Energy balance

An intensive lifestyle intervention (ILI) combining caloric restriction, structured meal replacements, and increased physical activity produces significant initial weight loss and modest long-term maintenance in adults with type 2 diabetes, but does not reduce cardiovascular morbidity or mortality compared to standard education.

For adults with type 2 diabetes, an intensive lifestyle program focusing on moderate caloric restriction (1200-1800 kcal), structured meal replacements (initially 2 meals/day), and 175 minutes of weekly moderate activity can achieve significant weight loss and improve metabolic markers like A1C and lipids. However, do not prioritize weight loss over glucose management or quality of life. Expect some weight regain after the first year, but maintain the focus on behavioral adherence and metabolic health, as initial losses provide long-term benefits even if full maintenance is difficult.