Obese and overweight patients with type 2 diabetes mellitus are not treated optimally – is it time to reconsider clinical practice?

INTRODUCTION: Type 2 diabetes mellitus (T2DM) pharmacotherapy guidelines recommend the assessment of individual cardiovascular (CV) risk. However, obesity still seems of lesser importance in the context of CV risk. Importantly, obesity-targeting pharmacotherapy use is limited. AREAS COVERED: A PubMed database search, up to August 2025, was performed. This review explores the rationale for prioritizing weight reduction as a key treatment strategy for overweight/obese T2DM patients and provides evidence supporting a weight-centric approach. Furthermore, it addresses the challenges associated with implementing weight management strategies in clinical practice. Higher doses of medications approved for obesity treatment may be indicated compared with those recommended for T2DM therapy. Additionally, the high cost and the lack of reimbursement policies for these drugs create a significant financial burden. Drug side effects may also minimize their use. EXPERT OPINION: The effectiveness of available pharmacotherapy in treating obesity in T2DM patients is discussed. There is still an urgent need to raise awareness regarding the importance of weight-centric management in overweight/obese T2DM patients. There is a need for a multidisciplinary approach, including health-care providers, the health system and policy makers, taking into consideration the multiple challenges, health inequity concerns and disparities in medication accessibility.