Differences between Type 2 Diabetes Mellitus and Obesity Management: Medical, Social, and Public Health Perspectives
Article information
Abstract
Obesity and type 2 diabetes mellitus (T2DM) are among the most urgent global public health challenges, yet differ markedly in recognition and management across medical, social, infrastructure, and policy domains. T2DM is supported by clear diagnostic criteria, defined treatment targets, and broad acceptance as a chronic disease. In contrast, obesity is assessed using imprecise metrics like body mass index, lacks standardized treatment goals, and is often misunderstood as a lifestyle issue rather than a chronic, relapsing disease. This misconception contributes to stigma, discrimination, and unrealistic patient expectations. T2DM receives substantial research funding, comprehensive clinical guidelines, and structured medical education, with strong support from large professional societies and multidisciplinary care models. Obesity care remains underfunded, inconsistently delivered, and underrepresented in medical training. Public health and policy efforts strongly favor T2DM, providing coordinated programs, insurance coverage, and regulatory oversight. Conversely, obesity is marginalized, with limited policy influence and a largely unregulated commercial weight-loss industry. Bridging these disparities requires adopting lessons from T2DM management—such as evidence-based guidelines, improved provider training, expanded insurance coverage, and public health strategies—to enhance obesity care and recognize it as a chronic disease requiring long-term, structured management.
Highlights
• T2DM care offers a model for recognizing obesity as a chronic, relapsing disease.
• Evidence-based guidelines from T2DM can guide structured obesity management.
• Reducing obesity stigma requires public health strategies used in T2DM.
• Bridging gaps in training and care needs lessons learned from T2DM systems.
• Expanding insurance for obesity mirrors successful T2DM policy frameworks.
INTRODUCTION
Obesity and type 2 diabetes mellitus (T2DM) have emerged as two of the most significant global public health challenges, with their prevalence rising at an alarming rate. Worldwide obesity has surged over the past three decades, with projections indicating 1.95 billion adults will be living with obesity by 2050 [1]. Similarly, diabetes affected approximately 537 million in 2021 and is projected to reach 783 million by 2045 [2]. The increasing prevalence of obesity in children and adolescents has contributed to the earlier onset of T2DM, a condition historically considered a disease of middle-aged and older adults [3].
The economic burden of these conditions is substantial. In 2021, global healthcare expenditures for diabetes exceeded $966 billion, marking a 316% increase over 15 years [4]. Obesity accounts for 2% to 7% of national healthcare spending, with additional indirect costs from reduced productivity, disability, and premature mortality [2]. Both diseases have a significant impact on workplace productivity through increased absenteeism and reduced workforce participation [3].
While diabetes management has advanced through pharmacological and technological interventions, such as glucagonlike peptide 1 (GLP1) based therapy, once weekly insulin, continuous glucose monitoring (CGM) system, and artificial pancreas [4], treatment for obesity has remained relatively underfunded and underdeveloped, despite recent progress with incretin- based therapy. Many healthcare systems still do not recognize obesity as a chronic relapsing disease requiring longterm management, leading to insufficient investment in prevention and treatment [2]. This systemic neglect exacerbates healthcare disparities, with marginalized populations living with obesity disproportionately affected due to socioeconomic barriers and healthcare inequities [3].
Despite their strong epidemiological association, obesity and T2DM remain distinct disease entities with unique pathophysiological mechanisms and clinical implications. While insulin resistance and chronic inflammation are common denominators [5], significant differences exist in disease recognition, patient expectations, healthcare infrastructure, and societal attitudes, all of which shape their diagnosis, management, and social perception. Furthermore, the majority of people living with obesity are at risk of developing numerous complications affecting mental and physical health [6]. This review will explore the critical differences and similarities between T2DM and obesity from medical, social, and public health perspectives, providing insights that can guide future research, policy development, and clinical practice to enhance the prevention and treatment of both conditions.
DIFFERENCES BETWEEN T2DM AND OBESITY
Awareness amongst physicians and the general public
T2DM is widely recognized as a chronic disease by both the medical community and the general public, largely due to extensive awareness campaigns, structured medical education, and well-defined diagnostic criteria (Fig. 1). Physicians receive comprehensive training in diabetes management, and healthcare systems have implemented guidelines that prioritize early detection and timely intervention [4]. Public health initiatives have successfully increased awareness of diabetes risk factors, leading to routine screening programs and proactive management strategies. Additionally, advocacy organizations have played a critical role in shaping policies that improve access to care and broaden treatment options for individuals living with T2DM [3].
