Diabetes Standards of Care & Clinical Practice Resources

Weight Management, Overweight, and Obesity

Obesity and overweight, increasingly prevalent risk factors among American Indian and Alaska Native people with diabetes, increase insulin resistance, and raise blood glucose levels. In turn, they exacerbate diabetes complications and make diabetes management more complex. Therapeutic lifestyle changes designed to achieve weight loss are the core components of weight management counseling, and are essential for managing diabetes and its comorbidities.

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Weight Management, Overweight, and Obesity Sections

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Section 1 – Clinical Practice Recommendations: Weight Management, Overweight, and Obesity
Section 2 – Clinician and Educator Resources: Weight Management, Overweight, and Obesity
Section 3 – Patient Education Resources: Weight Management, Overweight, and Obesity

Clinical Practice Recommendations

Recommendations for Weight Management, Overweight, and Obesity

Assess weight and Body Mass Index (BMI) at diabetes visits.
Refer patients who are overweight (BMI 25.0-29.9 kg/m²) or obese (BMI ≥ 30 kg/m²) to structured community-based or clinic-based weight loss programs that emphasize goal setting, coaching, and motivational interviewing; education and skills development, physical activity, self-monitoring, problem solving, behavioral change, stress and stimulus control, the importance of social support, and the use of community resources.
Provide weight management counseling by a multidisciplinary team.
Bariatric surgery
- Providers may consider whether to discuss the option of bariatric surgery with diabetes patients who have:
  - BMI ≥ 40 kg/m², at any level of glycemic control or pharmacotherapy
  - BMI ≥ 30.0-39.9 kg/m², particularly when lifestyle therapy and pharmacotherapy fail to control diabetes
- Candidates for bariatric surgery should receive a comprehensive behavioral health assessment prior to surgery.
- Post-surgery
  - Provide ongoing lifestyle support and medical and nutritional monitoring.
  - Assess need for behavioral health services.

Classification of Weight and Body Mass Index (BMI)

Classification	BMI
Underweight	< 18.4 kg/m²
Normal	18.5-24.9 kg/m²
Overweight	25-29.9 kg/m²
Obesity (Class 1)	30-34.9 kg/m²
Obesity (Class 2)	35-39.9 kg/m²
Extreme Obesity (Class 3)	> 40 kg/m²