Continuing Education Activity

Obesity is a major global health concern and a leading contributor to the development and progression of type 2 diabetes (T2D). Since 1990, adult obesity has more than doubled, and childhood obesity has quadrupled. As of 2022, 1 in 8 people worldwide was living with obesity. Excess body weight increases the lifetime risk of T2D, from 7% to 70% in men and 12% to 74% in women, as body mass index (BMI) increases. Effective management of obesity is crucial for the prevention and treatment of T2D. Lifestyle interventions, pharmacological therapies, and bariatric surgery have all been shown to reduce the incidence of diabetes and improve glycemic control. Even modest weight loss (5%–10%) can lead to significant metabolic improvements and, in some cases, diabetes remission. Clinicians should screen all patients with obesity for T2D and follow evidence-based guidelines to tailor treatment. BMI remains the primary metric for classifying weight status, with lower thresholds recommended for Asian populations due to higher diabetes risk at lower BMI levels.

Although the World Health Organization classifies obesity as a chronic disease (code 5B81), its designation remains debated due to lacking a universal clinical definition. Regardless, early identification and comprehensive, individualized treatment are essential for reducing the global burden of diabetes. This activity reviews the treatment of patients with obesity and diabetes, including lifestyle modification, pharmacological therapy, and metabolic and bariatric surgery. This activity also underscores the importance of interprofessional collaboration in implementing evidence-based strategies and achieving optimal outcomes in preventing and managing these interrelated conditions.

Objectives:

• Identify the pathophysiological mechanisms linking obesity to the development and progression of type 2 diabetes.
• Implement individualized care plans that integrate weight loss strategies to improve glycemic control and reduce diabetes-related complications.
• Apply body mass index–based classification systems, including adjusted thresholds for Asian populations, to guide appropriate clinical decision-making.
• Collaborate with interprofessional healthcare professionals to support comprehensive obesity and diabetes care.

Access free multiple choice questions on this topic.

Introduction

Excess body weight and obesity are significant risk factors for type 2 diabetes (T2D). Clinicians should manage obesity in patients with T2D by adhering to guidelines from the American Diabetes Association and the American Obesity Association, which recommend lifestyle modifications, pharmacological therapies, and surgical options. At the Second Diabetes Surgery Summit (2016), an international consensus conference, experts developed a treatment algorithm for metabolic and bariatric surgery in patients with obesity and diabetes.[1][2] 

Issues of Concern

The lifetime risk of developing diabetes in men aged 18 or older increases from 7% to 70% as the body mass index (BMI) increases from less than 18.5 kg/m² to over 35 kg/m². In women, the risk increases from 12% to 74% across the same BMI values.[3] Given this strong association, diabetes screening is recommended for all patients with obesity. Managing obesity is crucial for both the prevention and treatment of T2D. Weight loss is associated with a significant reduction in the incidence of diabetes among at-risk populations. In the landmark Diabetes Prevention Program (DPP) trial (2002), participants who achieved modest lifestyle changes—losing 5% to 10% of baseline body weight and engaging in at least 150 minutes of physical activity per week—experienced a 58% reduction in the incidence of T2D compared with the placebo group.[4] 

Similarly, bariatric surgery has been associated with a fivefold decrease in T2D incidence over 7 years.[5] Weight loss is also effective in controlling T2D. Glycemic control improves proportionally with weight loss, sometimes resulting in remission.[6] Treating T2D starts with lifestyle changes, followed by medication and surgery if needed. BMI is the most commonly used measure to assess body weight, calculated by dividing a person's weight in kilograms by the square of their height in meters (kg/m²). BMI is used to classify individuals into the following categories:

• Underweight: <18.5 kg/m²
• Healthy weight: 18.5 to 24.9 kg/m² (18.5-22.9 kg/m² for Asian populations)
• Overweight: 25 to 29.9 kg/m² (23-27.4 kg/m² for Asian populations)
• Obese, class 1: 30 to 34.9 kg/m² (27.5-32.4 kg/m² for Asian populations)
• Obese, class 2: 35 to 39.9 kg/m² (32.5-37.4 kg/m² for Asian population)
• Obese, class 3: ≥40 kg/m² (≥37.5 kg/m² for Asian populations)

