Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation

Obesity is now recognised as a disease that is associated with serious morbidity and increased mortality. One of its main metabolic complications is type 2 diabetes, as the two conditions share key pathophysiological mechanisms. Weight loss is known to reverse the underlying metabolic abnormalities...

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Bibliographic Details
Published in:The Lancet (British edition) 2022-01, Vol.399 (10322), p.394-405
Main Authors: Lingvay, Ildiko, Sumithran, Priya, Cohen, Ricardo V, le Roux, Carel W
Format: Article
Language:English
Subjects:
Abnormalities
Body fat
Body weight loss
Chronic illnesses
Complications
Diabetes
Diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
Disease
Endocrinology
Gastrointestinal surgery
Glucose
Goals
Health risks
Humans
Hyperglycemia
Hypoglycemic Agents - adverse effects
Insulin resistance
Intervention
Jargon
Metabolism
Morbidity
Obesity
Obesity - prevention & control
Obesity Management
Pathology
Pathophysiology
Quality of Life
Remission (Medicine)
Risk analysis
Risk Factors
Risk management
Weight control
Weight Loss
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Summary:Obesity is now recognised as a disease that is associated with serious morbidity and increased mortality. One of its main metabolic complications is type 2 diabetes, as the two conditions share key pathophysiological mechanisms. Weight loss is known to reverse the underlying metabolic abnormalities of type 2 diabetes and, as such, improve glucose control; loss of 15% or more of bodyweight can have a disease-modifying effect in people with type 2 diabetes, an outcome that is not attainable by any other glucose-lowering intervention. Furthermore, weight loss in this population exerts benefits that extend beyond glycaemic control to improve risk factors for cardiometabolic disease and quality of life. We review the evidence supporting the role of weight loss in the management of type 2 diabetes and propose that many patients with type 2 diabetes would benefit from having a primary weight-centric approach to diabetes treatment. We discuss the logistical challenges to implementing a new weight-centric primary treatment goal in people with type 2 diabetes.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(21)01919-X