The United States Preventive Services Task Force (USPSTF) recently published a recommendation statement on behavioral interventions for weight loss in adults with overweight or obesity. Susan Z. Yanovski, MD, co-director of the NIDDK’s Office of Obesity Research, shares insight on how benefits of behavioral weight management treatment can apply to the care of people with diabetes.

Q: Why is weight loss or weight management important for people with diabetes?

A: Most adults with type 2 diabetes have overweight or obesity, and people with diabetes have an increased risk of health conditions including cardiovascular disease and chronic kidney disease. Losing weight can help to improve blood glucose, blood pressure, and blood fats, including cholesterol and triglycerides. Although behavioral weight loss treatment may not necessarily reduce the risk of cardiovascular events, it does have many additional health benefits in people with diabetes.

Some people with type 1 diabetes may also have overweight or obesity and benefit from weight loss. They will need to work closely with their physician to determine the safest way for them to manage their weight while also controlling their blood glucose and avoiding hypoglycemia.

Q: The USPSTF recommends that for adults with a body mass index of 30 or greater, health care professionals should offer intensive, multicomponent behavioral interventions. What does this entail?

A: Behavioral interventions for weight management provide a series of skills to help people lose weight and maintain weight loss. These interventions can target diet and physical activity as well as stress and sleep. Examples of behavioral interventions include self-monitoring of diet and physical activity, goal setting, help with problem solving and social support, and preventing relapse. Multicomponent behavioral interventions can be provided in groups or individually, and they can be provided in-person, on the telephone, or online. The most effective programs are of high intensity, which has been defined as 14 sessions or more over 6 months. 

Q: Few physicians have the time to provide a multicomponent behavioral intervention, so what should they do?

A: Health care professionals with the skills and the time may offer these treatments themselves, but many will want to refer to other providers or programs. Fortunately, multicomponent interventions don’t have to be provided by physicians to be effective. Interventions can be provided by other health professionals such as registered dietitians or nurses, psychologists, exercise specialists, or even trained laypeople. Intensive multicomponent behavioral treatment can be provided in specialized programs in medical settings, community-based programs, or even commercial programs that have published research showing evidence of their effectiveness.

Regardless of whether clinicians personally provide behavioral weight management treatment, they have an important role to play in evaluating and monitoring their patients’ medical conditions and medications during treatment, and in providing referrals to trusted providers or programs, including bariatric surgery programs where appropriate. 

Q: The USPSTF recommendation statement is based on trials that did not target people with diseases, such as diabetes, for which weight loss can be part of disease management. Nonetheless, what can health care professionals treating people with diabetes take away from the statement?

A: Although the USPSTF did not review weight management programs that primarily targeted individuals with conditions such as diabetes or cardiovascular disease, their findings on the benefits of behavioral weight management treatment should be applicable to patients with these conditions as well. For example, the Look AHEAD study, which was not reviewed by the USPSTF, was an NIDDK-funded clinical trial of the impact of intensive lifestyle intervention on health outcomes in 5,000 adults with type 2 diabetes and with overweight and obesity. Although there was no reduction in cardiovascular disease outcomes, this study showed multiple health benefits associated with weight loss, including improvements in sleep apnea, chronic kidney disease, sexual functioning, depression, physical health-related quality of life, and mobility and physical functioning.

Q: What are the evidence gaps regarding weight management for people with diabetes and overweight or obesity?

A: Many identified gaps are applicable to people with overweight or obesity, regardless of other medical conditions. For example, there is a need for more information about how weight management treatment affects important patient-centered outcomes, like how a person feels and functions. We also need more information about the best ways for health care professionals to provide ongoing medical care for patients who are referred to specialists for some aspect of their weight management treatment. This may be particularly important for patients with diabetes, who may need adjustments in diabetes medications as they lose weight. Another research area to be explored is the impact of obesity medications, as well as some of the more recent surgical procedures and devices, on the health of people with type 2 diabetes. 

Q: What is the NIDDK doing to help close the research gaps?

A: The NIDDK is funding research to improve care for patients with diabetes and overweight and obesity, ranging from basic science studies that are looking at genetic, metabolic, and behavioral factors that may increase health risks or responses to treatment, to finding new and innovative ways to provide care for people who may not be able to access in-person multicomponent behavioral treatment in their communities.

One important area is our initiative to encourage research to improve diabetes and obesity prevention and treatment in health care settings. We are also continuing to follow participants in the Look AHEAD study to see if participating in multicomponent behavioral treatment has a long-term beneficial effect on healthy aging, including cognitive function and disability. And, of course, our ultimate goal is to prevent both obesity and diabetes, so we are funding a number of studies targeting prevention across the lifespan, including in women before and during pregnancy, children and adolescents, and adults.

Q: How can health care professionals help people with diabetes and overweight or obesity, but who aren’t losing weight?

A: Many people struggling with obesity are very successful in many other areas of their lives, but for a number of reasons—genetic, metabolic, behavioral—it’s just really difficult for them to lose weight and maintain weight loss. Health care professionals need to work with their patients as partners and recognize it’s going to be a lifelong struggle. It’s also important to address other related health problems regardless of whether the patient is motivated right now or able to lose weight. We don’t want health care professionals saying, “Well, if you’d only lose weight your blood pressure would go down, so keep trying and trying,” and not managing the patient’s blood pressure with medications.

What are the challenges or concerns you have when it comes to implementing behavioral weight loss interventions? Share below in the comments.