We all are familiar with the words like obesity and diabetes but very few are aware of the emerging epidemic of Diabesity. Diabesity refers to the concomitant occurrence of obesity and diabetes in a single individual, both these nutritional diseases complement each other and worsen overall prognosis.
Diabesity is defined as the combination of obesity and type 2 diabetes mellitus, with or without hypercholesterolemia and hypertension. Thus, diabesity is a type of metabolic syndrome. The emergence of obesity and diabetes is increasing exponentially around the globe.
In earlier times the developed and industrialized countries were having a higher prevalence of obesity, cardiovascular diseases, strokes, and diabetes mellitus. The new epidemic of Diabesity is equally emerging in both developed and undeveloped countries. In developing countries, around 150 million people are obese or are having obesity-related complications.
Diabesity = Diabetes + Obesity
Diabesity is a present-day emerging epidemic, which indicates the interlinked existence of obesity and diabetes. This condition is associated with many pathophysiological mechanisms involving insulin resistance, hyperinsulinemia, inflammatory markers, higher BMI, and other complications like stroke and heart diseases.
The two newly emerging epidemics of obesity and diabetes, the latter being linked to the former, are continuously rising among the population worldwide. They both collectively contribute to the prevalence of the cardiovascular disease.
In earlier times these non-communicable diseases were limited to the industrialized countries only but the new statistics are equally significant in developing countries as well. Roughly estimated that every 1 kilogram of rising in body weight increases the risk of diabetes by 4.5 fold.
According to WHO data statistics, in 1995 around 200 million adults were obese having a BMI higher than 30kg/m² whereas in the early twentieth century this figure has peaked to 300 million worldwide. The most common associated non-communicable disease along with obesity is diabetes mellitus i.e DIABESITY also called insulin-resistant or adult-onset diabetes.
According to research conducted by different scientists, it is concluded that obese people have an 80 times higher risk for developing type 2 diabetes than those who have BMI within the normal range.
Obesity is the hallmark of Diabesity:
Obesity is the overaccumulation of fats in one’s body, if a person weighs 20% more of his or her ideal weight is considered obese or having a body mass index ( BMI ) greater than 30 kg/m2
Obesity is a multifactorial disease, various factors can give rise to it such as consuming higher calories than required, having a sedentary lifestyle, insomnia, hypothyroidism, OCPs, etc.
Obesity is one of the most common nutritional disorders increasing exponentially but still ignored by the masses. Obesity is a complicated condition. It is not only related to health complications but poses serious social and psychological effects as well.
Usually, men have higher rates of being overweight but obesity is more prevalent among women. For both of them, uncontrolled weight gain and obesity can lead to other serious diet-related diseases including diabetes mellitus, cardiovascular complications, hypertension, stroke, and certain forms of neoplasms.
Excess Calories: Caloric Intake – Calorie Consumption
The main fact behind gaining weight is when the energy consumption is more than the energy expenditure so the extra calories are taken up by the adipocytes and stored. These cells are exhausted and the stress triggers an inflammatory response which releases cytokines. The insulin signaling pathway is blocked by the cytokines, thus rendering cells to become insulin resistant and giving rise to insulin-resistant type 2 DM.
Obesity remarkably increases the risk of other comorbidities such as hypertension and diabetes, these conditions are closely associated with other cardiovascular diseases as well. An obese person has three times increased risk for cardiac arrest than a person with a healthy body weight.
Diabetes is preventable in Obese patients:
Diabetes mellitus is one of the most common prevailing endocrine disorders globally. Diabetes is defined as having a two-hour post-meal blood glucose level greater than 200 mg/dl, Fasting blood glucose exceeding 125 mg/dl, or HbA1C levels higher than 48 mmol/mol or ( 6.4%).
During the last few decades, a large rise in this disease burden has been demonstrated in almost all areas of the world, no matter the western or eastern population. Diabetes is classified as insulin-dependent and insulin-resistant diabetes mellitus.
Either the pancreas doesn’t produce sufficient amounts of insulin or the body is not able to utilize the insulin due to the downregulation of insulin receptors. The most common consequence of uncontrolled diabetes is hyperglycemia which can give rise to a lot of associated complications such as stroke, hypertension, and retinopathies.
How to Prevent Obesity and Diabetes and end the Diabesity Pandemic:
The major goal for controlling the surge of epidemics is to not only control the disease but also to educate the population about the prevalence, pathogenesis, and complications to avoid such situations in the future.
The management of diabesity should be directed towards weight loss, controlling glycemic index, maintaining healthy BMI, avoiding high carbohydrates diet, minimizing refined sugar use, etc. some of the most important approaches are discussed below:
Prevent Obesity and Diabetes with your Diet:
Human health is directly related to the food one consumes. The diet plays a crucial role in maintaining the weight of the person and also improving quality of life. The diet should be planned in such a way as to include all the essential nutrients in required proportions fulfilling daily intake.
