Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition.

Overweight and obesity are important risk factors for type 2 diabetes. The marked increase in the prevalence of overweight and obesity is presumably responsible for the recent increase in the prevalence of type 2 diabetes. Lifestyle modification aimed at reducing energy intake and increasing physical activity is the principal therapy for overweight and obese patients with type 2 diabetes. Even moderate weight loss in combination with increased activity can improve insulin sensitivity and glycemic control in patients with type 2 diabetes and prevent the development of type 2 diabetes in high-risk persons (ie, those with impaired glucose tolerance). The American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition have joined together to issue this statement on the use of lifestyle modification in the prevention and management of type 2 diabetes.

[1]  Winston,et al.  Obesity : impact on cardiovascular disease , 1998, Circulation.

[2]  P. Kris-Etherton,et al.  Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. , 1999, The American journal of clinical nutrition.

[3]  Robert M. Russell,et al.  Present Knowledge in Nutrition , 2001 .

[4]  T. Wadden,et al.  One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. , 1994, Journal of consulting and clinical psychology.

[5]  W. Yancy,et al.  A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia , 2004, Annals of Internal Medicine.

[6]  E. Antman,et al.  ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). , 2002, Journal of the American College of Cardiology.

[7]  UK Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients, UKPDS Group. , 1990, Metabolism: clinical and experimental.

[8]  The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-year follow-up of a randomized trial☆ , 2004 .

[9]  S. Grundy Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. , 1999, The American journal of cardiology.

[10]  G. Colditz,et al.  The disease burden associated with overweight and obesity. , 1999, JAMA.

[11]  N. Milas,et al.  Long-Term Weight Loss and Changes in Blood Pressure: Results of the Trials of Hypertension Prevention, Phase II , 2001, Annals of Internal Medicine.

[12]  T. Wadden,et al.  Treating the obese patient. Suggestions for primary care practice. , 1999, Archives of family medicine.

[13]  G A Colditz,et al.  Weight as a risk factor for clinical diabetes in women. , 1990, American journal of epidemiology.

[14]  T. Wadden,et al.  Behavioral treatment of obesity. , 2000, The Medical clinics of North America.

[15]  G. Reaven,et al.  Effects of weight reduction on obesity. Studies of lipid and carbohydrate metabolism in normal and hyperlipoproteinemic subjects. , 1974, The Journal of clinical investigation.

[16]  J. Foreyt,et al.  Successful management of the obese patient. , 2000, American family physician.

[17]  J W Erdman,et al.  AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. , 2000, Circulation.

[18]  E. Poehlman,et al.  Weight Loss Reduces C-Reactive Protein Levels in Obese Postmenopausal Women , 2002, Circulation.

[19]  Graham A. Colditz,et al.  Walking Compared With Vigorous Physical Activity and Risk of Type 2 Diabetes in Women , 2000 .

[20]  J W Erdman,et al.  AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. , 2000, Stroke.

[21]  B. Rolls,et al.  Dietary approaches to the treatment of obesity. , 2000, The Medical clinics of North America.

[22]  Goldstein Dj Beneficial health effects of modest weight loss , 1992 .

[23]  R. Wing,et al.  Long-term maintenance of weight loss: do people who lose weight through various weight loss methods use different behaviors to maintain their weight? , 1998, International Journal of Obesity.

[24]  J M Jakicic,et al.  Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. , 1995, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[25]  T. Valle,et al.  Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. , 2001, The New England journal of medicine.

[26]  Arshag D Mooradian,et al.  Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. , 2003, Diabetes care.

[27]  L. Phillips,et al.  Prediction of glucose response to weight loss in patients with non-insulin-dependent diabetes mellitus. , 1990, Archives of internal medicine.

[28]  H. Sugerman,et al.  A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. , 1987, Annals of surgery.

[29]  F. Pi‐Sunyer,et al.  Medical Hazards of Obesity , 1993, Annals of Internal Medicine.

[30]  P. Whelton,et al.  Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. , 2000, Hypertension.

[31]  R. Marfella,et al.  Reduction of Inflammatory Cytokine Concentrations and Improvement of Endothelial Functions in Obese Women After Weight Loss Over One Year , 2002, Circulation.

[32]  R. Glasgow,et al.  Physical activity promotion through primary care. , 2003, JAMA.

