Most patients with type 2 diabetes are overweight or obese. Therefore, weight management should be a central component of any treatment strategy, as weight loss has been convincingly shown to provide a marked improvement in metabolic control. However, as conventional concepts combining an energy-reduced diet and an increase in physical activity frequently have poor long-term results, more effective weight loss strategies should be developed and applied. Such components with additional benefit are VLCD, weight-lowering drugs, and bariatric surgery, the latter particularly for severely obese subjects. Long-term studies are urgently needed to obtain more precise information on the relative success of the various strategies in the management of obese diabetic patients.

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