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This issue discusses the relationship between diabetes and obesity. Articles highlight counseling skills, the HAES® approach, guidelines for interventions (physical activity, sleep hygiene, medications, surgery), and barriers to care.
To facilitate behavior change, a patient-clinician relationship built on trust and respect must be established. This issue begins with an overview of evidence-based theories and counseling modalities that can be used to develop collaborative relationships. Ms. Schwartz provides examples of statements and questions to put into practice in your sessions with patients in her article Using Language and Counseling Skills Effectively to Promote Sustained Behavior Change.
Dr. Heiss and colleagues provide an objective review on the Health at Every Size® (HAES®) approach in their article Can Health at Every Size® and Weight Management Coexist?. While there are some differences in the frameworks of weight management and HAES®, there is overlap in our ultimate goal: promoting well-being and quality of life for people living in all body sizes.
The next four articles provide guidelines for interventions that are effective in managing both obesity and T2D: physical activity, sleep hygiene, medications, and metabolic and bariatric surgery.
Physical activity provides physiological, metabolic and psychological benefits for people with obesity and T2D. Recognizing that not everyone has a positive relationship with physical activity, Dr. Creel and Mr. Szabo encourage clinicians to promote enjoyment and convenience when recommending the incorporation of activity into lifestyles in their article The Role of Exercise in Weight Management for People with Diabetes.
Historically, sleep health has not been incorporated into interventions for metabolic health. With sufficient evidence to support the role of sleep in obesity and T2D management, this essential lifestyle factor is finally receiving attention. In his article Sleep Disorders, Appetite Regulating Hormones, and Implications for Patients with Obesity, Dr. Gorman provides recommendations for addressing sleep health as a non-sleep professional.
While medications are commonly prescribed for T2D, this is not the case in obesity. As Dr. Bartfield describes in the article Pharmacological Management of Obesity and Diabetes Important Considerations for Optimal Patient Care, medications for obesity are greatly underutilized which may be a result of providers’ perceptions or lack of knowledge. Although registered dietitian nutritionists (RDNs) do not have prescribing capabilities, awareness of medications and their mechanisms is important for providing thorough care to people with diabetes and obesity.
Metabolic and bariatric surgery was added to the American Diabetes Association treatment algorithm in 2017 but remains underutilized. The metabolic and weight-independent effects of surgery are remarkable and can lead to remission of T2D. Ms. Ariagno outlines the essential role of the RDNs in optimizing the health of patients before and after surgery in her article Nutrition Management Before & After Metabolic and Bariatric Surgery for Patients with Type 2 Diabetes.
The last article, Barriers to Providing the Best Patient Care for People with Obesity, addresses some of the barriers to providing the best patient care, including weight bias and health disparities. Drs. Davidson and Crowley provide a call-to-action for clinicians to recognize their roles in perpetuating these barriers and to engage in advocacy for patients.
CPE Level: 2
Performance Indicators: 8.1.1, 8.2.3, 9.6.1
- Describe the multifactorial, metabolic and chronic nature of obesity
- Use language and counseling skills that promote respectful relationships when addressing overweight and obesity
- Develop interventions related to physical activity, sleep, and identify patients who would benefit from surgery or pharmacotherapy