Lifestyle Therapy in the Management of Cardiometabolic Risk: Diabetes Prevention, Hypertension, and Dyslipidemia

  • W. Timothy GarveyEmail author
  • Gillian Arathuzik
  • Gary D. Miller
  • Jamy Ard


Insulin resistance is a trait that is expressed early in life and progresses to clinically identifiable states of high cardiometabolic risk, namely prediabetes and metabolic syndrome, and culminates in type 2 diabetes (T2D), cardiovascular disease (CVD) events, or both in individual patients. Lifestyle therapy is highly effective in achieving therapeutic goals to manage cardiometabolic risk, which includes preventing T2D, reducing CVD risk, treating hypertension and dyslipidemia, and improving functionality and quality of life. Lifestyle therapy and weight loss are highly effective in achieving these goals in individuals who are overweight or obese. Patient-focused approaches to lifestyle therapy are described that incorporate evidence-based practices involving diet, physical activity, behavioral interventions, and multidisciplinary care, with demonstrated effectiveness for weight loss. Nutritional therapy for the active phase of weight loss (~first year) is accomplished using any one of several healthy meal plans in a reduced calorie format, selected on the basis of personal and cultural preference. During the chronic phase of weight loss maintenance (years–decades) when patients are in energy balance, the rational choice is to emphasize nutrients shown to enhance insulin sensitivity (monounsaturated fatty acids, fiber, and whole grains; represented in Mediterranean diets) and to minimize or avoid foods that promote insulin resistance (saturated fat, trans-fat, and refined grains; represented in the typical ‘Western diet’). In patients who are overweight or obese and have cardiometabolic risks, lifestyle therapy remains the cornerstone of treatment to optimize outcomes, including those patients treated with weight loss medications or bariatric surgery.


Cardiometabolic risk Insulin resistance Diabetes prevention Hypertension Dyslipidemia Healthy meal plan Exercise Weight loss Obesity 



American Association of Clinical Endocrinologists


American College of Sports Medicine


American Diabetes Association


American Heart Association


Blood pressure


Body Mass Index


Complete blood count


Cardiometabolic Disease Staging


Certified public accountant


Cardiovascular disease


Dietary Approaches to Stop Hypertension diet


Dietary Guidelines for Americans




Extended release


Health-care professionals


High-density lipoprotein cholesterol


Impaired fasting glucose


Impaired glucose tolerance


International Diabetes Federation


Low-density lipoprotein


Low-density lipoprotein cholesterol


Metabolic syndrome


Polyunsaturated fatty acids


Registered dietitian


Very low-calorie diets


Very low-density lipoprotein particles


World Health Organization



We acknowledge the support of the Diabetes Research Center at the University of Alabama at Birmingham funded by an award from the National Institutes of Health (DK-079626).


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • W. Timothy Garvey
    • 1
    Email author
  • Gillian Arathuzik
    • 2
    • 3
  • Gary D. Miller
    • 4
  • Jamy Ard
    • 5
    • 6
  1. 1.Department of Nutrition Sciences, University of Alabama at Birmingham, GRECC, Birmingham VA Medical CenterUAB Diabetes Research CenterBirminghamUSA
  2. 2.Lahey Outpatient CenterDanversUSA
  3. 3.Addison Gilbert HospitalGloucesterUSA
  4. 4.Department of Health and Exercise ScienceWake Forest UniversityWinston-SalemUSA
  5. 5.Department of Epidemiology and PreventionWake Forest UniversityWinston-SalemUSA
  6. 6.Weight Management CenterWinston-SalemUSA

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