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Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY (J.W.A.)
Risk Factor Medical Center, St. Michael’s Hospital and Department of Nutrition, University of Toronto, Toronto, CANADA (C.W.C.K., D.J.A.J.)
Address correspondence to: James W. Anderson, MD, Metabolic Research Group, 1030 S. Broadway St., Suite 5, Lexington, KY 40504-2681. E-mail: jwandersmd{at}aol.com
Obesity is a major risk factor for development of diabetes, and excessive energy intake is a major contributor to poor glycemic control in Type 2 diabetes. The impact of obesity on risk for diabetes as well as coronary heart disease (CHD) risk factors and the benefits of weight loss in decreasing risk for developing diabetes and improving glycemia and CHD risks were reviewed. A systematic review of the medical literature to assess the impact of obesity and weight gain on risk for diabetes and CHD was done. We performed a meta-analysis of the effects of weight loss for obese diabetic individuals. Controlled clinical trials assessing lifestyle changes on risk for developing diabetes and weight loss effects on glycemia and CHD risk factors were reviewed. Obesity and weight gain can increase risk for diabetes by greater than ninetyfold and CHD by about sixfold. Very-low-energy diets (VLED) decrease fasting plasma glucose values by 
50% within two weeks and these changes are sustained with continued energy restriction. Twelve weeks of energy-restricted diets were associated with these significant decreases: body weight, 9.6%; fasting plasma glucose, 25.7%; serum cholesterol, 9.2%; serum triglycerides, 26.7%; systolic blood pressure, 8.1%; and diastolic blood pressure, 8.6%. Larger weight losses were associated with larger reductions in these values. The reviewed data suggest that US health care providers should endorse the American Heart Association’s and European diabetes associations’ recommendations that diabetic persons achieve and maintain a BMI of 
25 kg/m2. Weight management may be the most important therapeutic task for most obese Type 2 diabetic individuals.
Key words: diabetes, obesity, coronary heart disease, weight loss, diabetes risk
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