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

## TL;DR

This paper reviews how personalized nutrition and exercise can help manage diabesity, a combination of diabetes and obesity, more effectively than traditional treatments.

## Contribution

The paper highlights the potential of very-low-energy ketogenic therapy as a novel approach in diabesity care.

## Key findings

- Personalized medical nutrition therapy improves glycemic control and reduces weight in diabesity patients.
- Structured physical exercise enhances metabolic outcomes and may lead to diabetes remission.
- Very-low-energy ketogenic therapy shows promise in addressing key mechanisms of diabesity.

## Abstract

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).

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.