Hosted by Ray Shields, MD

In people who have diabetes, overweight and obesity can worsen complications and complicate diabetes management by increasing insulin resistance and raising blood sugar levels.  Lifestyle changes are the core components of weight management and are essential for management of diabetes and its co-morbidities hypertension, dyslipidemia, and cardiovascular disease.  The role of the clinician is to educate, monitor, and support the patient during these processes. All clinical providers should encourage their adults with diabetes to make healthier diet choices.

Regular documentation of weight and height for body mass index (BMI) computation is necessary for meaningful monitoring, support and encouragement.  Following BMI trends over time may identify weight gain issues early.  The degree of insulin resistance, the incidence of type 2 diabetes, and the increased risk for cardiovascular disease are highest in those subjects with upper body or abdominal obesity, as manifested by a waist-to-hip circumference ratio that is >0.95 in men and >0.85 in women.  Measurement of waist circumference and/or waist-to hip ratio should be considered as these have also been correlated with increased risk for cardiovascular disease.

We highly recommend that weight management counseling be a multidisciplinary team approach and include a registered dietitian or a public health nutritionist. Patients who are overweight (BMI 25.0 – 29.9) or obese (BMI ≥ 30) should be referred to community or clinic based structured programs where weight loss is addressed. Such programs should emphasize goal setting, coaching and motivational interviewing, education and skills development, physical activity, self-monitoring, problem solving, behavioral change, stress and stimulus control, the importance of social support, and the use of community resources.