Studies that aim to reduce obesity or prevent it from developing are relevant to the prevention of type 2 diabetes, since obesity is one of the major modifiable risk factors. Like diabetes, overweight and obesity have been the outcomes for a large number of clinical trials and observational studies exploring risk factors for their development and reduction. Comprehensive reviews of obesity prevention issues and approaches have been published13,163,262-264 and it is not possible to review them here. The interventions studied have been similar to those for type 2 diabetes, and have focused on lifestyle modification as well the use of selected pharmacological agents that may reduce weight. No large RCTs have investigated the prevention of obesity (in contrast to obesity reduction) as it relates to type 2 diabetes.
Several community-based cardiovascular prevention studies have included obesity as one of several outcomes, often with limited success265-267. However, hypertension prevention trials with individual, rather community interventions, have often used weight loss and prevention of weight gain to decrease BP. While BP was the primary outcome, it is of interest to note that several of these studies achieved and maintained significant weight loss over 18 months to five years268-270. These studies, seldom cited in the diabetes or weight loss literature, offer hope that sustainable weight loss and weight gain prevention are possible using intensive interventions. Had these studies included measures of glucose tolerance, we would be much closer to an answer about the role of weight loss and obesity prevention on the incidence of diabetes.
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