3.4.0.0 Weight Management
Management and reduction of weight is important for people with type 1 diabetes, type 2 diabetes, or prediabetes who have overweight or obesity. Lifestyle intervention programs should be intensive and have frequent follow-up to achieve significant reductions in excess body weight and improve clinical indicators. There is strong and consistent evidence that modest persistent weight loss can delay the progression from prediabetes to type 2 diabetes (51,68,69) (see Section 3 “Prevention or Delay of Type 2 Diabetes”) and is beneficial to the management of type 2 diabetes (see Section 8 “Obesity Management for the Treatment of Type 2 Diabetes”).
Studies of reduced calorie interventions show reductions in A1C of 0.3% to 2.0% in adults with type 2 diabetes, as well as improvements in medication doses and quality of life (50,51). Sustaining weight loss can be challenging (70,71) but has long-term benefits; maintaining weight loss for 5 years is associated with sustained improvements in A1C and lipid levels (72). Weight loss can be attained with lifestyle programs that achieve a 500–750 kcal/day energy deficit or provide ~1,200–1,500 kcal/day for women and 1,500–1,800 kcal/day for men, adjusted for the individual’s baseline body weight. For many obese individuals with type 2 diabetes, weight loss of at least 5% is needed to produce beneficial outcomes in glycemic control, lipids, and blood pressure (70). It should be noted, however, that the clinical benefits of weight loss are progressive and more intensive weight loss goals (i.e., 15%) may be appropriate to maximize benefit depending on need, feasibility, and safety (73). MNT guidance from an RD/RDN with expertise in diabetes and weight management, throughout the course of a structured weight loss plan, is strongly recommended.
Studies have demonstrated that a variety of eating plans, varying in macronutrient composition, can be used effectively and safely in the short term (1–2 years) to achieve weight loss in people with diabetes. This includes structured low-calorie meal plans that include meal replacements (72-74) and the Mediterranean eating pattern (75) as well as low-carbohydrate meal plans (62). However, no single approach has been proven to be consistently superior (76,77), and more data are needed to identify and validate those meal plans that are optimal with respect to longterm outcomes as well as patient acceptability. The importance of providing guidance on an individualized meal plan containing nutrient-dense foods, such as vegetables, fruits, legumes, dairy, lean sources of protein (including plant-based sources as well as lean meats, fish, and poultry), nuts, seeds, and whole grains, cannot be overemphasized (77), as well as guidance on achieving the desired energy deficit (78-81). Any approach to meal planning should be individualized considering the health status, personal preferences, and ability of the person with diabetes to sustain the recommendations in the plan.