Type 2 diabetes mellitus vs. obesity: key differences in the medical aspect.
In contrast, although obesity is officially classified as a chronic disease by the World Health Organization (WHO) and by multiple medical societies, it is still not consistently recognized as such by healthcare professionals (HCPs) and the general public. Many still view obesity primarily as a simple lifestyle issue, rather than a complex, multifactorial disease driven by genetic, environmental, and metabolic factors (Fig. 1) [2]. This misperception leads to underdiagnosis, undertreatment, and a lack of standardized medical care for individuals with obesity. While diabetes is diagnosed using specific biomarkers such as glycosylated hemoglobin (HbA1c) and glucose levels, obesity is typically assessed using body mass index (BMI), a limited metric that does not fully capture disease severity or its health consequences [4].
Public health messaging around obesity often emphasizes personal responsibility, which overshadows the systemic and biological drivers of the disease. Consequently, obesity receives less research funding, has fewer long-term pharmacological treatments approved, and faces limited insurance coverage for intervention [2]. Efforts to improve awareness of obesity as a chronic disease through targeted education, advocacy, and policy reform are essential to ensure equitable care paralleling the progress seen in diabetes care and management.
Differences in social aspects
The social perception of T2DM and obesity differs significantly (Fig. 1). T2DM is generally viewed as a manageable chronic disease, with widespread acceptance of medical treatment and lifestyle interventions. Public health campaigns have established diabetes as a medical condition requiring structured care, which has minimized stigmatization [3]. HCPs typically approach diabetes with a supportive framework [4], and virtually all countries have dedicated programs and resources for T2DM management [7-10].
Conversely, obesity faces considerably more stigma, frequently being perceived as a personal failing rather than a complex medical condition with genetic, environmental, and metabolic determinants. Individuals with obesity experience significant discrimination across healthcare settings, workplaces, and social interactions [2]. Weight stigma, prevalent even among HCPs, leads to implicit biases that influence medical decision-making and result in suboptimal care for patients with obesity [4]. Consequently, patients often delay seeking medical attention, show reduced adherence to treatment, and experience poorer health outcomes [11].
The impact of weight-based discrimination extends beyond healthcare. Research indicates that individuals with obesity face reduced employment opportunities, lower promotion rates, and diminished earning potential compared to peers with lower body weights [3,12]. The stigma contributes to significant psychological distress, increasing the risk of anxiety, depression, and reduced self-esteem [2]. These mental health consequences further exacerbate barriers to successful weight management, perpetuating a cycle of obesity-related complications that further reinforces social discrimination [13,14].
Differences in size, role, and academic interest between diabetes and obesity
Size and membership: large diabetes societies vs. smaller obesity associations
Diabetes associations, such as the American Diabetes Association (ADA) (https://diabetes.org/), European Association for the Study of Diabetes (EASD) (https://www.easd.org/index.html), and International Diabetes Federation (IDF) (https://idf.org/), have established extensive global networks that engage endocrinologists, primary care physicians, and researchers with a focus on T2DM prevention and management. These organizations host major conferences and attract significant funding. In contrast, obesity-focused organizations, such as The Obesity Society (TOS) (https://www.obesity.org/), European Association for the Study of Obesity (EASO) (https://easo.org/), and World Obesity Federation (WOF) (https://www.worldobesity.org/), have relatively smaller memberships and limited institutional reach.
Role and influence: strong policy impact for diabetes vs. limited influence for obesity
Diabetes associations play a key role in shaping clinical guidelines and public health policies, influencing healthcare provider training and insurance reimbursement for people living with T2DM. Their collaborations with regulatory agencies drive drug approvals and national prevention programs like the U.S. National Diabetes Prevention Program (DPP) [15]. Despite advocating for recognition of obesity as a chronic disease, obesity organizations exert weaker policy influence. Governments often prioritize diabetes over obesity prevention, and obesity organizations struggle to influence insurance coverage and provider education [16].
