Managing obesity in people with type 2 diabetes

Abstract

Obesity is a modifiable risk factor in the development of type 2 diabetes mellitus (T2DM), with the prevalence of both increasing worldwide. This trend is associated with increasing mortality, cardiovascular risk and healthcare costs. An individual's weight will be determined by complex physiological, psychological and societal factors. Assessment by a skilled multidisciplinary team will help identify these factors and will also support screening for secondary causes, assessing cardiovascular risk and identifying sequelae of obesity. A range of treatment options are available for people with obesity and T2DM, including low-calorie diets, medications and bariatric surgery. People should be carefully counselled and personalised care plans developed. Bariatric surgery is an under-utilised resource in this context. Obesity should also be considered when choosing medical therapy for T2DM. Common diabetes medications may lead to weight gain whereas others (such as glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors) support weight loss. Bariatric surgery improves obesity-related complications and all-cause mortality. Diabetes remission is possible after surgery and is recommended by National Institute for Health and Care Excellence in individuals with a body mass index of >35 kg/m2 and recent onset T2DM.