The best strategy to lose weight is to consume fewer calories and expend more in order to maintain a healthy balance. The most important factor in regulating weight is carbohydrates. Diabesity can be best managed by following a diet that is less in carbohydrates and refined sugars, increasing intakes of dietary fibers, proteins, omega fats, consuming more fresh vegetables and fruits, and strictly avoiding processed foods.
Consume fewer calories
The diet should be designed in such a way that it should be beneficial to treat both conditions cumulatively. A healthy balanced diet which should be low in carbohydrates and glycemic sugars to maintain weight and control blood sugar levels to avoid further complications.
Prevent Obesity and Diabetes with Exercise:
The major impact of having an active lifestyle is insulin sensitivity. One of the leading causes for insulin resistance is lack of physical exercise or having a sedentary lifestyle which leads to higher levels of HbA1C.
The recommended guidelines for physical exercising is 30 minutes of moderate-intensity workout thrice a week or simply doing exercise on alternate days. This improves insulin sensitivity, lowers the glycemic index, and helps in weight loss. Resistance exercises can also be performed twice a week to attain muscular strength and stay active.
The modernization and technological advancements in developed nations have replaced human power in many fields and reduced energy expenditures leading to a sedentary lifestyle. This marked decrease in physical activity is a significant factor in the obesity epidemic. Regular exercising should be promoted and recommended to every person with Diabesity in order to keep their weight controlled.
Prevent Obesity and Diabetes with Medical Nutrition Therapy:
Medical nutrition therapy or abbreviated as MNT plays a therapeutic role in managing the Diabesity epidemic. MNT is a customized nutrition plan for every single individual for testing chronic diseases like obesity, diabetes mellitus, hypertension, etc.
MNT can play a life-changing role in managing the epidemics of obesity and diabetes and improving the overall prognosis of the disease. The nutrition plan is structured by a certified nutritionist keeping in mind the specific history of the patient.
The plan is approved by the primary physician of the patient and implemented by the nutritionist. The main aim of this therapy is weight loss, improving insulin sensitivity, lowering blood glucose levels, and decreasing lipid profiles. MNT focuses more on calorie redistribution rather than calorie restrictions.
Prevent Obesity and Diabetes with Lifestyle Intervention:
The most widely used method for eradicating metabolic syndromes like overweight, obesity, diabetes, etc is through making changes in one daily routine. Lifestyle modifications play a pivotal role in improving the overall prognosis of the Diabesity epidemic. We should encourage the patient to exercise regularly, try to avoid taking escalators and use stairs whenever possible, should promote activities like cycling, running, and walking, and eating a balanced diet. Such small changes in daily lifestyle can have a huge impact on the health quality of the patient.
Avoid medicines that cause weight gain:
Managing diabetes and obesity consecutively can be a very challenging task for the physician because most of the oral anti-diabetogenic drugs lead to weight gain. Oral hypoglycemics like sulfonylureas, pioglitazone, gliptins, etc. have a tendency for weight gain.
All these things should be kept in mind while treating such patients and those drugs should be preferred which least likely lead to weight gain and also provide good glycemic control. The use of monotherapy for diabetes should be considered with weight-sparing drugs like metformin. The novel classes of medicines such as the SGLT-2 inhibitors (Jardiance, Frxiga) and GLP-1 analogs (Liraglutide, Dulaglutide, and Semaglutide) should be preferably used.
High dose Semaglutide (Wegovy) can cause a weight loss of up to 15%
Weight loss Surgeries (Bariatric and Cardiometabolic Surgeries)
Bariatric surgery is defined as reducing weight through surgical procedures or metabolic surgeries. These procedures are not only effective in treating obesity but also help in minimizing diabetes. That is why they can be considered as a safe option for treating the Diabesity epidemic. This is one of the most modern-day interventions for treating obesity and are gaining popularity worldwide.
The main objective of these surgeries is to modify or resect the stomach and intestine to make them smaller. This leads to decreased calorie intake, decreased hunger, and increased fullness. A few of the most commonly used procedures are listed below:
- Sleeve Gastrectomy
- Roux-en-Y Gastric Bypass
- Adjustable Gastric Band
- Biliopancreatic Diversion with Duodenal Switch
- Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy
In Summary, to prevent obesity and diabetes;
Simple lifestyle measures have a great role in eradicating Diabesity. Lifestyle modifications, diet therapy, behavioral counseling, physical exercise, pharmacological therapies, bariatric surgeries are widely used methods to treat diabesity.
Along with all these interventions, public awareness about this epidemic is also very crucial in controlling the widespread of this disease and minimizing its global burden. Healthy eating habits and dietary choices should be promoted and made affordable for the less privileged population as well. With the combined effort of every single individual, this epidemic can be controlled at a very early stage and further consequences can be avoided because prevention is always better than cure.