 diabetes, but the results are largely dependent on assumptions about the long-term effectiveness and safety of the procedures 62 , Metabolic surgery is costly and has associated risks.

Longer-term concerns include dumping syndrome nausea, colic, diarrhea , vitamin and mineral deficiencies, anemia, osteoporosis, and, rarely 64 , severe hypoglycemia from insulin hypersecretion. Postprandial hypoglycemia is most likely to occur with RYGB 66 , The exact prevalence of symptomatic hypoglycemia is unknown. Patients who undergo metabolic surgery may be at increased risk for substance use, including drug and alcohol use and cigarette smoking People with diabetes presenting for metabolic surgery also have increased rates of depression and other major psychiatric disorders Candidates for metabolic surgery with histories of alcohol or substance abuse, significant depression, suicidal ideation, or other mental health conditions should therefore first be assessed by a mental health professional with expertise in obesity management prior to consideration for surgery Individuals with preoperative psychopathology should be assessed regularly following metabolic surgery to optimize mental health management and to ensure psychiatric symptoms do not interfere with weight loss and lifestyle changes.

Obesity management for the treatment of type 2 diabetes. In Standards of Medical Care in Diabetes— Diabetes Care ;40 Suppl. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.

We do not capture any email address. Skip to main content. Diabetes Care Jan; 40 Supplement 1: B At each routine patient encounter, BMI should be calculated from the height and weight.

View inline View popup. A Diets should be individualized, as those that provide the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss. Look AHEAD Trial Although the Action for Health in Diabetes Look AHEAD trial did not show that an intensive lifestyle intervention reduced cardiovascular events in overweight or obese adults with type 2 diabetes 13 , it did show the feasibility of achieving and maintaining long-term weight loss in patients with type 2 diabetes.

E Whenever possible, minimize the medications for comorbid conditions that are associated with weight gain. Antihyperglycemic Therapy When evaluating pharmacological treatments for overweight or obese patients with type 2 diabetes, providers should first consider their choice of glucose-lowering medications. Assessing Efficacy and Safety Efficacy and safety should be assessed at least monthly for the first 3 months of treatment.

A Metabolic surgery should be considered for adults with type 2 diabetes and BMI B Metabolic surgery should be performed in high-volume centers with multidisciplinary teams that understand and are experienced in the management of diabetes and gastrointestinal surgery.

C Long-term lifestyle support and routine monitoring of micronutrient and nutritional status must be provided to patients after surgery, according to guidelines for postoperative management of metabolic surgery by national and international professional societies.

C People presenting for metabolic surgery should receive a comprehensive mental health assessment. E People who undergo metabolic surgery should be evaluated to assess the need for ongoing mental health services to help them adjust to medical and psychosocial changes after surgery.

C Several gastrointestinal GI operations promote dramatic and durable improvement of type 2 diabetes. Adverse Effects Metabolic surgery is costly and has associated risks. The emerging global epidemic of type 1 diabetes.

Curr Diab Rep ; Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med ; UK Prospective Diabetes Study 7.

UK Prospective Diabetes Study 7: Metabolism ; Beneficial health effects of modest weight loss. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care ; Reversal of type 2 diabetes: Diabetologia ; Diabetes ; Very-low-energy diet for type 2 diabetes: J Diabetes Complications ; A new glucagon and GLP-1 co-agonist eliminates obesity in rodents.

Nat Chem Biol ; 5: Very low-calorie diet and 6 months of weight stability in type 2 diabetes: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet ; Diabetes ; 63 Suppl. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. Eight-year weight losses with an intensive lifestyle intervention: Obesity Silver Spring ; The importance of weight management in type 2 diabetes mellitus.

Int J Clin Pract ; Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: Am J Clin Nutr ; Comparison of weight loss among named diet programs in overweight and obese adults: JAMA ; Partial meal replacement plan and quality of the diet at 1 year: J Acad Nutr Diet ; Preventative Services Task Force.

Accessed 18 November Efficacy of commercial weight-loss programs: Ann Intern Med ; The evolution of very-low-calorie diets: Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: Long-term drug treatment for obesity: Effect of naltrexone plus bupropion on weight loss in overweight and obese adults COR-I: A randomized, controlled trial of 3. Rubino F , Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: Ann Surg ; Metabolic surgery in the treatment algorithm for type 2 diabetes: MyPlate, along with its exercise section, "Stronger," is very detailed and offers one-click meal tracking and progress graphs, plus minute exercise videos you can do at home.

Registering does not require entering a credit card. ChooseMyPlate is the U. Department of Agriculture's program to improve the nutrition and well-being of Americans. This noncommercial site covers an array of healthful information that can allow you to achieve your weight-loss goals with easy-to-understand sections on weight management, empty calories, fats and protein, physical activity and even fun quizzes. The primary tool for weight loss is SuperTracker, a food journal to allow tracking and an extensive nutrition evaluation comparing your eating with the minimum daily requirements.

You may also enter your physical activity to see how your daily energy use balances out with your calorie count. FitClick offers free weight-loss programs, diet plans and workout routines. The site includes a plethora of information, including food journals, a calories-burned calculator and workout trackers.

You can create and share diets and workouts or participate in the community, which includes message boards, teams, blogs and challenges. The site also offers pages of weight-loss tips, weight-loss program reviews and recipes. It uses a three-phase approach that begins with education about food energy and calorie balance in the body.

Weight Loss in People With Diabetes