The upper BMI thresholds for each weight category are lower for individuals of Asian descent because of their higher body fat percentage and increased risk of T2D and cardiometabolic complications at lower BMI levels. Consequently, many international health organizations have adopted adjusted BMI cutoffs to more accurately classify overweight and obesity in Asian populations.[7]

Lifestyle Management

Obesity is a chronic medical condition and a known risk factor for the development of T2D. In patients diagnosed with overweight or obesity and T2D, treatment should begin with intensive lifestyle modifications, which include: 

• Self-management education for diabetes
• Nutritional counseling
• Increased physical activity
• Psychosocial care, when indicated
• Smoking cessation for smokers [8]

Patient self-management education fosters a deeper understanding of coexisting chronic conditions and enhances knowledge about self-monitoring and adherence to medical treatment. Patient education begins at the time of diabetes diagnosis, continues annually, and is revisited if complications arise.[9] Interprofessional healthcare providers play essential roles in patient education, including physicians, primary care clinicians, nurses, registered dietitians, and specialists. Effective teaching strategies include motivational interviewing, visual aids, printed handouts, and digital resources to reinforce learning and promote engagement.

Lifestyle modification aims to achieve at least a 5% weight loss, which is necessary to obtain meaningful health benefits.[10] The Look AHEAD trial offers extensive data on the impact of intensive lifestyle intervention (ILI), demonstrating sustained weight loss greater than 5% in over half of participants, with 27% achieving more than 10% weight loss at 8 years.[11] Participants in the ILI group required fewer medications for diabetes, hypertension, and lipid management.

A daily calorie deficit of 500 to 750 kcal is usually recommended for weight loss. This typically means a daily calorie target of 1200 to 1500 kcal for women and 1500 to 1800 kcal for men. Meal replacement plans can help some individuals reach their calorie goals, but they are generally unsuitable for long-term use. More sustainable and effective eating strategies include the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets.[12][13] Among intermittent fasting methods, modified alternate-day fasting and the 5:2 diet are the only approaches proven to cause statistically significant weight loss exceeding 5%.[14] 

The chosen diet should be tailored to the patient's cultural and dietary patterns, food availability, and factors such as hunger and access to healthy foods. All patients should have access to counseling sessions on nutrition, physical activity, and behavioral strategies to achieve weight loss. Standard intensive ILI includes more than 16 sessions over 6 months, with monthly follow-ups for those who achieve target weight loss after 1 year. However, this level of ILI may not be easily accessible or financially feasible in primary care settings.  Individuals with T2D and obesity should be encouraged to increase their physical activity gradually. Most professional guidelines recommend at least 150 minutes of moderate-intensity exercise per week. The optimal plan combines aerobic exercise with 2 to 3 resistance-training sessions per week. Daily physical activity or avoiding more than 2 consecutive days without activity helps reduce insulin resistance.[15]

Dietary sugar intake, particularly excess fructose consumption, plays an essential role in the development of insulin resistance and increased type 2 diabetes risk in individuals with obesity. Fructose is primarily metabolized in the liver, where high intake promotes de novo lipogenesis, hepatic fat accumulation, and metabolic dysfunction–associated steatotic liver disease (MASLD), all of which contribute to hepatic insulin resistance. Unlike glucose, fructose does not stimulate insulin or leptin secretion and does not adequately suppress ghrelin, potentially leading to increased caloric intake and weight gain. Diets high in added sugars, particularly sugar-sweetened beverages and ultra-processed foods, are consistently associated with poorer glycemic control, greater visceral adiposity, and higher cardiometabolic risk. Reducing intake of added sugars, particularly fructose-containing sweeteners, is therefore an essential component of lifestyle management for obesity and type 2 diabetes.

Regular screening for mood disorders and other psychosocial factors associated with diabetes and obesity is essential.[16][17] Addressing coexisting mental health conditions can enhance treatment adherence and improve outcomes in patients with obesity and T2D. Adolescents and adults with obesity and diabetes should be screened for tobacco use, including electronic cigarettes. Smoking is associated with an increased risk of developing diabetes, possibly by increasing insulin resistance.[18] Clinicians should offer counseling and consider appropriate pharmacological interventions to support smoking cessation.

