Why WAIT Program: A Novel Model for Diabetes Weight Management in Routine Clinical Practice

The prevalence of overweight and obesity has increased rapidly among U.S. adults, and in particular, among those diagnosed with type 2 diabetes mellitus (T2DM). Data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES) indicate that the prevalence of overweight and obesity among U.S. adults with diabetes now exceeds 85%. We previously demonstrated that modest weight reduction of approximately 7% over a 6-month period through caloric reduction and increased physical activity improved insulin sensitivity, endothelial function, and several markers of inflammation and coagulation in obese patients with and without diabetes.1,2 The ongoing Look AHEAD (Action for Health in Diabetes) study is exploring the health outcomes associated with modest weight loss maintained over 10 years using an intensive lifestyle intervention (ILI) that combines decreased caloric intake, increased physical activity, and behavior modification versus standard diabetes support and education (DSE) in patients with T2DM. The Look AHEAD study group recently published their first-year results, which are encouraging.3 They found that participants randomized to ILI lost an average of 8.6% of their initial body weight compared with 0.7% in the DSE group. Although both groups experienced blood glucose reductions compared to baseline, A1c improvement in the ILI group was significantly greater than that observed in the DSE group (absolute A1c reduction: −0.64% [ILI] versus −0.14% [DSE], p < 0.001; baseline A1c for both groups: ~7.3%). Notably, A1c lowering was Why WAIT Program: A Novel Model for Diabetes Weight Management in Routine Clinical Practice