Research funding and academic interest: well-funded diabetes studies vs. limited support for obesity research
Diabetes research benefits from substantial funding, supporting landmark trials such as the Diabetes Control and Complications Trial (DCCT) [17], United Kingdom Prospective Diabetes Study (UKPDS) [18], and Look Action for Health in Diabetes (Look AHEAD) [19], which have shaped global diabetes care. The pharmaceutical industry has also prioritized diabetes treatments, leading to numerous therapeutic advancements [20,21]. In contrast, obesity research remains underfunded despite its significant public health burden. Large-scale clinical trials for obesity treatments are fewer, with limited long-term follow-up [22]. Stigma further restricts funding and opportunities for high-impact publications [12].
This discrepancy is reflected in academic research output, where diabetes-related publications far exceed those on obesity [15]. Obesity medications have faced greater regulatory scrutiny, with several withdrawn due to safety concerns [21]. Additionally, medical education focuses heavily on diabetes management, whereas training in obesity remains limited, contributing to underdiagnosis and undertreatment [20].
Integration into medicine: diabetes as a core specialty vs. obesity as a subspecialty
Diabetes is well-integrated into multiple specialties, including endocrinology, cardiology, and primary care, ensuring strong representation in medical training and clinical practice [7]. Obesity medicine remains an emerging field with limited training opportunities and fellowships. Unlike diabetes, which is widely recognized as a distinct medical condition, obesity is often managed indirectly through broader specialties, limiting its academic presence [16].
Addressing the disparities
Bridging the gap between diabetes and obesity research requires increased investment in obesity research, expanded clinical trials, and better integration of obesity care into medical training. Greater investment in obesity research, stronger academic networks, and policy integration will be necessary to elevate obesity to the same level of recognition and influence as diabetes.
Differences in patients’ expectations in treatment goals between type 2 diabetes mellitus and obesity
Patients’ expectations significantly influence the management and outcomes of both T2DM and obesity, though with marked differences in goal-setting approaches. In T2DM management, HCPs typically drive treatment goals, focusing on objective biomarkers such as achieving target HbA1c levels. In contrast, patients seeking obesity treatment often arrive with their own—frequently unrealistic—weight loss expectations [23].
Despite widespread availability and funding for diabetes treatments, reduced adherence and poor glycemic control may stem from limited disease awareness, prior negative experiences, or concerns about medication side effects [24,25]. For obesity treatment, reduced engagement and adherence commonly result from internalized weight bias, unrealistic weight loss expectations or frustration from previous unsuccessful weight-loss attempts as well as limited access to treatments [26]. In both conditions, psychological factors, including depression and condition-specific distress, further contribute to disengagement, exacerbating poor treatment adherence and suboptimal outcomes [27].
Bridging the gap between HCP-driven and patient-driven expectations is crucial for optimizing treatment. Strategies such as motivational interviewing, structured education, and psychological support can enhance patient confidence and adherence while ensuring realistic goals [16]. Shared decision-making, where patients and clinicians collaboratively establish evidence-based treatment goals, has been shown to improve adherence, clinical outcomes, and overall quality of life [28].
Differences in medical and social infrastructure and management guidelines based on evidence
Medical and social infrastructure and evidence-based guidelines for T2DM and obesity vary globally, but nearly all health systems dedicate substantially more resources to diabetes management (Fig. 1). Even in high-income countries, T2DM care benefits from robust funding, medication access, specialized HCPs, and advanced medical technologies, along with public health policies and prevention programs.
In contrast, obesity management remains underdeveloped, with obesity management still emerging as a field. Unlike diabetology’s widespread recognition as a distinct specialty, obesity care lacks formal recognition in many healthcare systems. Training programs are limited, and relatively few HCPs specialize in obesity treatment, resulting in fragmented and inconsistent care for affected individuals [16,29]. This imbalance in infrastructure creates significant barriers to accessing effective, evidence-based interventions for obesity, perpetuating disparities in treatment outcomes and health equity.