Obesity Medical and Surgical Management in Type 2 Diabetes

The management of obesity in T2D has evolved rapidly since 2023, with tirzepatide emerging as the most effective Food and Drug Administration (FDA)-approved therapy, and newly approved cardiovascular indications broaden treatment eligibility.[19][20] Dual incretin agonists, such as trizepatide, now represent the gold standard for pharmacotherapy, while Roux-en-Y gastric bypass maintains its superiority among bariatric procedures.[21][2] Recent head-to-head clinical trials have demonstrated that tirzepatide produces approximately 47% greater weight loss than semaglutide, marking a paradigm shift in the management of obesity among patients with T2D.[22]

Evidence from randomized clinical trials establishes a clear hierarchy of effectiveness: tirzepatide achieves up to 20.2% weight loss with superior glycemic control, while investigational triple agonists, such as retatrutide, show unprecedented 24% weight loss in clinical trials.[23][24] The updated 2024–2025 clinical guidelines now emphasize complication-centric approaches rather than relying solely on BMI thresholds, with early, intensive intervention shown to be critical for long-term success.[25][20] Real-world data reveal substantial effectiveness gaps relative to clinical trials, underscoring the importance of multidisciplinary care models and appropriate patient selection for optimal outcomes.[26]

FDA-Approved Therapies and Investigational Agents

The FDA has significantly expanded obesity treatment options through strategic approvals and indication extensions. Tirzepatide (Zepbound) received FDA approval on November 8, 2023, becoming the first dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist approved for chronic weight management.[23] This landmark approval was followed by an unprecedented December 2024 indication expansion for moderate-to-severe obstructive sleep apnea, making it the first medication approved for this condition.[US Food and Drug Administration. FDA approves Zepbound (tirzepatide) as the first and only prescription medicine for moderate-to-severe obstructive sleep apnea in adults with obesity [Internet]. Silver Spring (MD): U.S. Food and Drug Administration; 2024 Dec [cited 2025 Jan 15]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-zepbound-tirzepatide]

Semaglutide (Wegovy) received a pivotal indication for cardiovascular risk reduction on March 8, 2024, based on the SELECT trial, which demonstrated a 20% reduction in major adverse cardiovascular events.[27] This expansion opened Medicare coverage pathways and established weight management as a cardiovascular intervention. The FDA also approved the first generic of liraglutide (Teva Pharmaceuticals) in August 2025, resulting in approximately 30% cost reduction compared to the branded Saxenda.[US Food and Drug Administration. FDA approves first generic liraglutide injection for chronic weight management. https://www.fda.gov/news-events/press-announcements/fda-approves-generic-liraglutide]

Investigational agents remain in development phases. Retatrutide, the highly anticipated triple hormone agonist, continues Phase 3 TRIUMPH trials with FDA approval expected in 2026-2027.[7] See Table 1. Despite promising 24.2% weight loss in phase 2 studies, it remains unavailable for clinical use and cannot be compounded under federal law. Similarly, survodutide completed Phase 2 trials, showing a 19% weight loss, and received Breakthrough Therapy designation in September 2024. However, Phase 3 results will not be available until 2025 or 2026.[28]

Table

Table 1. Comprehensive Medication Efficacy and Safety Profiles of FDA-Approved Obesity Medications for Type 2 Diabetes: Clinical Data Table.

BID, twice daily; GABA, gamma-aminobutyric acid; GIP, glucose-dependent insulinotropic polypeptide; GLP-1, glucagon-like peptide-1; HbA1c, hemoglobin A1c; MEN-2, multiple endocrine neoplasia type 2; MTC, medullary thyroid carcinoma; NDRI, norepinephrine-dopamine reuptake inhibitor; SC, subcutaneous; T2D, type 2 diabetes; TID, three times daily.

* Tirzepatide is approved by the U.S. Food and Drug Administration (FDA) as Mounjaro® for the treatment of type 2 diabetes and as Zepbound® for chronic weight management in adults with obesity or overweight with at least one weight-related comorbidity.

**Semaglutide is approved by the FDA as Ozempic® (injectable) and Rybelsus® (oral) for the treatment of type 2 diabetes, and as Wegovy® for chronic weight management in adults with obesity or overweight with at least one weight-related comorbidity.

