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U.S. Department of Health and Human Services
Division of Diabetes Treatment and Prevention (DDTP)

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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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

Clinician and Educator Resources

Integrating Case Management Into Your Practice [PDF – 290 KB]

Integrating DSMES Into Your Practice [PDF – 275 KB]

SDPI Diabetes Prevention Toolkit

IHS Division of Diabetes Treatment and Prevention

American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes: Standards of Medical Care in Diabetes 2021 Exit Disclaimer: You Are Leaving www.ihs.gov  Diabetes Care 2021;44(Suppl.1):S100-110. doi:10.2337/dc21-S008

American Diabetes Association

Overweight & Obesity Exit Disclaimer: You Are Leaving www.ihs.gov 

Centers for Disease Control and Prevention

Preventing Type 2 Diabetes Exit Disclaimer: You Are Leaving www.ihs.gov 

Talking with Patients about Weight Loss: Tips for Primary Care Providers Exit Disclaimer: You Are Leaving www.ihs.gov 

National Institute of Diabetes and Digestive and Kidney Diseases

Patient Education Resources

Online Catalog: Free Weight Management, Overweight, and Obesity Resources

IHS Division of Diabetes Treatment and Prevention

Aim for a Healthy Weight Exit Disclaimer: You Are Leaving www.ihs.gov 

National Heart, Lung, and Blood Institute

Preventing Type 2 Diabetes Exit Disclaimer: You Are Leaving www.ihs.gov 

National Institute of Diabetes and Digestive and Kidney Diseases

Overweight & Obesity Exit Disclaimer: You Are Leaving www.ihs.gov 

Prediabetes – Your Chance to Prevent Type 2 Diabetes Exit Disclaimer: You Are Leaving www.ihs.gov 

Centers for Disease Control and Prevention