JAMA Clinical Guidelines Synopsis
July 11, 2022
Major recommendations
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Diet, physical activity, and behavioral therapy should be designed to achieve and maintain at least 5% weight loss. Additional weight loss usually results in further improvements in control of diabetes and cardiovascular risk (level of evidence B).
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Interventions to achieve weight loss should include a high frequency of counseling (≥16 sessions in 6 months) to achieve a 500- to 750-kcal/d energy deficit (level of evidence A).
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When selecting glucose-lowering medications for people with type 2 diabetes and overweight or obesity, consider the effect of medications on weight (level of evidence B).
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Weight loss medications are effective as adjuncts to diet, physical activity, and behavioral counseling for selected people with type 2 diabetes and body mass index (BMI) of at least 27 (level of evidence A).
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Metabolic surgery should be a recommended option to treat type 2 diabetes in those with BMI of at least 40 (≥37.5 in Asian American individuals) and in those with BMI of 30 to 39.9 (32.5-37.5 in Asian American individuals) who do not achieve durable weight loss or improvement in comorbidities with nonsurgical methods (level of evidence A).