Overweight and Obesity in Adults

In overweight and obese people with impaired glucose tolerance or raised blood pressure, modest weight loss (3–5 kg) achieved using a combination of increased moderate physical activity (e.g. walking) and improved dietary quality will reduce the progression to diabetes by about 50% and reduce blood pressure by about 3 mmHg. Given the high levels of diabetes, cardiovascular disease and renal failure in Aboriginal people, it would be sensible to recommend modest weight loss to all overweight and obese people. The advice should contain both information about moderate physical activity and dietary quality; it should not focus on cutting calories (kilojoules) alone. People should not be discouraged from losing some weight by being told what their ‘ideal’ weight ‘should be’ when this is too big a target to be achieved realistically. However, it should be noted that trials showing that progression to diabetes in people with impaired glucose tolerance could be reduced with lifestyle modification when subjects received up to 16 counselling sessions. Achieving the same level of effect in Aboriginal communities would probably require a large commitment in resources.