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Is continued weight gain inevitable in type 2 diabetes mellitus?

Endocrinology Harold Wood Hospital, Romford, Essex

D. Donaldson

East Surrey Hospital, Redhill, Surrey and Crawley Hospital, Crawley, West Sussex

Prevention and treatment of obesity are major clinical problems encountered in the management of Type 2 diabetes mellitus (DM); indeed, up to 90% of such patients are regarded as being overweight. Except for a brief period following diagnosis, when presumably enthusiasm to adopt lifestyle change is at its greatest, weight gain is generally progressive unless severe hyperglycaemia or complications inter vene. Even a relatively modest weight loss of 10% can have major benefits in terms not only of reducing the risk of developing DM in the first place, but also in improving metabolic control after the disorder has become established. Behavioural therapy (BT) in combination with a hypocaloric diet achieves weight loss in the short-term, but is poorly sustained in the long-term. Exercise has metabolic benefits beyond its rather minimal effects on short-term weight loss in that it may also aid long-term weight control. The difficulties encountered in maintaining lifestyle change do, however, suggest the need for ongoing intervention - perhaps including a regular period on a stricter dietary regimen (800-1000 kcalday^-1), possibly a very low calorie diet (VLCD) (<800 kcalday^-1) or even the use of orlistat, a pancreatic lipase inhibitor which reduces the absorption of dietary fat. Realistically, the aim should be for long- term weight stability.

Key Words: Diabetes mellitus (DM) Type 2 • diet • glycaemic control • obesity • very low calorie diet (VLCD)

The Journal of the Royal Society for the Promotion of Health, Vol. 119, No. 4, 235-239 (1999)
DOI: 10.1177/146642409911900406


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