Type 2 diabetes is associated with many comorbid medical conditions including obesity, neuropathy, microvascular pathology and atherosclerotic arterial disease. Due to its complications and chronicity, reducing risk factors such as obesity and sedentary lifestyle through lifestyle modification is crucial to the long-term health of patients with type 2 diabetes. Patients must learn how to adopt lifelong, low-fat eating habits and regular activity patterns, with formal treatments focusing on weight loss, increased physical activity and low-fat, low-saturated fat diets. In this article we review the efficacy of lifestyle modification programmes for obese diabetic patients. In addition, we discuss barriers to lifestyle changes and methods for improving long-term adherence. Finally, we present information on how this approach has been adapted to a group of Mexican Americans in the USA, a population at high risk for type 2 diabetes, obesity and sedentary lifestyle.