 Data demonstrate tirzepatide's superiority across all efficacy metrics, achieving nearly double the weight loss of semaglutide in patients with T2D while providing superior glycemic control.[21][22] Recent STEP UP trial data show that investigational semaglutide 7.2 mg achieves a 20.7% weight loss, suggesting potential for enhanced GLP-1 agonist effectiveness with higher dosing. (US Food and Drug Administration. FDA approves first generic liraglutide injection for chronic weight management [Internet]. Silver Spring (MD): FDA; 2025 Aug [cited 2025 Sep 15]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-generic-liraglutide)

Advanced Therapies and Comparative Effectiveness

Head-to-head trials establish clear efficacy rankings among current therapies. The landmark SURMOUNT-5 trial directly compared tirzepatide with semaglutide, demonstrating tirzepatide's 47% greater weight-loss efficacy (20.2% vs 13.7%; P < 0.001) and a better tolerability profile.[22] Real-world evidence from 18,386 propensity-matched patients confirms these findings, showing consistently higher rates of achieving 5%, 10%, and 15% weight-loss thresholds with tirzepatide.[26]

Investigational triple agonists represent the future of obesity pharmacotherapy (see Table 2). Retatrutide's phase 2 results in patients with T2D showed a remarkable 16.9% weight loss, with 82% achieving an HbA1c of less than 6.5%, whereas obesity trials demonstrated an unprecedented 24.2% weight loss at 48 weeks.[24] Survodutide's dual glucagon/GLP-1 mechanism achieved an 18.7% weight loss, with nearly 40% of patients meeting a weight-loss threshold of>20%.[28] Combination therapies show exceptional promise. The investigational CagrANDsema (cagrilintide + semaglutide) achieved 14.13 kg weight reduction in network meta-analyses, representing the most effective combination studied to date.[26] These findings suggest that combination approaches may bridge effectiveness gaps while maintaining acceptable safety profiles. 

Table

Table 2. Bariatric Surgery Outcomes and Recommendations in Patients With Type 2 Diabetes .

BPD, biliopancreatic diversion; EWL, excess weight loss; HbA1c, hemoglobin A1c; LAGB, laparoscopic adjustable gastric banding; RYGB, Roux-en-Y gastric bypass; TWL, total weight loss; VSG, vertical sleeve gastrectomy.

RYGB is the optimal surgical approach for most patients with T2D, according to evidence from 2023 to 2025. The procedure achieves superior diabetes remission rates compared to VSG (75% vs 34.8% sustained remission at 5 years), with acceptable complication rates.[34] The 12-year follow-up data from the ARMMS-T2D study confirm surgery's superiority over medical therapy, with 54% maintaining HbA1c levels below 7%, compared with minimal improvement with medical therapy.[39]

Updated surgical guidelines reflect expanding indications. The American Diabetes Association's 2025 Standards now recommend metabolic surgery for individuals with a BMI of 35 or higher and T2D, with consideration given to those with a BMI of 30 to 34.9 who have inadequate glycemic control.[20] Asian populations are assigned lower thresholds (BMI ≥27.5) based on their metabolic risk profiles.[20] The evidence demonstrates that baseline BMI does not predict glycemic or cardiovascular benefits, emphasizing metabolic dysfunction over weight thresholds.[2]

Clinical Application and Treatment Algorithms

Updated 2024–2025 treatment algorithms emphasize complication-centric approaches rather than relying solely on BMI thresholds.[20][25] The ADA Standards of Care recommend weight management as a primary treatment goal alongside glycemic control, and recommend GLP-1 and dual GIP/GLP-1 agonists as preferred agents due to their combined benefits.[20] The AACE algorithm incorporates the adiposity-based chronic disease (ABCD) framework, recognizing obesity as a chronic condition requiring long-term management.[20][25]

Real-world data highlight substantial challenges in implementation. While academic obesity clinics achieve clinical trial outcomes with 73.8% medication persistence at 6 months, general practice settings demonstrate only 32.3% persistence after a year.[26] Early weight loss response within the first 4 weeks consistently predicts long-term success across multiple studies, providing crucial decision points for optimizing or escalating treatment.[26]

Patient selection criteria focus on individualized risk-benefit assessments. Predictors of medication success include younger age, shorter diabetes duration, higher pretreatment weight, and early response patterns.[26] Patients with complex comorbidity with established cardiovascular disease benefit significantly from semaglutide's proven 20% reduction in major adverse cardiovascular events. Tirzepatide shows emerging real-world cardiovascular benefits, with a 46% reduction in cardiovascular disease risk compared with semaglutide.[40][27]