Differences in medical training: widespread diabetes education vs. limited obesity training
Diabetes education is well-integrated into medical curricula worldwide. Physicians, including general practitioners, endocrinologists, and cardiologists, receive standardized training on its pathophysiology, complications, and treatments. Guidelines from the ADA, EASD, and WHO ensure evidence-based diabetes care across disciplines, while nurses, dietitians, and pharmacists contribute to self-management education in patients with diabetes [24,30]. Continuing medical education (CME) further supports providers updated on innovations such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and GLP1 receptor agonists (GLP1RAs) [31].
In contrast, training in obesity remains limited. Less than 30% of U.S. medical schools offer dedicated obesity education beyond basic nutrition, leaving many physicians inadequately prepared to address its complex pathophysiology and treatment options [29]. This gap is exacerbated by persistent stigma, with obesity often misperceived as a personal failing rather than a genuine disease [11]. As a result, obesity management is frequently defaulted to generic lifestyle advice instead of intensive behavioral therapy, pharmacotherapy, or surgical options. Fewer than 2% of eligible patients receive anti-obesity medications, and bariatric surgery remains underutilized [16,32].
Progress is emerging through certification programs from the American Board of Obesity Medicine (ABOM) (https://www.abom.org/) for U.S. and Canadian physicians, which signifies specialized knowledge and competency in obesity care. Similarly, organizations like the TOS, EASO and The Korean Society for the Study of Obesity (KSSO) offer their own certification programs (https://easo.org/coms-2/easo-certificationin-obesity-management-ecom/). Some medical schools are implementing obesity-focused curricula; however, systematic changes are necessary to ensure all HCPs receive at least basic obesity management training. Expanding obesity education will improve patient outcomes and reduce the burden of obesity-related diseases, including T2DM.
Differences in diagnostic approach
Diabetes and obesity differ significantly in diagnostic clarity, standardization, and clinical implementation (Fig. 2). T2DM is diagnosed based on established biomarkers: fasting plasma glucose (FPG) ≥126 mg/dL, HbA1c ≥6.5%, 2-hour plasma glucose ≥200 mg/dL during a 75-g oral glucose tolerance test, or 2-hour or random plasma glucose ≥200 mg/dL in individuals with classic symptoms of hyperglycemia or hyperglycemic crisis, enabling routine screening and early intervention [33]. Prediabetes, a recognized early stage, facilitates preventive strategies [34].
Type 2 diabetes mellitus vs. obesity: key differences in the social and public health aspect.
In contrast, obesity diagnosis predominantly uses BMI (≥30 kg/m²) [35], which fails to account for fat distribution or metabolic health, often leading to misclassification [2]. While waist circumference (WC) and body fat percentage provide additional insights, they remain inconsistently applied [36]. More comprehensive staging systems such as the Edmonton Obesity Staging System [37], which better describe severity and guide clinical decision making, have yet to be widely adopted.
The disparity extends to screening practices. Diabetes screening is recommended for at-risk individuals over 35 years or younger with risk factors [33], whereas obesity screening is frequently overlooked despite its strong association with a host of related diseases and complications. Many HCPs neglect routine BMI or WC assessment, missing opportunities for early intervention [38]. A diabetes diagnosis typically initiates immediate treatment protocols, while obesity diagnosis often fails to trigger medical intervention, being commonly perceived as merely a lifestyle issue [39].
Advanced diagnostic tools further highlight this gap. Diabetes benefits from specialized biomarkers like C-peptide and autoantibody testing to differentiate diabetes types, and recent introduction of CGM to enhance treatment planning [31]. Obesity lacks standardized biomarkers for risk stratification, though emerging research on adipokines and metabolic signatures may improve precision medicine approaches (Fig. 2) [40]. Imaging methods such as computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry scans offer detailed body composition analysis but remain costly and largely confined to research settings [41]. Bioelectrical impedance analysis, which was introduced several decades ago and has undergone significant technological advancements, has several advantages, including easy accessibility, low-cost, and importantly, poses no radiation risk [42]. Despite these advantages, further studies are needed to validate its accuracy and utility in clinical practice.
The recent concept of ‘clinical obesity’ offers a promising framework to address diagnostic ambiguity in obesity care. It distinguishes individuals with biologically significant adiposity-related organ dysfunction from those with excess weight alone, and supports the development of structured screening criteria and stratified care models [2]. Incorporating this framework could also inform tiered insurance coverage models, whereby individuals meeting the criteria for clinical obesity receive comprehensive treatment, while those with preclinical obesity are guided through preventive strategies.
