In the annual update of American Diabetes Association standards for diabetes care, the language used for obesity and weight management for the prevention and treatment of type 2 diabetes is now person centered and expanded to reflect its importance and support in the clinical literature. The Obesity Society endorses the revised section.
The 2024 recommendations include these specifics:
• Recommendations 8.2a, 8.2b, and 8.3 were expanded to incorporate additional anthropometric measurements beyond BMI (i.e., waist circumference, waist-to-hip ratio, and/or waist-to-height ratio) to encourage individualized assessments of body fat mass and distribution.
• Recommendation 8.6 was added to highlight that approaches to treating obesity should be individualized and that any of the established approaches (i.e., intensive behavioral interventions, pharmacologic treatment, or metabolic surgery) can be considered in people with obesity and diabetes alone or in combination.
• Recommendation 8.8b was updated to suggest counseling strategies to address barriers to access.
• Recommendations 8.11a and 8.11b were updated to highlight the effectiveness of weight maintenance programs and to suggest monitoring weight loss progress while providing ongoing support for maintaining goals over the long term.
• Recommendation 8.17 was added to include glucagon-like peptide 1 (GLP-1) receptor agonists or a dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist with greater weight loss efficacy as preferred pharmacotherapy for obesity management in people with diabetes.
• Recommendation 8.18 was added to address the importance of reevaluation for obesity treatment intensification or deintensification for people with diabetes to reach their weight goals.
• The text of the “Metabolic Surgery” subsection was updated to emphasize preventing and addressing therapeutic inertia pertaining to weight management goals in people with obesity and type 2 diabetes.
• Recommendation 8.19 was updated in response to growing evidence of the long-term benefits of metabolic surgery treatment in people with obesity and type 2 diabetes.
• Recommendation 8.20 now includes a link to accredited metabolic and bariatric surgery centers.
• Recommendation 8.25 was added to emphasize the importance of monitoring weight loss progress of individuals who have undergone metabolic surgery. In the case of inadequate progress, potential barriers and additional weight loss interventions should be considered.
• Table 8.1 was updated to include the recent FDA approvals and price changes for several obesity pharmacotherapies.