The growing prevalence of type 2 diabetes mellitus (T2DM) and the parallel increase in the prevalence of obesity warrants for effective intervention strategies. Overweight/obese patients with T2DM who attempt weight reduction often face considerable challenges. A recent study in Malaysia conducted among overweight/obese patients with T2DM showed that weight reduction and improved glycaemic control could be achieved with structured lifestyle intervention and the incorporation of behavioural counselling. The structured lifestyle recommendations in this study consisted of 1) a fixed low-calorie diet plan of 1200 kcal/day for female and 1500 kcal/day for male patients; 2) incorporation of one or two servings/day of diabetes-specific formula as a meal replacement; 3) a 14-day structured meal plan consisting of the ingredients list, cooking methods and nutrition facts; and the 4) healthy low-calorie snack options. Exercise prescription of ≥150 min/week of moderate-intensity was also encouraged. Behavioural counselling such as motivational interviewing not only facilitated adherence to the lifestyle recommendations but also further enhanced weight loss and glycaemic control in these patients. This article outlines the localisation of the structured lifestyle recommendations and its effectiveness in achieving weight loss and good glycaemic control in overweight/obese patients with T2DM.

Introduction: Self-efficacy for eating predicts successful weight loss and maintenance in Type 2 Diabetes Mellitus (T2DM) individuals. The Weight Efficacy Lifestyle (WEL) questionnaire determines self-efficacy for controlling eating. This study aims to validate the Malay-translated version of the WEL questionnaire and to establish the cut-off scores to define the level of eating self-efficacy in Malaysian T2DM individuals. Methods: A total of 334 T2DM individuals, aged 55.0±9.0 years, were recruited from a primary healthcare clinic based on sampling ratio. Medical records were reviewed for eligibility. Inclusion criteria included BMI ≥23kg/m2, and no severe diabetes complications. The WEL questionnaire assessed eating resistance during negative emotions, food availability, social pressure, physical discomfort and positive activities, and was back translated into Malay language. Self-efficacy was rated on a 0-9 scale with higher WEL scores indicating greater self-efficacy to resist eating. Factor analysis established the factor structure of the WEL questionnaire. Inter-item and item-total correlations determined construct validity while internal consistency described the reliability of the structure. Results: A two-factor structure accounting for 49% of variance was obtained, and it had adequate reliability, as indicated by Cronbach’s α of 0.893 and 0.781 respectively. Item-total correlations of r>0.700, p<0.01 and inter-item correlations of r<0.500, p<0.01 demonstrated construct validity. Cut-off scores of ≥44 and ≥32, respectively for factor one and two defined high eating self-efficacies in T2DM individuals. Conclusion: The Malaytranslated version of the WEL questionnaire appears to be a valid and reliable tool to assess self-efficacy for controlling eating behaviour in Malaysian T2DM population.