Weight Reduction Strategies for Patients with Type-2-Diabetes

Therapeutic weight reduction is a basic component of type 2 diabetes treatment. Individual goals-body weight reduction and weight maintenance after weight loss-are frequently not achieved with nutritional advice, recommendations to increase physical activity, and behavior changes. To achieve these goals, a conservative treatment strategy with energy-reduced diet, increased physical activity, behavioral modifications or treatment is primarily recommended. If individual targets are not achieved, stepwise intensification should be initiated with very low calorie diets, pharmacotherapy, and/or endoscopic obesity therapies. Metabolic surgery may be considered in patients with a body mass index (BMI) > 35 kg/m(2) if conservative treatment strategies fail. In addition, it has been shown to be more effective than conservative approaches with regard to weight reduction, long-term weight maintenance, blood glucose lowering, and reduced mortality, but is associated with considerable acute and long-term risks.