Meal Pattern

Eating a balanced diet with plenty of fruits, vegetables, whole grains, and lean proteins can significantly reduce your risk of developing diabetes and heart disease, in line with the 2019 ACC/AHA Guidelines (12). This type of diet is essential for promoting metabolic health and reducing cardiovascular risk. Specific recommendations include:

• Limit sugary drinks and foods high in unhealthy fats: Avoid trans fats entirely and minimize saturated fats by choosing monounsaturated fats (e.g., olive oil, nuts) and polyunsaturated fats (e.g., fatty fish, seeds). This helps reduce cholesterol levels and supports heart health (ACC/AHA, 2019) (12, 14).
• Reduce intake of red and processed meats: Minimize processed meats and high-fat red meats, which are linked to increased cardiovascular disease risk. Instead, prioritize lean protein sources like poultry, fish, beans, and legumes (12).
• Emphasize complex carbohydrates like whole grains, which improve blood sugar control and insulin sensitivity. Avoid refined sugars and processed carbohydrates found in sweets and sugary beverages (12, 14).
• Control salt intake by keeping it below 2.3 grams per day to manage blood pressure and reduce cardiovascular disease risk. Cooking at home and reading food labels helps with sodium control (5, 12).
• Include adequate protein from fish, poultry, beans, and legumes to support muscle health and overall well-being (12).
• Non-nutritive sweeteners like stevia and aspartame can help reduce sugar intake and manage carbs without raising blood sugar, but more research is needed to fully understand their long-term health effects (14).

It’s essential to work with your healthcare team to find a nutrition plan that suits your lifestyle, cultural preferences, and health goals. A diet plan you enjoy and can stick with long term will make it easier to manage your health (5, 12, 14).

The Mediterranean Diet

One of the most effective meal plans is the Mediterranean diet, proven in the well-known PREDIMED study conducted in Spain to significantly reduce the risk of heart disease, diabetes, and other cardiometabolic conditions (8). The Mediterranean diet emphasizes the consumption of healthy fats, such as those found in olive oil and nuts, alongside a variety of vegetables, fruits, and whole grains (8). Following meal plans like the Mediterranean diet, DASH diet, and plant-based diets can help reduce inflammation and prevent the progression of diseases (3, 5). These meal patterns are designed to be sustainable and adaptable to your personal and cultural preferences, making them easier to follow in the long term (14). These habits improve insulin sensitivity and help maintain healthy blood sugar and cholesterol levels, protecting you from serious health conditions like type 2 diabetes, heart attack, and stroke (5, 8).

Physical Activity

Regular exercise, such as walking, running, or swimming, can help lower your risk of cardiometabolic disease (CMD) (3, 5, 12 ,13). Aim for at least 30 minutes of moderate exercise five days a week or 75 minutes of vigorous exercise (like running) weekly (12). Activities like brisk walking, cycling, and swimming are great ways to stay active and keep your heart healthy (3). Also, even simple activities like walking can significantly reduce your risk of developing diabetes (3). Exercise improves insulin sensitivity, making it easier for your body to manage blood sugar levels, and it can also help lower blood pressure and cholesterol levels, which are key factors in preventing heart disease (13). Combining aerobic exercises (like walking or swimming) with resistance exercises (like lifting weights) provides the best results for your overall health (12). Try to avoid sitting for too long and find ways to be active during your free time—break up sedentary time with movement throughout the day (12). For individuals with physical limitations, consider working with your healthcare provider to design tailored activities to help improve insulin sensitivity and prevent CMD progression (12). It's also important to find exercises that you enjoy and that are compatible with what you can do physically. This will help you keep up with your exercise routine in the long term. If you have any physical limitations, you can still find ways to exercise that work for you and will help you stay healthy.

Self-Monitoring

Keeping track of your weight, blood sugar levels, and blood pressure at home can help you stay on top of your health and make necessary changes sooner. Using tools like a bathroom scale, glucose meter, and blood pressure monitor can be very helpful (3). If your doctor offers digital health tools or mobile applications to monitor your health, these resources can be valuable for accountability as you stick to your health plan. Regular monitoring allows you and your doctor to see how well your treatment plan is working and make adjustments as needed. By monitoring these numbers, you can catch problems early and take action to prevent serious health issues.

Sleep, Stress, Depression/Anxiety/Disordered Eating

To reduce your risk of cardiometabolic disease, it's important to prioritize getting enough sleep, managing stress, and addressing any mental health issues (5, 12, 13, 14). Poor sleep and high stress can make CMD symptoms worse by influencing inflammation and metabolism in your body (5). If you feel these issues are affecting your quality of life, please seek counseling from a trained professional, clinical psychologist, or psychiatrist as needed. Establishing habits like sticking to a consistent sleep routine, practicing relaxation techniques, and seeking support for mental health concerns can help improve your overall well-being (5). Behavioral interventions like counseling, specifically cognitive-behavioral therapy and stress management programs, and participation in support groups can assist in stress management and promote adherence to healthy lifestyle changes, which are vital for reducing CMD risk (5, 12).

Smoking Cessation

Quitting smoking is one of the most impactful steps you can take toward improving your health. While many people associate smoking with lung disease, it also greatly increases the risk of heart disease, stroke, and other life-threatening conditions (12). The good news is that it’s never too late to quit, and the benefits start almost immediately. However, even light smoking carries risks, including a heightened chance of heart attacks (12). Simply reducing the number of cigarettes smoked each day, while helpful, does not fully eliminate these dangers (12).

