Diabetes Discoveries & Practice Blog

Obesity Management in People with Diabetes

The approach to obesity management in people with diabetes can be much more challenging because of metabolic changes.

Because obesity is so prevalent, many health care professionals have the opportunity to help patients manage their weight. In the third and final video from the “Diabetes Care: Finding Common Ground with Guiding Principles” blog series, Dr. Scott Kahan discusses recommendations and resources that health care professionals can use to address obesity and weight management in patients with diabetes.

Download the Guiding Principles for the Care of People with or at Risk for Diabetes, updated in August 2018, to learn more about existing guidelines that have been synthesized to help primary care providers and health care teams deliver quality care to adults with or at risk for diabetes.

Clinicians often are quite hesitant to address obesity and weight management in practice, and I think a big part of that is feeling overwhelmed. There's so much to do in counseling on obesity. Often, we don't know where to start, and it seems like we should just move on to other areas of medicine. I think that's a mistake.

The approach to obesity management in patients with diabetes is not significantly different from addressing obesity in the general population, but it can be much more challenging in patients with diabetes because of the metabolic changes that can make it tougher. One of the nuances though, is that patients with diabetes are often on medications that can cause weight gain, and so identifying those when possible, changing them to weight-neutral or even weight-losing medications can be very helpful in their management.

Because obesity is so prevalent, most doctors are going to be in a position where they have the opportunity to help patients to manage their weight. Unfortunately, most physicians and other health care providers don't get much, if any, training on obesity in medical school and other health care professional training programs.

One of the things I frequently hear from clinicians is that even when they are ready to counsel a patient about obesity and weight management, that they're concerned that they may put off the patient or they don't otherwise know how to start the conversation, how to broach the sensitive topic. And I have one very straightforward recommendation on that: start by asking permission. Ask the patient if it's okay if we talked about weight during that encounter. It's a way of breaking the ice on an otherwise very sensitive – potentially very sensitive – topic, and it's a way of showing the patient that the patient’s in control, you're supporting their autonomy.

The most important thing, if possible, is to go to the published guidelines. They're very good. And if you take some time to read through those, you have a wealth of evidence-based information that you can apply in practice. Unfortunately, they can be fairly voluminous and dense, and so they tend not to be read by many providers.

A resource like the NDEP Guiding Principles can be extremely helpful for primary care providers that don't focus all the time on obesity because it gives the relevant evidence-based information in a digestible format with the key topics that primary care providers and other health care providers would benefit to know to help their patients.

I'm so excited that the Guiding Principles added a section on obesity and what's covered in there right now is valuable for clinicians and up-to-date with the evidence-based guidelines. But we keep learning more and more as we have better and better research in this area.

I think that primary care providers need to be at the center of weight management counseling. But I would offer two key suggestions to make it a little bit easier. One is don't try to do it all by yourself. The other is don't try to do it all at once. This is a chronic management condition, so we don't have to and we can't possibly solve it all in a single visit, in a single episode of care. And so just by way of starting the discussion, it goes a long way. And then it's something, just like diabetes, that clinicians can work with their patients, over the course of many months and years, to manage the weight and the weight-related health problems, rather than trying to solve it all at once.

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