[33]  R R Wing,et al.  A descriptive study of individuals successful at long-term maintenance of substantial weight loss. , 1997, The American journal of clinical nutrition.

[34]  R. Wing,et al.  Successful weight loss maintenance. , 2003, Annual review of nutrition.

[35]  F. Pi‐Sunyer,et al.  Comorbidities of overweight and obesity: current evidence and research issues. , 1999, Medicine and science in sports and exercise.

[36]  T. Wadden,et al.  Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. , 1999, JAMA.

[37]  J. Chan,et al.  Weight management and current options in pharmacotherapy: orlistat and sibutramine. , 2003, Clinical therapeutics.

[38]  L. V. Van Gaal,et al.  The beneficial effects of modest weight loss on cardiovascular risk factors. , 1997, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[39]  S. Fowler,et al.  Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. , 2002 .

[40]  J. Kampert,et al.  The Association between Cardiorespiratory Fitness and Impaired Fasting Glucose and Type 2 Diabetes Mellitus in Men , 1999, Annals of Internal Medicine.

[41]  B. Goldstein,et al.  Beneficial health effects of modest weight loss. , 1992, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[42]  J. Mayer Exercise and weight control. , 1959, Postgraduate medicine.

[43]  B. Modan,et al.  Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. , 1978, The New England journal of medicine.

[44]  S. Grundy,et al.  Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. , 1994, JAMA.

[45]  W. Pories,et al.  Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult‐Onset Diabetes Mellitus , 1995, Annals of surgery.

[46]  S M Grundy,et al.  Obesity: Impact on cardiovascular disease , 2000 .

[47]  D A Schoeller,et al.  How much physical activity is needed to minimize weight gain in previously obese women? , 1997, The American journal of clinical nutrition.

[48]  R N Bergman,et al.  Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. , 1998, JAMA.

[49]  G. Bray,et al.  Current and potential drugs for treatment of obesity. , 1999, Endocrine reviews.

[50]  Claude Bouchard,et al.  Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: Executive summary , 1998 .

[51]  J M Jakicic,et al.  Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. , 1999, JAMA.

[52]  R. Elashoff,et al.  Clinical evaluation of a minimal intervention meal replacement regimen for weight reduction. , 1994, Journal of the American College of Nutrition.

[53]  J. Anderson,et al.  Obesity and disease management: effects of weight loss on comorbid conditions. , 2001, Obesity research.

[54]  C. Ebbeling,et al.  A reduced-glycemic load diet in the treatment of adolescent obesity. , 2003, Archives of pediatrics & adolescent medicine.

[55]  D. Rader,et al.  A randomized trial of a low-carbohydrate diet for obesity. , 2003, The New England journal of medicine.

[56]  S. Blair,et al.  Exercise capacity and body composition as predictors of mortality among men with diabetes. , 2004, Diabetes care.

[57]  Pi-Sunyer Fx Short-Term Medical Benefits and Adverse Effects of Weight Loss , 1993 .

[58]  E. Gracely,et al.  A low-carbohydrate as compared with a low-fat diet in severe obesity. , 2003, The New England journal of medicine.

[59]  R. Wing,et al.  Food provision as a strategy to promote weight loss. , 2001, Obesity research.

[60]  A. Astrup,et al.  Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. The Carbohydrate Ratio Management in European National diets. , 2000, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[61]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[62]  M. Stefanick Exercise and Weight Control , 1993, Exercise and sport sciences reviews.

[63]  S. Oparil,et al.  Physical activity and cardiovascular health , 1996 .

[64]  L. Garfinkel,et al.  Variations in mortality by weight among 750,000 men and women. , 1979, Journal of chronic diseases.

[65]  K. Flegal,et al.  Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults: The Third National Health and Nutrition Examination Survey, 1988–1994 , 1998, Diabetes Care.

[66]  G. Blackburn,et al.  Effect of degree of weight loss on health benefits. , 1995, Obesity research.

[67]  R B Haynes,et al.  A randomized trial of improved weight loss with a prepared meal plan in overweight and obese patients: impact on cardiovascular risk reduction. , 2000, Archives of internal medicine.

[68]  Ralph B D'Agostino,et al.  Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. , 2002, Archives of internal medicine.

[69]  D. Kelley,et al.  Metabolic consequences of weight loss on glucose metabolism and insulin action in type 2 diabetes , 2000, Diabetes, obesity & metabolism.

