Personalized Medical Nutrition Therapy and Physical Exercise: The Future of Diabesity Care.

Ludovica Verde, Giuseppe Annunziata, Elisabetta Camajani, Maria Grazia Tarsitano, Silvia Savastano, Annamaria Colao, Giovanna Muscogiuri, Massimiliano Caprio, Luigi Barrea

Journal: Current obesity reports 2026;15(1):

PMID: 41813871

View on PubMed

Abstract

PURPOSE OF THE REVIEW

Diabesity, the coexistence of type 2 diabetes mellitus (T2DM) and obesity, represents one of the major global health challenges. This review aims to synthesize current evidence on personalized medical nutrition therapy (MNT) and structured physical exercise as cornerstones of diabesity management, with a particular focus on very-low-energy ketogenic therapy (VLEKT).

RECENT FINDINGS

Conventional pharmacotherapies improve glycemic control and promote weight reduction but often fail to fully address the multifactorial pathophysiology of diabesity. MNT has demonstrated significant efficacy in improving glycemic regulation, reducing weight, and modulating cardiometabolic risk factors. Among dietary strategies, the Mediterranean diet provides sustainable benefits, while more intensive interventions such as low-energy diets and ketogenic diets can induce rapid and clinically meaningful improvements, with emerging evidence supporting favorable effects on gut microbiota and inflammation. Complementary lifestyle interventions, particularly structured exercise programs combining aerobic and resistance training, further enhance metabolic outcomes and may contribute to T2DM remission in selected patients. Integration of MNT with incretin-based therapies holds promise for optimizing efficacy while preserving nutritional adequacy and functional health. Effective management of diabesity requires a multidisciplinary, precision-based approach. Personalized MNT and structured exercise represent foundational strategies, while pharmacological therapies provide valuable adjuncts. Among available options, VLEKT stands out for its ability to target key mechanisms of diabesity, including insulin resistance, adiposity, and chronic inflammation. Future diabesity care will rely on integrating nutrition, physical exercise, and pharmacotherapy within individualized frameworks to achieve sustained metabolic control and improved quality of life.

Address: Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Unità Di Endocrinologia, Diabetologia E Andrologia, Dipartimento Di Medicina Clinica E Chirurgia, Università Degli Studi Di Napoli Federico II, Naples, Italy.; Division of Endocrinology, Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA.; Department for the Promotion of Human Sciences and Quality of Life, San Raffaele Open University, Rome, Italy.; Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy.; Department for the Promotion of Human Sciences and Quality of Life, San Raffaele Open University, Rome, Italy.; Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Unità Di Endocrinologia, Diabetologia E Andrologia, Dipartimento Di Medicina Clinica E Chirurgia, Università Degli Studi Di Napoli Federico II, Naples, Italy.; Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Endocrinologia, Diabetologia Ed Andrologia, Università Degli Studi Di Napoli Federico II, Naples, Italy.; Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Unità Di Endocrinologia, Diabetologia E Andrologia, Dipartimento Di Medicina Clinica E Chirurgia, Università Degli Studi Di Napoli Federico II, Naples, Italy.; Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Endocrinologia, Diabetologia Ed Andrologia, Università Degli Studi Di Napoli Federico II, Naples, Italy.; Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", Università Degli Studi Di Napoli Federico II, Naples, Italy.; Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Unità Di Endocrinologia, Diabetologia E Andrologia, Dipartimento Di Medicina Clinica E Chirurgia, Università Degli Studi Di Napoli Federico II, Naples, Italy. [email protected].; Division of Endocrinology, Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA. [email protected].; Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Endocrinologia, Diabetologia Ed Andrologia, Università Degli Studi Di Napoli Federico II, Naples, Italy. [email protected].; Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", Università Degli Studi Di Napoli Federico II, Naples, Italy. [email protected].; Dipartimento Di Psicologia E Scienze Della Salute, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, 80143, Naples, Italy. [email protected].

DOI: 10.1007/s13679-026-00688-6

MeSH Terms: Humans, Diabetes Mellitus, Type 2, Precision Medicine, Exercise, Nutrition Therapy, Obesity, Diet, Ketogenic, Diet, Mediterranean, Exercise Therapy, Diabesity