Is continued weight gain inevitable in type 2 diabetes mellitus?

Prevention and treatment of obesity are major clinical problems encountered in the management of Type 2 diabetes mellitus (DM); indeed, up to 90% of s uch patients are regarded as being overweight. Except for a brief period fo llowing diagnosis, when presumably enthusiasm to adopt lifestyle change is at its greatest, weight gain is generally progressive unless severe hypergl ycaemia or complications intervene. Even a relatively modest weighs loss of 10% can have major benefits in terms nor only of reducing the risk of deve loping DM in the first place, but also in improving metabolic control after the disorder has become established. Behavioural therapy (BT) in combinati on with a hypocaloric diet achieves weighs loss in the short-term, but is p oorly sustained in the long-term. Exercise has metabolic benefits beyond it s rather minimal effects on short-term weight loss in that it may also aid long-term weight control. The difficulties encountered in maintaining lifes tyle change do, however, suggest the need for ongoing intervention - perhap s including a regular period on a stricter dietary regimen (800-1000 kcalda y(-1)), possibly very low calorie diet (VLCD)(<800 kcalday-1) or even the u se of orlistat, a pancreatic lipase inhibitor which reduces the absorption of dietary far. Realistically, the aim should be for longterm weight stabil ity.