Reimagining Diabetes Care – A New Focus On Obesity
- Nicole Fong
Diabetes is a long-term illness that affects over 422 million people worldwide. It is predicted that this prevalence will increase to 642 million by 2040. With the conversation surrounding diabetes evolving in recent years, it has become apparent that obesity is the most significant risk factor for this disease, given the similar connection the two conditions share. Therefore, it is crucial to address the root cause of this epidemic. This article looks at the link between diabetes and obesity from many angles. Of particular importance is the role of weight loss in managing diabetes.
Insulin resistance: the primary culprit
There is more to obesity and diabetes than a straightforward cause-and-effect relationship. In this exchange, the spotlight is on the insulin hormone. Upon consumption of foods or drinks containing carbohydrates, our blood sugar level increases. Our pancreas responds by secreting more insulin to help our cells take in more sugar and prevent it from building up in our bloodstream.
Obesity triggers a biological process of fat production, known as lipogenesis, which primarily happens in fat tissue and the liver. As fat tissue expands and gets closer to its maximum size, the excess fat accumulates in vital organs such as the liver, muscles, and pancreas. This phenomenon creates a hostile condition, making it difficult for insulin to work properly. As a result, the body would become resistant to insulin, much like a rusty lock makes it difficult for the key (insulin) to unlock a door (body cells). In the long run, an increase in fat in the bloodstream can eventually clog up the lock, further hampering the key’s function.
A heterogeneous relationship between Type 2 diabetes and Obesity
Although body mass index (BMI) has been used in professional settings to measure the degree of overweight and obesity, it has limitations in accurately predicting the risk of diabetes. It is not as simple as just looking at a person's weight; not everyone living with obesity (BMI ≥ 30kg/m2) has a lot of body fat. The same goes for individuals with a lean physique who may not be immune to diabetes. The truth is that there is no straight line between BMI and diabetes.
BMI is often misunderstood because it doesn't consider the properties of the fat tissue in our body, which can vary in size and distribution. These factors can impact how our bodies store and use fat, ultimately affecting our health in the long run. Therefore, a stronger link has been found between the risk of diabetes and the properties of fat tissue.
So, relying solely on BMI to determine if someone is likely to get diabetes can lead to misunderstandings and inaccurate assessments. A prime example of fat distribution is waist circumference. It may suggest the existence of extra fat in the body, in the specific context of centralized fat distribution, which has an increased risk of obesity-linked illnesses. Measuring the waist circumference is particularly useful for identifying people who don't have obesity (based on their BMI) but still carry a disproportionate amount of weight around their midsection.
While these are helpful obesity screening tools, they do not provide insight into a person's risk for certain health conditions like diabetes. There are two types of obesity: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). People with MHO tend to have better control over their blood sugar, less fat buildup, and lower inflammation levels than those with MUO. More tests, such as blood sugar levels, are needed to differentiate between the two, which is important for diabetes prevention and treatment.
Weight-centric approaches for type 2 diabetes
Despite the growing evidence linking obesity and diabetes, the role of genetic predisposition cannot be overlooked. And here's why.
The concept of "polygenic obesity", in which obesity is manifested because of the interaction between multiple genes, rather than just one, and is compounded by a combination of environmental and genetic factors. Although our genetic makeup undeniably plays a role in determining our weight, it is not the only factor. We live in an 'obesogenic' environment favouring energy storage through high food intake and little physical exercise. As a result, high-fat diets store excess calories, which increases body fat. This change in energy balance makes it harder for our body to use insulin in just a few days before obesity can develop. Therefore, eating healthy food and being physically active should be the top objectives to avoid diabetes and obesity. While we cannot change our genetic makeup, we can control our environmental triggers.
Although the benefits of weight loss are on a continuum, achieving and maintaining long-term weight loss poses a formidable challenge.
We should not be too hard on ourselves for not achieving our weight loss goals, given that obesity is a condition influenced by biological, environmental, and behavioural factors. The key to breaking free from this complex condition lies in prioritising our health and working collaboratively with healthcare professionals to develop a personalised plan, ultimately adopting a new mindset and reframing our approach to managing this intricate condition effectively.
A recommended primary goal of diabetes treatment is achieving a double-digit weight loss. The evidence supports this as the most effective way to combat the leading cause of the condition, obesity. Focusing on weight loss (ideally >15%) can improve the root problem and is beneficial in lowering risk factors for heart diseases and long-term complications from diabetes. Such an approach is a big step towards more patient-centered care that considers the person as a whole rather than just tackling their high blood sugar and heart problems with traditional medications. Acknowledging the complex interplay between obesity and diabetes, and not just its downstream effects, it holds a greater promise for improving the quality of life for people with diabetes.
Take home message
Managing obesity is a recent paradigm change in the treatment of diabetes. The target of double-digit weight loss emphasizes the significance of empowerment and engagement with healthcare professionals. Let’s strive to foster a culture of optimism in tackling the root causes rather than merely alleviating symptoms. Keep going and never lose sight of our goals; the path to better health is always worthwhile.
References
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