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Diabetes Mellitus and Obesity

February 9, 2021
Statistical data indicate that about 80% of individuals with type 2 diabetes are obese. It also suggests a significant association between obesity and diabetes. Obesity can be defined as an accumulation of excessive fat imposing serious health risk. A person with a body mass index (BMI) of 30 kg/m2 or more is considered as obese. It is considered as a major risk factor for several chronic diseases including diabetes.

Diabetes is a chronic disease that is associated with high levels of blood glucose levels. Type 1 diabetes results when the body’s own immune system acts against the pancreatic beta cells. They are the only cells in the body that produce insulin, a hormone that helps the body to efficiently use glucose as a fuel, thereby regulating blood glucose levels. Type 1 diabetes can occur at any age, but usually occurs in children and young adults. It is a rare condition and accounts for only five to ten percent of all the diabetes cases diagnosed. 

In contrast, type 2 diabetes accounts for 90 to 95 percent of all diagnosed diabetes cases. It develops due to insulin resistance, which refers to the inability of the cells to respond to insulin. As a result, the cells cannot take up glucose in sufficient amounts, resulting in high blood sugar levels. Overtime, as the need for insulin increases the pancreas loses its ability to produce insulin.

Global statistics reveal dramatic increase in the incidence and prevalence of type 2 diabetes over the past 20 years. About 415 million people across the globe were affected with diabetes in 2015, which was expected to hit 642 million by 2040.

An insight on their co-occurrence

Majority of the individuals with type 2 diabetes are obese, suggesting that obesity can have a high impact on raising an individual’s risk for diabetes. “Diabesity” is the term coined to demonstrate the link between diabetes and obesity. In India, evidence suggests a steep increase in age-adjusted prevalence of obesity in both men and women over the past couple of decades. Both obesity and diabetes can substantially decrease the quality of life and life expectancy. Type 2 diabetes is also a major non-communicable disease that can substantially decrease the quality of life (QOL) and can lead to many other complications including death.

How are they linked?

Several modifiable or non-modifiable factors can increase the risk of developing type 2 diabetes.  However, obesity is considered as a major independent and modifiable risk factor for type 2 diabetes. In fact, several obesity indices, such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio (WSR) are significantly associated with type 2 diabetes. Especially, BMI is considered as the marker that is more frequently used to assess the risk of future type 2 diabetes. Studies clearly portray a progressive increase in the prevalence of type 2 diabetes with obesity. The risk for type 2 diabetes rises with the increase in body weight, irrespective of age. The risk for type 2 diabetes is three to seven times higher in an obese individual when compared to adults of normal weight. The risk may even rise by 20 times for people with BMI greater than 35 kg/m2. In addition to the degree of obesity, the location of fat distribution in the body also acts as a critical determinant for the risk of type 2 diabetes. The degree of insulin resistance and the incidence of type 2 diabetes are found to be directly proportional with increase in the waist circumference. The fact that obesity can lead to diabetes is also best explained by its ability to cause insulin resistance. The concrete reason behind the development of insulin resistance may not be clearly understood. However, it is well known that obesity and lack of physical activity can make it worse. Additionally, insulin resistance and defective insulin are observed to occur early in obese patients. Increase in an overall fat, especially visceral as well as ectopic fat deposits are found to be associated with insulin resistance.

Know what is in your control

Modifiable risk factors for type 2 diabetes include high blood pressure, abnormal cholesterol levels, physical inactivity and obesity. However, evidences suggest that obesity acts as an independent risk factor for type 2 diabetes, which turns out to be a major risk factor in its severe state. Working towards making healthy lifestyle changes can reduce the risk of diabetes and even delay its onset. Losing about five to ten percent of the body weight can reduce the risk of developing pre-diabetes by 50%, which can be reduced further with subsequent weight loss. Physical activities in any form, improves insulin sensitivity and glycemic control and may reduce the risk of developing diabetes. Engaging in aerobic physical activity for at least 150 minutes per week or intense physical activity for 75 minutes per week helps to manage weight and improve quality of life. Making healthy changes in eating habits such as including more fruits and vegetables coupled with whole grains and low-fat dairy and avoiding foods with high calorific value and sugars can substantially aid in weight loss and also help to maintain healthy weight. Even modest weight loss through lifestyle or behavioral interventions, obesity medications, or bariatric surgery can improve glycemic control and reduce diabetes risk or help control type 2 diabetes.

Outlook

To sum up, it is imperative to view and address both obesity and diabetes collectively, as the pandemic effect of obesity could have serious implications for future incidences of diabetes. Due to their high prevalence and incidence in a synchronous fashion, several guidelines recommend treatments specifically for dealing with obese patients with type 2 diabetes. Hence, understanding the benefit of following a healthy-lifestyle and maintaining a normal body weight is crucial to stay away from diabetes and improve quality of life in many other facets.

References :

  1. Chen L, Pei JH, Kuang J, et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015;64(2):338-347. doi:10.1016/j.metabol.2014.10.018
  2. Bramante CT, Lee CJ, Gudzune KA. Treatment of Obesity in Patients With Diabetes. Diabetes Spectr. 2017;30(4):237-243. doi:10.2337/ds17-0030
  3. Luhar S, Timæus IM, Jones R, et al. Forecasting the prevalence of overweight and obesity in India to 2040. PLoS One. 2020;15(2):e0229438. Published 2020 Feb 24.
  4. Bhupathiraju SN, Hu FB. Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications. Circ Res. 2016;118(11):1723-1735.
  5. Wang S, Ma W, Yuan Z, et al. Association between obesity indices and type 2 diabetes mellitus among middle-aged and elderly people in Jinan, China: a cross-sectional study. BMJ Open. 2016;6(11):e012742. Published 2016 Nov 3.

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