Disparities in obesity and diabetes foreshadow important differences in health outcomes including long-term disability, cardiovascular disease, some cancers, and premature mortality. African Americans have a significantly increased rate of obesity, even starting in the school-age populations. In general, African Americans have a higher prevalence of obesity and are at a greater risk for weight management problems. Most research involving African Americans and diabetes points to increased insulin resistance and upregulated beta cell function when compared to European Americans. HbA1c at diagnosis is generally one point higher in African Americans. “Fatalism” in African Americans with diabetes is common, and this attitude of hopelessness as it relates to diabetes control is “significantly associated with poor medication adherence and self-care.” There are ways to address “fatalism” but the first step is to recognize it. Adequate diabetes education, both in small groups and individually, has been shown to improve overall diabetes care. Advising patients on food and beverage choices using stepwise recommendations will allow for a graduated, better-tolerated, and accepted change.