[70]  G A Colditz,et al.  Impact of overweight on the risk of developing common chronic diseases during a 10-year period. , 2001, Archives of internal medicine.

[71]  B. Howard,et al.  Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study , 1997, Diabetes Care.

[72]  E. Gracely,et al.  The Effects of Low-Carbohydrate versus Conventional Weight Loss Diets in Severely Obese Adults: One-Year Follow-up of a Randomized Trial , 2004, Annals of Internal Medicine.

[73]  S. Grundy,et al.  Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus. , 1988, The New England journal of medicine.

[74]  Richard L. Atkinson,et al.  Very Low-Calorie Diets , 1993 .

[75]  J. Vidal Updated review on the benefits of weight loss , 2002, International Journal of Obesity.

[76]  A. Lichtenstein,et al.  Very low fat diets. , 1998, Circulation.

[77]  K. Brownell,et al.  Eating disorders and obesity : a comprehensive handbook , 1995 .

[78]  F. Pi‐Sunyer,et al.  The Prevention and Treatment of Obesity: Application to type 2 diabetes , 1997, Diabetes Care.

[79]  M. Engelgau,et al.  The continuing increase of diabetes in the US. , 2001, Diabetes care.

[80]  A. Mokdad,et al.  Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. , 2003, JAMA.

[81]  J. Dixon,et al.  Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. , 2002, Diabetes care.

[82]  D. Mark,et al.  ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). , 1997, Journal of the American College of Cardiology.

[83]  V F Froelicher,et al.  Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. , 2001, Circulation.

[84]  Carol Ewing Garber,et al.  ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults , 1998 .

[85]  G A Colditz,et al.  Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study. , 1997, American journal of epidemiology.

[86]  A. Astrup,et al.  Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study , 2000, International Journal of Obesity.

[87]  M. Flechtner-Mors,et al.  Metabolic and weight-loss effects of a long-term dietary intervention in obese patients. , 1999, The American journal of clinical nutrition.

[88]  J. Kampert,et al.  Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. , 1999, JAMA.

[89]  A. Kriska,et al.  Handbook of Exercise in Diabetes , 2004 .

[90]  T. Wadden,et al.  AGA technical review on obesity. , 2002, Gastroenterology.

[91]  B. Zinman,et al.  Physical activity/exercise and diabetes mellitus. , 2003, Diabetes care.

[92]  A. Dattilo,et al.  Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. , 1992, The American journal of clinical nutrition.

[93]  Anson,et al.  DIET , LIFESTYLE , AND THE RISK OF TYPE 2 DIABETES MELLITUS IN WOMEN , 2001 .

[94]  J. Olefsky,et al.  Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. , 1985, The Journal of clinical endocrinology and metabolism.

[95]  R. Weinsier,et al.  Medically safe rate of weight loss for the treatment of obesity: a guideline based on risk of gallstone formation. , 1995, The American journal of medicine.

[96]  R. Brolin,et al.  Bariatric surgery and long-term control of morbid obesity. , 2002, JAMA.

[97]  A. Gorin Strategies for Changing Eating and Exercise Behavior , 2002 .

[98]  M. Perri,et al.  Effects of group- versus home-based exercise in the treatment of obesity. , 1997, Journal of consulting and clinical psychology.

[99]  Rena R Wing,et al.  Behavioral interventions for obesity: recognizing our progress and future challenges. , 2003, Obesity research.

[100]  L. Sjöström,et al.  XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. , 2004, Diabetes care.

[101]  G A Colditz,et al.  Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men , 1994, Diabetes Care.

[102]  S. Daniels,et al.  A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. , 2003, The Journal of clinical endocrinology and metabolism.

[103]  R R Wing,et al.  Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. , 1993, Journal of consulting and clinical psychology.

[104]  Joseph S Alpert,et al.  ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). , 2002, Journal of the American College of Cardiology.

[105]  S. Grundy,et al.  Comparison of Effects of High and Low Carbohydrate Diets on Plasma Lipoproteins and Insulin Sensitivity in Patients With Mild NIDDM , 1992, Diabetes.

[106]  L. V. Van Gaal,et al.  Overweight, obesity, and blood pressure: the effects of modest weight reduction. , 2000, Obesity research.

[107]  Fernando Costa,et al.  Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Ph , 2003, Circulation.