Within just a few days of quitting, blood pressure and heart rate begin to normalize, setting the stage for longer-term cardiovascular improvements (12). Over time, the risk of heart disease steadily declines, highlighting the importance of quitting entirely. Experts encourage combining counseling with evidence-based therapies—such as nicotine patches, gums, or prescription medications like varenicline or bupropion—to increase the chances of long-term success (12). Even small efforts toward quitting make a difference, and healthcare providers can offer continuous support during check-ups to help you stay motivated.

In addition, avoiding secondhand smoke is significant, as exposure to others' smoke also raises the risk of cardiovascular problems (12). While e-cigarettes may appear to be a safer alternative or quitting aid, research has yet to confirm their long-term safety or effectiveness (12). Experts recommend caution when using e-cigarettes, as they may introduce new health risks rather than solve existing ones (12). Each day without smoking strengthens your heart and health, proving that quitting is always worth it—no matter when you start (12).

Blood Pressure Targets

According to the 2020 International Society of Hypertension (ISH) Global Guidelines (16):

• No additional risk factors: Blood pressure should ideally be maintained at <140/90 mm Hg.
• 1 or 2 risk factors: Aim for a target of <130/80 mm Hg.
• ≥3 risk factors or specific conditions (ex: diabetes, chronic kidney disease, cardiovascular disease): The target is <130/80 mm Hg, though less strict targets of <140/80 mm Hg may be considered for older adults based on tolerability.

LDL Cholesterol Targets

LDL cholesterol (LDL-c) (the “bad” cholesterol) should be reduced based on individual cardiovascular risk (19). Suggested targets for LDL-c are listed below:

Achieving these goals often requires a combination of dietary adjustments, physical activity, and appropriate medical therapies. It is always recommended to consult with your healthcare provider to determine the best approach for achieving your personal health targets (16).

Understanding BMI and Health Risks

If your body mass index (BMI, units kg/m2) is between 25 and 29.9, you might have overweight. If your BMI is 30 or greater, you may have obesity. In certain ethnicities (such as Southeast Asians), a lower BMI (for example a BMI cutoff of 25 or greater) may represent obesity because of higher health risks at lower BMI values in these populations (15). BMI can be calculated with tools available online and represents a ratio of weight over height. Since body water and muscle (i.e., things other than fat) can contribute to higher BMI values, BMI should be considered only for screening until your healthcare professional can make sure that the elevated BMI is due to excess body fat (11). It's important to know this because carrying excess body fat can increase your risk of developing serious health problems such as diabetes and heart disease (2, 12, 13). Additionally, Increased waist circumference is linked to higher cardiometabolic and cardiovascular disease (CVD) risks, even when BMI is normal, and waist circumference is recommended as an additional screening tool to BMI for identifying at-risk individuals (13). Losing just 5-10% of your body weight through healthy eating and regular exercise can make a difference, but many people need more than 10% or more than 15% weight loss to gain maximal health benefits and to prevent or treat obesity complications and related diseases (12, 13, 14). Weight loss improves your body's sensitivity to insulin, which helps regulate blood sugar levels, and losing weight can lower your blood pressure and cholesterol levels and improve sleep and fatty liver (2). These changes can reduce your risk of developing conditions like type 2 diabetes and cardiovascular disease (2, 12, 13).

Healthy Diet for Weight Management

One highly recommended dietary approach for those with overweight and obesity is the Mediterranean diet, which emphasizes healthy fats, vegetables, fruits, and whole grains. Research shows that the Mediterranean diet not only supports heart health but also aids in weight management when consumed in a reduced-calorie format, particularly for those with overweight or obesity (8). Incorporating this diet into your lifestyle, alongside regular physical activity, can be an effective way to achieve and maintain weight loss. The Mediterranean Diet has also been shown to prevent heart attacks and progression to diabetes (8). Additionally, adjusting meal timing, like following an intermittent fasting schedule, may be helpful for some people to control blood sugar and support weight loss. Talk to your healthcare provider to see if this approach is right for you (14).

Treatment of Obesity as a Disease: It is Not Your Fault!

It is important to know that obesity is a disease, and it's helpful to understand that it’s not your fault. An excess of body fat is produced by interactions involving genes, environment, and behavior (2). The ability of factors to influence how the brain regulates food intake is altered in obesity and generates and sustains a state of excess body fat (2). Losing weight means fighting against these abnormalities in food intake and body fat regulation. Some people may require medical care beyond lifestyle changes, including medications or even surgery, to effectively manage their weight, especially if there are related health complications (3). Organizations like the American Association of Clinical Endocrinology and the European Association for the Study of Obesity use the term Adiposity-Based Chronic Disease (ABCD) to highlight the medical aspects of obesity and its risk of complications, similar to other chronic diseases (10, 11). There are effective medications available, such as GLP-1 receptor agonists, which have been shown to help with significant weight loss and improve health outcomes, including the prevention of type 2 diabetes and heart disease (9). These medications together with a healthy lifestyle and working with your healthcare professional can help you achieve 15% or more weight loss when needed to improve you health and treat obesity complications and related diseases. Please consider seeing a healthcare professional for help managing ABCD and improving your overall health.