Treatment of the morbidly obese diabetic patient in internal medicine

In morbidly obese diabetics (BMI > 35 kg/m(2)) there is an urgent need for effective and long-lasting weight reduction for several reasons. Since the therapeutic target is a weight loss of > 10 kg a pronounced negative energy balance has to be induced. As far as adjustments in nutrition are concerned, a reduction in fat intake or an increased consumption of fruits and vegetables alone is not sufficient. The foodstuffs selected should be low in density and portion sizes should be reduced. Energy expenditure in leisure time activities should exceed 2000 kcal/week. This level of activity is often limited by co-morbidities in the muscular-skeletal and cardiovascular system. Since only extensive changes in lifestyle lead to therapeutic effects and given that most of the patients concerned will fail to reach this therapeutic goal, anti-obesity drugs have to be taken into consideration. Weight loss is most effective when foodstuffs with low energy density, endurance as well as resistance training, anti-obesity compounds, and group sessions are combined.