Several studies have documented that lifestyle intervention is the capable one to reduce body weight in obese people. Diabetes Prevention Program4 did a comparison of weight loss percentage by giving lifestyle intervention, placebo, and metformin to obese people. The result stated that after four years, lifestyle intervention which is the combination of dietary modification, physical activity, and behavior therapy gives more significant weight loss by 58% compared to placebo and 39% compared to metformin.
In Look AHEAD study,10 it examined the effect of intensive lifestyle modification on obese, type 2 diabetic people. After a year, those who were given intensive lifestyle modification lost weight up to 8.6% from initial body weight. It is observed11 that a weight loss up to 7% of body weight can reduce the risk of developing type 2 diabetes by more than 55%.
Physical activity also takes an important weight loss contribution in obese, diabetic people. Continuous low-intensity exercise training can improve fat oxidation by 44% while moderate-to-high intensity exercise training is more beneficial to increase insulin sensitivity.12 In a cohort study, daily physical activity, like walking, can lower the risk of type 2 diabetes. Finnish Diabetes Prevention found that walking for 2.5 hours per week can lower the incident of diabetes by 63-69%.13
Weight loss is the result of dietary modification and physical activity if they produce energy deficit. After having weight loss, it’s crucial to maintain the reduced weight so that weight regain doesn’t happen. Behavior therapy takes an important role in weight control. It prevents weight regain by creating goal setting, self-monitoring, and stimulus control.9 National Heart, Lung, and Blood Institute14 stated that regular self-monitoring is the point of long term weight loss maintenance. Maintenance of weight reduction means not only follow up the weight loss but also reduce the risks.
In face-to-face behavior therapy, the dieters are taught to use their weight data to regulate their eating portion and exercise behavior.14 Dietary changes plus regular physical activity, besides promotes weight loss, it reduces abdominal adipose tissue as well.9
Obesity is related to body fat distribution, that insulin resistance happens more frequently in central obesity than in peripheral body fat distribution.15 This adipose excess leads to development of insulin resistance and beta cell dysfunction that causes glucose intolerance and type 2 diabetes.16 Increased insulin resistance is directly proportional with the increase of BMI, waist circumference, and waist-hip ratio. The adipose tissue that represents these measurements is visceral adipose tissue. Visceral adipose tissue is more metabolically active than subcutaneous adipose tissue and induces the insulin resistance in cellular level.17
In a study of obese adolescents, they are more insulin resistant because obesity is the most common cause of insulin resistance in...