Comparison of medical treatment strategies between type 2 diabetes mellitus and obesity
Although T2DM and obesity are closely interrelated metabolic conditions, their medical management strategies differ significantly in terms of therapeutic approaches, efficacy, accessibility, and insurance coverage.
Pharmacologic therapies
T2DM treatment benefits from a broad armamentarium of well-established pharmacologic agents targeting hyperglycemia, including metformin, SGLT2 inhibitors, GLP1RAs, dipeptidyl peptidase-4 inhibitors, insulin analogs, and others, with clear guidelines for treatment intensification based on individualized risk profiles [10,43]. Pharmacotherapies for obesity, while expanding, remain relatively limited and are mostly represented by recently developed GLP1RAs (e.g., semaglutide) and dual agonists (e.g., tirzepatide) [44,45]. Weight loss efficacy of anti-obesity medications has markedly improved, with newer agents achieving 10% to 20% mean body weight reduction in clinical trials. Nevertheless, obesity pharmacotherapy remains underutilized due to stigma, regulatory barriers, and limited insurance coverage.
Bariatric and metabolic surgery
Bariatric/metabolic surgery, such as sleeve gastrectomy and Roux-en-Y gastric bypass, is an established intervention for both T2DM and obesity. However, indications differ. In obesity, surgery is primarily recommended for individuals with a BMI ≥35 kg/m² with comorbidities or ≥40 kg/m² [44-46]. Obesity surgery is recommended in Asians with obesity at lower BMI cutoff than that of European descendant [44]. In T2DM, particularly among patients with inadequately controlled disease despite optimal medical therapy, surgery has been increasingly recognized as a metabolic intervention even at lower BMI thresholds (≥30 kg/m²) [44,47]. Surgical procedures lead to sustained remission or improvement of T2DM, in addition to significant weight loss [46].
Medical devices
Device-based therapies are more established in T2DM, including insulin pumps, CGMs, and closed-loop artificial pancreas systems [43,48]. These technologies substantially improve glycemic control and quality of life. In contrast, medical devices for obesity management, such as intragastric balloons and vagal nerve blockade devices, are available but less widely adopted, with generally modest efficacy compared to pharmacotherapy and surgery [44,45].
Treatment target: well-established targets in T2DM vs. no well-defined targets in obesity
A fundamental distinction between T2DM and obesity management lies in the establishment of treatment targets. T2DM management centers around well-defined glycemic targets, including HbA1c levels, FPG, and postprandial glucose, which are widely recognized in clinical practice. Guidelines from the ADA, EASD, and WHO consistently emphasize these parameters, enabling structured treatment pathways and individualized therapeutic goals [7,8]. These clear targets guide pharmacologic interventions, lifestyle modifications, and continuous monitoring to optimize outcomes.
In contrast, obesity treatment lacks universally accepted targets. While weight loss is a common goal, there is no consensus on the ideal percentage reduction required to improve long-term health outcomes. Current guidelines suggest modest weight loss (5% to 10% of baseline weight) as beneficial for metabolic improvements; however, no standardized biomarker exists to definitively assess treatment success [47]. Unlike diabetes, where glycemic thresholds dictate treatment intensification, obesity management relies on subjective endpoints such as patient-reported quality of life, clinician judgment, and comorbidity prevention or resolution. Additionally, treatments, including pharmacotherapy and bariatric surgery, often lack clear criteria for initiation and escalation, further contributing to the inconsistent management approaches [49]. Differences in many aspects between T2DM and obesity are described in Table 1.
Key differences between type 2 diabetes mellitus and obesity
Differences in insurance coverage between diabetes and obesity
Diabetes: comprehensive coverage for screening, treatment, and monitoring
Diabetes care is broadly covered under public and private insurance plans, including routine screenings (FPG, HbA1c, CGM), pharmacologic treatments including SGLT2 inhibitors and GLP1RAs, and medical devices (glucometers, test strips, insulin pumps) [2]. Insurance also supports diabetes self-management education (DSME) and specialist access.