Evidence for Clinical Decision-Making Scenarios

Complex comorbidity management requires integrated approaches. For patients with a BMI of 40 or greater and multiple comorbidities (cardiovascular disease, chronic kidney disease, and obstructive sleep apnea), early intensive intervention with dual incretin agonists is supported.[20][25] Real-world data show that inflammatory markers nearly double with each increase in weight class, whereas tirzepatide demonstrates superior cardiovascular risk reduction in established patients with cardiovascular disease.[27][40] The SELECT trial's cardiovascular outcomes with semaglutide provide additional evidence that weight management can be considered a cardiovascular intervention.[27]

Medication failure progression follows predictable patterns. Studies demonstrate that patients with longer diabetes duration, insulin use, and poor early response are more likely to progress to surgical evaluation.[34] The STAMPEDE trial's 5-year data show that surgery achieves a 29% target HbA1c achievement compared to 5% with medical therapy in patients who failed initial management.[34] Bariatric surgery provides diabetes remission even in patients with medication failures, with sustained benefits despite potential diabetes recurrence.[35]

Treatment selection algorithms incorporate real-world effectiveness data. For newly diagnosed T2D patients with obesity, early combination therapy with weight-centric medications (tirzepatide > semaglutide > liraglutide) provides optimal outcomes.[20][25] Multidisciplinary support systems are essential for medication persistence and long-term success, with evidence demonstrating significant improvements in outcomes in structured programs compared with standard care.[26]

Pharmacotherapy for Complex Comorbidities

Table

A 52-year-old woman with newly diagnosed T2D (BMI 38 kg/m², HbA1c 8.9%) presents with hypertension, dyslipidemia, mild obstructive sleep apnea, metabolic syndrome, microalbuminuria, and fatty liver. She has not achieved sustained weight (more...)

Surgical Candidacy After Medical Review

Table

A 46-year-old man with 8-year T2D (BMI 42 kg/m², HbA1c 9.2%) has inadequate control despite metformin, semaglutide, and insulin. He has early retinopathy, chronic kidney disease stage 3a, neuropathy, and has gained 12 kg over 3 years. He discontinued (more...)

The evidence establishes a clear treatment hierarchy for obesity management in T2D, with tirzepatide representing the current gold standard for pharmacotherapy and Roux-en-Y gastric bypass maintaining surgical superiority.[21] Investigational triple agonists promise unprecedented efficacy, while real-world implementation challenges emphasize the critical importance of patient selection, early intervention, and comprehensive care models.[24] Integrating complications-centric treatment algorithms with proven cardiovascular benefits positions obesity management as a fundamental component of comprehensive diabetes care, with emerging therapies offering hope for transformative outcomes in this challenging patient population.[25]

Clinical Significance

Many healthcare quality metrics assess the effectiveness of diabetes prevention and treatment. Obesity is a significant risk factor for T2D, influencing both its development and severity. Early screening of patients with obesity, combined with intensive therapy, can lead to long-term improvement or remission. Strict diabetes control reduces complications such as ketoacidosis, diabetic ulcers, amputations, soft tissue infections, and osteomyelitis. Additionally, aggressive management of HbA1c lowers the risk of coronary artery disease and chronic kidney disease.

Enhancing Healthcare Team Outcomes

Diabetes is a chronic, disabling disease, and the rising obesity epidemic is contributing to its increasing prevalence. Treating obesity is essential for preventing and managing T2D, with successful results depending on coordinated, team-based care among healthcare providers. Early detection of patients with obesity in primary care is a vital first step toward achieving optimal clinical outcomes.

Primary care nurses are often the first point of contact and must accurately measure height and weight, calculate BMI, and document these measurements. Nursing staff should also review dietary habits and physical activity at baseline and during each follow-up visit. Patients with an elevated BMI are at an increased risk for T2D and should be informed of their BMI category during treatment discussions. Clinicians should support patients in setting individualized weight loss goals, ideally aiming for at least a 10% reduction in body weight to achieve meaningful metabolic improvements. Intensive lifestyle interventions and pharmacotherapy should be initiated in accordance with current clinical guidelines.

Suboptimal glycemic control should be evaluated and managed at every visit. Inadequate weight loss (defined as less than 10%) and ongoing hyperglycemia should prompt referral to an obesity medicine specialist or bariatric surgeon for further evaluation and treatment. Physicians, surgeons, and clinicians often collaborate in multidisciplinary weight loss programs. Obesity medicine physicians help patients achieve the target weights needed for surgical eligibility. They also play a critical role postoperatively by identifying complications and supporting healthy behaviors to maintain ongoing weight loss. Although many patients are ineligible for metabolic surgery due to operative risks from advanced cardiac or pulmonary disease, obesity medicine teams can still achieve positive outcomes for this population.

