weight loss include socioeconomic
status, an unsupportive environment,
and physiological changes (e.g.,
compensatory changes in circulating
hormones that encourage weight regain
after weight loss is achieved) (86).
The optimal macronutrient intake to
support reduction in excess body weight
has not been established. Thus, the
current state of the literature does not
support one particular nutrition therapy
approach to reduce excess weight, but
rather a spectrum of eating patterns
that result in reduced energy intake.
A weight loss of .6 kg (approximately a
7–8.5% loss of initial body weight),
regular physical activity, and frequent
contact with RDs appear important for
consistent beneficial effects of weight
loss interventions (85). In the Look
AHEAD study, weight loss strategies
associated with lower BMI in
overweight or obese individuals with
type 2 diabetes included weekly selfweighing,
regular consumption of
breakfast, and reduced intake of fast
foods (87). Other successful strategies
included increasing physical activity,
reducing portion sizes, using meal
replacements (as appropriate), and
encouraging individuals with diabetes to
eat those foods with the greatest
consensus for improving health.
Health professionals should collaborate
with individuals with diabetes to
integrate lifestyle strategies that prevent
weight gain or promote modest, realistic
weight loss. The emphases of education
and counseling should be on the
development of behaviors that support
long-term weight loss or weight
maintenance with less focus on the
outcome of weight loss. Bariatric surgery
is recognized as an option for individuals
with diabetes who meet the criteria for
surgery and is not covered in this review.
For recommendations on bariatric
surgery, see the ADA Standards of
Medical Care (1).
Optimal Mix of Macronutrients
c Evidence suggests that there is not an
ideal percentage of calories from
carbohydrate, protein, and fat for all
people with diabetes B; therefore,
macronutrient distribution should be
based on individualized assessment of
current eating patterns, preferences,
and metabolic goals. E