Obesity: limited and inconsistent insurance coverage
While BMI measurement is often included in clinical visits, other assessments often lack reimbursement [16]. Recent U.S. Food and Drug Administration (FDA)-approved obesity medications, such as semaglutide and tirzepatide, are not covered by Medicare, making them unaffordable for many patients [38]. Behavioral therapy and structured weight-loss programs receive inconsistent reimbursement, hindering long-term management [50].
Bariatric surgery, despite its effectiveness, faces restrictive insurance policies, requiring high BMI thresholds, prolonged weight-loss attempts, and extensive documentation before approval. Coverage is sometimes denied despite strong evidence of benefits in reducing obesity-related complications [32]. These barriers disproportionately impact low-income populations with higher obesity rates and fewer treatment resources [12].
Policy and economic implications
Diabetes organizations, including the ADA, EASD and IDF, have successfully advocated for comprehensive insurance coverage, expanding access to medications and prevention programs [51]. Obesity organizations, such as the TOS, EASO, and WOF, continue to push for coverage expansion, but progress remains slow due to limited recognition of obesity as a chronic disease [29]. The Treat and Reduce Obesity Act (TROA) in the U.S. seeks to expand Medicare coverage for obesity treatments, though implementation has been delayed [50]. Limited insurance coverage contributes to higher long-term healthcare costs, as untreated obesity increases the multiple chronic conditions. Expanding reimbursement for obesity interventions could reduce overall healthcare expenditures by preventing obesity-related complications [52].
From a cost-effectiveness perspective, many T2DM interventions— such as GLP1RAs [53] and prevention programs like the DPP [54]—have shown favorable incremental cost-effectiveness ratios, supporting their widespread adoption and insurance coverage. In contrast, while bariatric surgery is generally considered cost-effective for obesity management [55], newer pharmacologic treatments such as semaglutide and tirzepatide remain economically challenging due to high costs and limited reimbursement, despite their clinical efficacy. Incorporating cost-effectiveness evidence into reimbursement policies may help align public health investments with long-term clinical and economic value.
Differences in consumer markets: regulated diabetes care vs. the multi-billion dollar unregulated weight loss industry
The management of T2DM and obesity differs significantly in marketing, delivery, and regulation. The lack of regulatory oversight in obesity treatment contrasts starkly with the rigorous control and standardization present in diabetes management [2,3].
Diabetes care: physician-guided, evidence-based, and regulated
Diabetes management is anchored in scientifically validated guidelines from organizations such as ADA, EASD, and national regulatory bodies. Medications for T2DM, undergo extensive clinical trials before approval and are prescribed based on standardized criteria [7,8]. Treatment is predominantly managed within the medical system with structured patient monitoring. Regulatory agencies such as the FDA and the European Medicines Agency (EMA) impose strict oversight, limiting direct-to-consumer (DTC) advertising and ensuring prescription based on clinical need rather than commercial influence [39]. Insurance coverage for diabetes medications further reinforces medical oversight in treatment selection [51].
The unregulated weight-loss industry: a multi-billion dollar market with minimal oversight
In contrast, obesity treatment exists within a highly commercialized weight-loss industry including dietary supplements, meal replacement plans, extreme dieting programs, fitness regimens, and telehealth-based weight-loss prescriptions. These interventions often lack rigorous scientific validation and are marketed directly to consumers with exaggerated claims and minimal regulatory scrutiny [12,50]. DTC advertising, social media endorsements, and celebrity-backed programs fuel misconceptions about obesity management, often prioritizing short-term results over sustainable health improvements [52]. Over-the-counter weight loss supplements, many not subject to FDA approval, expose consumers to potentially ineffective or harmful products [56].
Implications of an unregulated market
This regulatory disparity significantly impacts patient outcomes. The unregulated weight-loss industry contributes to misinformation, leading individuals toward ineffective and sometimes unsafe interventions instead of evidence-based medical care. The promotion of fad diets and rapid weight-loss solutions often results in weight cycling, increasing long-term health risks [22,26]. Additionally, many individuals with obesity avoid medical guidance due to the perception that weight management is a personal responsibility rather than a chronic disease requiring professional intervention [29,57].
Bridging the gap: lessons from diabetes care
To address these issues, obesity management should follow diabetes care’s model by integrating evidence-based treatment into mainstream healthcare. This requires expanded medical training in obesity medicine, increased insurance coverage for effective treatments, and stricter regulations of the weight-loss industry [49,58]. Greater policy efforts are needed to establish obesity as a recognized chronic disease with structured care pathways comparable to those for T2DM [52].
