Research Review by Dr. Shawn Thistle©



Study Title:

Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition.


Klein S, Sheard NF, Pi-Sunyer X, Wylie-Rosett J, Kulkarni K, Clark NG

Publication Information:

American Journal of Clinical Nutrition 2004; 80: 257-263.


he prevalence of Type 2 Diabetes (T2D, or the adult onset variety) is reaching epidemic proportions in North America. The link between obesity and T2D is now well established. Further, obesity is an established, independent risk factor for dyslipidemia (poor blood lipid/cholesterol profile), hypertension (high blood pressure), and cardiovascular and heart disease.

This paper represents a joint effort among 3 large organizations: The American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition (see links to these organizations below). The goal of this project was to review the available literature to develop evidence-based recommendations regarding the role of weight management in the prevention and treatment of T2D.

Conclusions & Practical Application:

Specific recommendations for the prevention and management of diabetes are listed below (taken directly from the paper).
  1. Weight loss is recommended for all overweight (BMI = 25.0-29.9) and obese (BMI 30.0) adults who have, or who are at risk of developing, type 2 diabetes.
  2. The primary approach for achieving weight loss is therapeutic lifestyle change, which includes a reduction in energy intake and an increase in physical activity.
  3. A moderate decrease in caloric intake (500-1000 kcal/d) will result in a slow but progressive weight loss (1-2 lb/wk, or 0.45-0.90 kg/wk). For most patients, weight-loss diets should supply 1000-1200 kcal/d for women and 1200-1600 kcal/d for men.
  4. Overweight and obese patients with diabetes are encouraged to adopt the dietary recommendations known to reduce the risk of coronary heart disease. In conjunction with a moderate reduction in caloric intake (500-1000 kcal/d), this diet is likely to result in moderate weight loss as well as improvements in cardiovascular disease risk factors. Dietary guidance should be tailored to each person, allowing for individual food preferences and approaches to reducing caloric intake.
  5. Physical activity is an important component of a comprehensive weight-management program. Regular, moderate-intensity physical activity enhances long-term weight maintenance. Regular activity also improves insulin sensitivity, glycemic control, and selected risk factors for cardiovascular disease (eg, hypertension and dyslipidemia), and increased aerobic fitness decreases the risk of coronary heart disease.
  6. Initial physical activity recommendations should be modest, based on the patient's willingness and ability; thereafter, the duration and frequency should increase to 30-45 min of moderate aerobic activity 3-5 d/wk when possible. Greater activity levels of 1 h/d of moderate (walking) or 30 min/d of vigorous (jogging) activity may be needed to achieve successful long-term weight loss.
Further, this paper contains general dietary recommendations from the American Diabetes Association and the American Heart Association:
  • Consume a variety of fruit, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, poultry, and lean meats
  • Limit foods high in saturated fat, trans fatty acids, and cholesterol; substitute with unsaturated fat from vegetables, fish, legumes, and nuts
  • Emphasize a diet rich in fruit, vegetables, and low-fat dairy products
  • Limit salt to 6 g/d (2400 mg Na) by choosing foods low in salt and limiting the amount of salt added to food
  • Limit alcohol intake to 2 drinks/d (men) or 1 drink/d (women)
In terms of specific dietary composition, the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults recommends:

Saturated fat2,3 < 7% of total calories
Monounsaturated fat 20% of total calories
Polyunsaturated fat 10% of total calories
Total fat 25-35% of total calories
Fiber 20-30 g/d
Protein 15% of total calories
Cholesterol3 < 200 mg/d
Carbohydrate4 50-60% of total calories

It is no coincidence if most of these recommendations and guidelines look familiar to you. Most have been in existence for a number of years now. What is alarming is the lack of adherence to these guidelines, as evidenced by the continuing rise of obesity, T2D, and all of the resulting health problems that accompany them.

If you, or someone you know, needs to begin implementing effective lifestyle management strategies, contact your qualified health care professional…putting off such action can have severe health consequences.