Studies have shown weight loss to be a key predictor of diabetes risk reduction, so your first step may be to shed some pounds.

With that in mind, VA researchers enrolled 387 overweight or obese Veterans with prediabetes in a pilot study that compared the efficacy of two VA programs: the Veterans Affairs Diabetes Prevention Program (DPP), in which weight loss is a major element, and MOVE!, VA's flagship weight–management program for overweight or obese patients. Both programs are supported by VA's National Center for Health Promotion and Disease Prevention in Durham, North Carolina.

The study, published online in January 2017 in the American Journal of Preventive Medicine, found that DPP resulted in a much greater loss of pounds than MOVE! at the six–month mark: 9.0 versus 4.2. The margin was smaller after 12 months, with DPP participants weighing 7.5 pounds less than when the program began and MOVE! Veterans 4.4 pounds less. Lead author Dr. Tannaz Moin, an endocrinologist at the VA Greater Los Angeles Healthcare System, attributes the difference at six months mainly to the greater number of group sessions the DPP participants could attend. They were offered 16 core sessions in that period, many of them on a weekly basis, compared with 8 to 10 for MOVE! Veterans. She says the DPP participants regained some weight in the last six months because they met for only six monthly maintenance sessions.

Moin also suggested the DPP sessions may have held an advantage because they involved closed groups with the same Veterans and coaches, leading to greater intensity and cohesion in the meetings. Different coaches and Veterans took part in each MOVE! session.

The curriculum in both groups focused on healthy lifestyle changes. There was no physical activity during the sessions, but each group recommended exercise outside of class. All DPP participants aimed for 150 minutes of moderate exercise each week—for example, walking—and a 7–percent weight loss. In contrast, MOVE! participants assigned their own goals. As Moin sees it, the difference in weight loss at six months points to DPP as a more effective program than MOVE! for that time period.

"The statistically significant difference in weight loss is one way we can define that," she says. "But another way we might define that is around patient satisfaction. Veterans who participated in the DPP program were more satisfied with the intervention. We asked both groups to talk to us about their relationships with peers and coaches. Pretty consistently, the DPP participants gave higher ratings across the board."