LESSONS FROM T2DM FOR OBESITY: UNDERSTANDING, AWARENESS, MANAGEMENT, AND TREATMENT
Research and guideline implementation
Landmark diabetes trials, such as DCCT [17] and UKPDS [18], established clear glycemic control benefits, shaping comprehensive clinical guidelines [39]. Similarly in obesity, trials like the Semaglutide Treatment Effect in People with Obesity (STEP) series with semaglutide [59,60], and the SURMOUNT series with tirzepatide [61,62], and the Swedish Obese Subjects study [63] have confirmed the effectiveness of lifestyle interventions, pharmacotherapy, and surgery, yet these proven treatments remain underprescribed [32]. While extensive real-world data and patient registries continuously refine diabetes treatment approaches, comparable long-term obesity studies are limited, hampering guideline development and adoption [29]. CME ensures providers stay updated on advancements for diabetes, whereas obesity-specific training is notably deficient, contributing to undertreatment [36]. Applying diabetes’ evidence-based frameworks to obesity management—through structured guidelines, systemic real-world data collection, and enhanced provider education—could substantially improve treatment utilization and long-term outcomes, bringing obesity care in line with the rigor of diabetes management (Fig. 3).
Lessons from type 2 diabetes mellitus for obesity treatment.
Comprehensive assessment: medical, behavioral, and genetic factors
Medical and metabolic risk factors
T2DM care involves routine glycemic markers and screening for complications such as retinopathy, nephropathy, neuropathy and cardiovascular disease [39,64]. Obesity assessment should include BMI, WC, and metabolic indicators (insulin resistance, lipid profile, liver function tests), yet these are often overlooked, delaying intervention [31,65]. Applying structured metabolic assessments from T2DM and implementing a standardized panel of outcome measures (https://www.ichom.org/patient-centered-outcome-measure/adult-obesity/) could improve early obesity diagnosis and treatment [58].
Behavioral and psychosocial factors
T2DM management integrates behavioral interventions such as self-management education and motivational interviewing [66]. Similarly, obesity care should address factors like emotional eating and sleep disturbances, but few providers receive training in obesity behavioral therapy [16]. Structured behavioral coaching, cognitive behavioral therapy, and digital health tools could enhance obesity outcomes [50].
Genetic and precision medicine approaches
T2DM increasingly incorporates genetic risk assessment to personalize treatment [29,67]. Genetic testing helps predict β-cell function and determine the most effective medications [68]. While obesity research indicates genetic factors influence fat distribution and weight-loss responses [69,70], genetic testing remains rarely used in obesity care. A precision medicine approach, similar to T2DM, could optimize treatment selection, integrating lifestyle interventions, pharmacotherapy, and surgical referrals based on individual genetic profiles (Fig. 3) [36,71].
Multidisciplinary approach, patient education, and community-based support
Multidisciplinary approach
A key strength of diabetes care is its team-based structure, where multiple specialists collaborate to optimize patient outcomes [4,29,57,72,73]. Obesity care often relies on a single provider with limited multidisciplinary support [36,74]. Implementing a team-based care model—incorporating dietitians, exercise physiologists, and behavioral therapists—could improve adherence, and optimize obesity management outcomes (Fig. 3) [30,75].
Patient education and empowerment
Standardized programs like DSME improve glycemic control and self-care skills in diabetes [3]. Obesity care lacks similar structured education, often relying on generic weight-loss advice [4]. Public education campaigns have reduced diabetes stigma by framing it as a medical condition [12]. Similar antistigma education could help reframe obesity as a treatable disease, improving patient motivation and adherence [52].
Community-based support
Community-based programs, such as peer-led coaching and group counseling, have effectively reduced diabetes incidence [75]. Similar programs for obesity remain limited, despite evidence that group-based interventions improve weight maintenance [32]. Expanding obesity-specific community initiatives could provide long-term support, reduce stigma, and improve health outcomes [52].
