A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

At least 70% of US adults have metabolic disease, yet health systems insufficiently address early stages such as overweight, obesity, and prediabetes compared with advanced disease. This commentary argues for a systematic response spanning diagnosis, lifestyle intervention, pharmacotherapy, and bariatric surgery, supported by health-system protocols and technology. Key summary points: (1) Diabetes and other metabolic diseases are highly undesirable; (2) Prediabetes and obesity should be consistently diagnosed to enable population health initiatives; (3) With patient-specific factors considered, evidence supports treating prediabetes and obesity via lifestyle interventions, medications, and bariatric surgery. The authors propose a stepwise framework: consistently diagnose early metabolic conditions; offer Diabetes Prevention Program–aligned lifestyle interventions; screen for and offer pharmacotherapy when lifestyle is not feasible or fails; evaluate for bariatric surgery when indicated; and conduct ongoing surveillance for progression to advanced metabolic disease. Additional research is needed to optimize system-level rollout of these interventions and to improve strategies for youth metabolic health.