The treatment of obesity in type 2 diabetes mellitus

Obesity has a critical role in the pathophysiology of type 2 diabetes mellitus, and prevention of weight gain and treatment after onset of obesity is crucial to the management of the disease. A recent National Institutes of Health (NIH) report on the evaluation and treatment of overweight and obesity serves as a model for managing obese individuals with type 2 diabetes. Lifestyle intervention is the fundamental approach and should be implemented by a multidisciplinary team of health professionals. Adjunctive therapies, such as anti-obesity pharmacotherapy and surgery, should only be considered if at least 6 months of lifestyle intervention has produced suboptimal results. If adjunctive therapy is indicated, it will only be successful long term if lifestyle therapy remains central to treatment. The objective of this review is to integrate the recommendations of the NIH into the primary care management of the obese individual with type 2 diabetes.