Goal Setting in Obesity Management for People With Diabetes: Practical Recommendations

Dr Shehla Shaikh, Dept. of Endocrinology, Saifee Hospital and HN Reliance Hospital, Mumbai, India

In obese patients, structured, sustained weight loss of 5–10% should be a primary treatment goal to improve glycemic control, reduce cardiometabolic risk, and potentially achieve remission.

Obesity is a major pathophysiologic driver of type 2 diabetes and contributes to poor glycemic control, cardiovascular risk, and long-term complications. In individuals with diabetes and overweight or obesity, weight management should be a primary treatment goal alongside glycemic management.

The following recommendations guide goal setting and treatment planning in diabetes care:

• Use person-centered, nonjudgmental communication and person-first language (e.g., “person with obesity,” “person with diabetes”).
• Screen annually for overweight and obesity using BMI; consider additional anthropometric measures when appropriate.
• Monitor weight at least annually and every 3 months during active weight management.
• Make weight reduction a core therapeutic target in people with type 2 diabetes and overweight or obesity.
• Set realistic, individualized goals:
• Achieve at least 5–7% weight loss to improve A1C, blood pressure, lipids, and reduce medication needs.
• Aim for >10% weight loss when feasible, as greater reductions may substantially lower A1C and may support sustained diabetes remission in selected individuals.
• Recommend structured lifestyle interventions that include ≥16 sessions over 6 months, targeting a 500–750 kcal/day energy deficit through nutrition, physical activity, and behavioral strategies.
• Encourage at least 150 minutes/week of physical activity for overall metabolic and cardiovascular benefit.
• Prioritize glucose-lowering medications with weight benefit when selecting pharmacotherapy.
• Consider obesity pharmacotherapy or metabolic surgery when weight goals are not achieved with lifestyle therapy alone.
• Provide long-term maintenance support with regular follow-up, ongoing counseling, and frequent self-monitoring.

Effective obesity management in diabetes requires continuous care, shared decision-making, and sustained support to improve glycemic control, reduce cardiometabolic risk, and enhance quality of life.

(Source: American Diabetes Association Professional Practice Committee for Diabetes; 8. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes–2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S166–S182. https://doi.org/10.2337/dc26-S008 )