Physical exercise, diet and supportive counseling are the first steps of any weight-loss program. But sometimes that's not enough to take large amounts of weight off, and keep it off, doctors say. 13/Ocean/Corbis hide caption

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The Centers for Disease Control and Prevention estimates that 86 million Americans over age 20 have abnormal blood sugar levels. Over the long run, that can seriously damage the eyes, nerves, kidneys and blood vessels. iStockphoto hide caption

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Leahya Ellis and other spinning class participants use exercise as a way to shake away stress, anger and depression. Bastiaan Slabbers for NPR hide caption

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Diabetic patients get their feet treated at the Nauru Center of Public Health. The Pacific island nation has a high rate of type 2 diabetes. Matthieu Paley/Corbis hide caption

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University of Chicago medical student Manny Quaidoo adds a pinch of salt to the spinach feta frittata he's learning to cook as part of a culinary medicine class. Monica Eng/WBEZ hide caption

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