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

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.