Implementation of technologies and digital health integration
Technological advancements have notably transformed T2DM management, particularly through CGM systems, insulin pumps, telehealth, and artificial intelligence (AI)-driven decision support tools, all of which enhance patient self-management and adherence [7,8,76,77]. For instance, the latest CGM devices, such as the Dexcom G7 (Dexcom Inc., San Diego, CA, USA) and FreeStyle Libre 3 (Abbott, Abbott Park, IL, USA), offer improved accuracy, real-time glucose monitoring, and predictive alerts, helping optimize glycemic control and minimize hypoglycemia risk [78,79]. Additionally, AI-powered platforms support personalized diabetes care by assisting with insulin dosing and patient education [71].
In contrast, the integration of technology into obesity management has been comparatively slower. Nevertheless, recent developments indicate a growing adoption of digital interventions in obesity treatment. Expanding self-monitoring technologies for obesity—such as smartphone apps for meal tracking, wearable devices to measure physical activity and sleep, and remote weight monitoring programs—could improve patient engagement, adherence, and long-term obesity control [47,52,58,80,81].
Particularly, smartphone-based self-monitoring apps, such as ‘MyFitnessPal’ and ‘Noom,’ have demonstrated efficacy in improving dietary tracking, physical activity, and adherence to behavioral interventions [82-84]. Wearable devices, including Fitbit (Fitbit Inc., Boston, MA, USA) and Apple Watch (Apple Inc., Cupertino, CA, USA) provide real-time feedback on physical activity, sleep quality, and energy expenditure, enabling patients to track their progress and adjust their behavior accordingly [81,85,86].
AI-driven decision support systems have also shown promise in obesity management by providing personalized recommendations based on individual dietary habits, metabolic profiles, and behavioral patterns (Fig. 3) [56,87]. These systems can predict weight regain and suggest timely interventions, much like AI applications in diabetes management that forecast glucose fluctuations and optimize medication adjustments [56,87]. The integration of AI into obesity care could enhance the precision of dietary planning, improve patient engagement, and reduce the burden on healthcare providers.
CONCLUSIONS
Unlike diabetes, which has clear diagnostic markers and treatment targets and structured screening and management programs, obesity is primarily assessed using BMI, an imprecise metric that leads to underdiagnosis and inconsistent treatment [58,88]. HCP training in obesity remains insufficient, and despite strong clinical trial evidence supporting treatments, guideline adoption and insurance coverage remain limited [15].
Recognizing these gaps, the Lancet Diabetes & Endocrinology Commission has introduced a framework that redefines obesity as a spectrum of disease states [2]. This consensus introduces the concepts of preclinical and clinical obesity, moving away from a simplistic BMI threshold towards assessment of adiposity and a functional approach that evaluates organ and tissue dysfunction.
To enhance obesity care, structured diagnostic criteria beyond BMI, such as assessment of cardiometabolic risk, physical functioning and mental health, should be adopted [2,47,60]. Medical education should integrate comprehensive obesity training, and multidisciplinary care models involving dietitians, exercise physiologists, and behavioral therapists should be expanded [12,36]. Greater access to new pharmacological agents and surgical interventions, with improved insurance coverage, is essential [16]. Technology-driven tools, such as telemedicine and digital self-monitoring, should be widely implemented to improve adherence [38,66].
In conclusion, the gap between diabetes and obesity management highlights systemic deficiencies in training, infrastructure, and policy support. Applying diabetes care principles—structured screening, evidence-based treatment escalation, multidisciplinary care, expanded insurance coverage, and technology integration—will improve obesity outcomes and reduce related diseases, including T2DM itself [52]. Elevating obesity care to the level of diabetes care is both scientifically justified and a public health imperative.
Notes
CONFLICTS OF INTEREST
Soo Lim received research grants from Merck Sharp & Dohme, Novo Nordisk, and LG Chem; and honoraria as a consultant or speaker for AstraZeneca, Boehringer Ingelheim, Abbott, LG Chem, Daewoong Pharmaceutical, Chong Kun Dang Pharmaceutical, and Novo Nordisk. Arya M. Sharma received honoraria from Novo Nordisk, Eli Lilly, AstraZeneca, Boehringer Ingelheim, Currax, Oviva, and Vivus. Ga Eun Nam reported no potential conflict of interest relevant to this article.
FUNDING
None
ACKNOWLEDGMENTS
None