Is weight loss a realistic goal of treatment in type 2 diabetes? The implications of restraint theory

Obesity is a two-fold problem affecting both physical health and psychological well-being and one of the biggest obstacles to the management of type 2 diabetes because the most effective treatments frequently lead to weight gain. Recent studies have shown that addressing the problem of obesity first can lead to an improvement in blood glucose control, accompanied by favourable changes in physiological profiles. With the exception of surgical treatments, all obesity treatment programmes involve recommending dieting in one form or another, in order that individuals lose weight. However, all reviews document the failure of all obesity treatment approaches, behavioural, dietetic or pharmacological, to achieve significant and long-lasting weight loss. Research further suggests that dietary restraint may have many negative consequences and weight fluctuation may also have profound effects on psychological and physical health. The present paper highlights the need to reappraise the management of obesity in type 2 diabetes in light of these research findings and suggests an approach to treatment, which would help patients to limit the associated physical and psychological costs and importantly ensure that the treatment itself does not compound their difficulties. (C) 2004 Elsevier Ireland Ltd. All rights reserved.