Registered dietitians, nutritionists, and therapists are essential members of the healthcare team, providing regular sessions to support optimal nutrition and physical activity. These healthcare teams may be led by trained dietitians, therapists, nurses, physicians, or surgeons. Endocrinology consultations can offer additional strategies for managing persistent hyperglycemia. High-risk patients may require preoperative assessments by cardiologists or pulmonologists, and procedures should be performed in centers with on-site cardiac and pulmonary critical care. Pharmacists play a vital role in adjusting medication dosages, particularly in the perioperative period, as many drugs require weight-based dosing modifications after surgery.

The anesthesia team performs preoperative assessments and manages anesthesia-related issues during and after metabolic procedures. Physical therapists assist patients in strengthening muscles during the postoperative period. Because obesity is often linked with mental health conditions such as anxiety, depression, and body image issues, psychiatry or psychology consultations should be considered when appropriate. Obesity and T2D are long-term, systemic conditions that need a coordinated approach for effective prevention and management. Interprofessional healthcare team members should support patients throughout their evaluation and treatment, providing ample resources and guidance to help them make informed decisions and achieve optimal clinical outcomes.

Nursing, Allied Health, and Interprofessional Team Interventions

Interprofessional interventions focus on identifying T2D in patients with obesity. Clinicians need to recognize medications that cause weight gain and consider prescribing suitable alternatives. Nurses record the BMI at each visit and notify the clinician when the value exceeds 25 kg/m². Patients meeting this threshold are screened for T2D if they have not been previously tested. Primary care clinicians recommend lifestyle interventions for all individuals with a BMI of 25 kg/m² or higher. Standard written instructions about diet and exercise are reviewed at each visit.

Clinicians assist patients in setting realistic, measurable weight loss goals, aiming for a BMI below 25 kg/m² or a 5% to 10% weight loss. A BMI over 30 kg/m² alerts clinicians to consider ILI and pharmacological treatments. Registered dietitians and nutritionists provide patients and families with the knowledge to make informed, healthy dietary choices. Effective outcomes rely on an interprofessional approach with clear communication between primary care clinicians and endocrinologists. When ILI and pharmacotherapy do not achieve adequate diabetes control and weight loss, timely referral to bariatric and metabolic surgeons is crucial for optimal care.

Nursing, Allied Health, and Interprofessional Team Monitoring

Members of the interprofessional team caring for patients with diabetes and obesity monitor HbA1c, body weight, BMI, and lifestyle changes at every visit. Clinicians educate patients about potential adverse effects of medication and adjust doses as needed, and pharmacists reinforce this counseling and manage medication reconciliation. After metabolic surgery, patients require close monitoring by the healthcare team. Although surgical patients require fewer medications because of improved metabolic parameters, they have a higher risk of hypoglycemia. Nurses identify and document complications such as wound dehiscence, perforation, and signs of infection, and promptly alert physicians and other prescribing clinicians. Clinicians, dietitians, and nutritionists assess for signs of metabolic derangements, including vitamin and mineral deficiencies or malabsorption syndromes. Avoiding continuous use of nonsteroidal anti-inflammatory drugs during the first month helps prevent erosion of anastomosis sites. Internal quality metrics evaluate remission rates, procedural safety, postoperative recovery, and long-term outcomes after surgery.

Obesity increases the risk of T2D, cardiovascular disease, and numerous other chronic health conditions. Effective healthcare teams routinely screen for obesity and diabetes, using BMI to assess the severity of obesity. ILI and pharmacological therapy aim for at least 10% weight loss. Patients who do not achieve adequate weight loss or glycemic control despite optimal medical treatment should be referred for bariatric surgery. Over the past 2 decades, these procedures have become increasingly safe and effective. Continued postoperative monitoring by the interprofessional team is essential for early detection of complications and sustained clinical improvement.

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Disclosure: Venkata Sushma Chamarthi declares no relevant financial relationships with ineligible companies.

Disclosure: Chhavi Garg declares no relevant financial relationships with ineligible companies.

Disclosure: Sharon Daley declares no relevant financial relationships with ineligible companies.