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Insulin resistance is associated with weight gain and is highly prevalent in people with obesity (approximately 50–80%). However, it is primarily a consequence of excess adiposity rather than an independent cause of weight loss difficulty. Diet and exercise that produce modest weight loss (5–10%) improve insulin sensitivity substantially — regardless of which dietary approach achieves the loss. NICE recommends the NHS Diabetes Prevention Programme (NDPP) for non-diabetic hyperglycaemia.