Article Summary Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies. Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG. Diabetes Care. 2004;27:2067-2073. Objective: To review the role weight management plays in prevention and management of type 2 diabetes and to provide lifestyle modification strategies for patients. Observation: Obesity is up to 7 times more prevalent in patients with type 2 diabetes than in patients of normal weight. People with a body-mass index (BMI) of >35 kg/m2 are 20 times more likely to develop type 2 diabetes than are those with BMI between 18.5 kg/m2 and 24.9 kg/m2. In patients with type 2 diabetes, even moderate weight loss of 5% may show improvement in insulin action, a decrease in fasting plasma glucose levels, and a reduction in the need for diabetes medications, although patients with severe ß-cell dysfunction or long-standing disease are not as responsive to weight loss as are patients with less severe disease. In high-risk populations, such as those with impaired glucose tolerance (IGT), moderate weight loss and increased physical activity can prevent or delay the onset of type 2 diabetes. The National Heart, Lung, and Blood Institute (NHLBI) Obesity Education Initiative (OEI) Expert Panel recommends lowering BMI through a low-calorie diet that includes a decrease in total daily calories of 500 to 1000 kcal/day for women and 1200 to 1600 kcal/day for men, along with increased physical activity. In 5 controlled trials, patients with type 2 diabetes who were randomized to low-carbohydrate diets realized more improvement in glycemic control than those randomized to low-fat diets. Physical activity is a recognized component of any weight-reduction program and increases the long-term benefits of weight management. The NHLBI OEI Expert Panel recommends aerobic exercise of moderate to intense activity of 30 to 45 minutes, 3 to 5 days per week, gradually increasing the intensity and duration. Conclusion: The role of the physician is to encourage, monitor, and support patients during this behavior and lifestyle modification phase. The initial recommendation for patients is to begin a physical activity program that is modest and based on their willingness and ability to participate actively in managing their type 2 diabetes.