Interventions to address obesity are recommended as treatments for type 2 diabetes. In this article, nationally representative data are used to describe behavioral, pharmacologic, and surgical interventions employed by adults with diabetes for obesity treatment. Literature focused on youth with type 2 diabetes is also reviewed.
Data from the National Health and Nutrition Examination Survey (NHANES) 2015–2018 showed that only 2.3% of U.S. adults with diagnosed diabetes had Healthy Eating Index (HEI) scores ≥80 indicating a “good” diet, while 44.6% had HEI scores <50 indicating a “poor” diet. Data from the NHANES 2015–2020 showed that only 47.0% of U.S. adults with diabetes reported meeting physical activity standards, 15.6% achieved less than the recommended amount of physical activity, and 37.4% reported no physical activity. Between 2015 and 2020, NHANES data showed that 36.7% of U.S. adults with diagnosed diabetes reported attempting to lose weight in the past year. In order of decreasing frequency, the following weight reduction strategies supported by scientific evidence were reported: eating less, eating healthier, exercising, eating special diets, joining weight loss programs, taking prescription medications, and undergoing weight loss surgery.
The American Diabetes Association recommends that providers and patients consider the impact of antihyperglycemic medications on weight. Data from the NHANES 2015–2020 showed that metformin, which is associated with modest weight loss, was the most frequently prescribed antihyperglycemic agent (43.8%). Sulfonylureas and insulins, which are associated with weight gain, were the next most frequently prescribed classes of antihyperglycemic medications (23.2% and 22.0%, respectively). The frequency of prescribing glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), which are associated with weight loss, was 5.0%. Rates of GLP-1 RA use among commercially insured adult patients with type 2 diabetes increased substantially between 2015 and 2019 (3.2% to 10.7%) and have increased more in recent years but remain lower among Asian, Black, and Hispanic patients, those with lower incomes, and among adult patients with atherosclerotic cardiovascular disease, who are known to benefit from this class of medications.
Data from the Healthcare Cost and Utilization Project 2019 showed that metabolic (bariatric) surgery was infrequently performed as an inpatient (~1.4 per 100 per year) or outpatient (~2.0 per 100 per year) procedure among U.S. adults with diagnosed type 2 diabetes despite an increase in the total number of metabolic surgery procedures performed between 2015 and 2019 (n=163,072 to 202,804). The American Diabetes Association recommends considering metabolic surgery for adolescents with type 2 diabetes and body mass index (BMI) ≥35 kg/m2. Anti-obesity medications appear to be effective but require further study in youth.