What lifestyle modifications should I recommend to a patient with acanthosis nigricans to improve their insulin sensitivity?

To improve insulin sensitivity in a patient with acanthosis nigricans, which is a cutaneous marker of insulin resistance and hyperinsulinemia, lifestyle modifications are key (Shiana et al., 2025).

Weight Management:

• Achieving and maintaining a healthy weight is crucial for improving insulin sensitivity and reducing the risk of diseases associated with overweight and obesity, such as type 2 diabetes ¹.
• Effective weight-loss programmes should be tailored to individual needs, encourage regular physical activity, and aim for a gradual loss of 0.5 to 1 kg (1 to 2 lb) per week ¹.

Dietary Modifications:

• Patients should be advised to base meals on starchy foods, choosing wholegrain options where possible, such as potatoes, bread, rice, and pasta ¹.
• Encourage the consumption of fibre-rich foods, including oats, beans, peas, lentils, grains, seeds, fruit, vegetables, wholegrain bread, and brown rice and pasta ¹.
• Patients should aim to eat at least five portions of a variety of fruit and vegetables each day, replacing foods higher in fat and calories ¹.
• Adopting a low-fat diet and avoiding increased fat or calorie intake is recommended ¹.
• Minimise the consumption of fried food, drinks and confectionery high in added sugars (e.g., cakes, pastries, sugar-sweetened drinks), and other foods high in fat and sugar (e.g., some take-away and fast foods) ¹.
• Minimise calorie intake from alcohol ¹.
• Patients should be mindful of portion sizes for meals and snacks, and the frequency of eating throughout the day ¹.
• Eating breakfast is also recommended ¹.

Physical Activity:

• Regular physical activity is essential for improving insulin sensitivity (Shiana et al., 2025).
• Patients should make enjoyable activities, such as walking, cycling, swimming, aerobics, and gardening, a routine part of their life ¹.
• Building other activity into their daily routine, such as taking the stairs instead of the lift or walking at lunchtime, is beneficial ¹.
• Minimise sedentary activities, such as sitting for long periods watching television, at a computer, or playing video games ¹.
• Using physically active forms of travel, like walking and cycling, should be encouraged ¹.

Supporting Behaviour Change:

• When recommending these changes, it is important to help patients understand the short, medium, and longer-term consequences of their health-related behaviour ¹.
• Help them feel positive about the benefits and value of health-enhancing behaviours ¹.
• Recognise how people's social contexts and relationships may affect their behaviour ¹.
• Help patients plan changes in terms of easy, sustainable steps over time ¹.
• Identify and plan for situations that might undermine changes, developing explicit 'if–then' coping strategies to maintain new behaviours ¹.