Obesity and Weight Management for Prevention and Treatment of Type 2 Diabetes

JAMA Clinical Guidelines Synopsis 

July 11, 2022

Major recommendations

  • 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).

  • 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).

  • 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).

  • 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).

  • 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).