Diabetes Management

Obesity and Type 2 Diabetes What’s the link?

The vast majority of people with type 2 diabetes are overweight or obese.

The rates of both diabetes and obesity have climbed over the decades and closely mirror each other.

It’s no secret that these two conditions are related, but what exactly links them together, and what can you do to reduce your risk of type 2 diabetes?

This article will provide an overview of both conditions and how they intertwine.

What is Type 2 Diabetes?

Diabetes mellitus is a disease defined by high levels of sugar, or glucose, in the blood. There are two main types of diabetes: type 1 and type 2.

  • Type 1 diabetes compromises about 5% of all diabetes cases. It involves a complete deficiency of insulin and often starts in the youth.

  • Type 2 diabetes is, by far, the most common type of diabetes. It occurs after progressive insulin resistance leads to high blood glucose.

Let’s break down type 2 diabetes in more detail since this is the type more strongly related to obesity.

The body works hard to maintain a certain level of glucose in the blood. Too much blood glucose will cause various complications over time, and too little glucose can quickly lead to fainting.

We consume glucose in the form of carbohydrates, which are sugar and starch-containing foods.

When these foods are eaten, blood sugar levels rise, and the pancreas secretes the hormone insulin. Insulin allows glucose to leave the bloodstream and enter the cells of muscles and tissues to be used as energy.

In type 2 diabetes, the body becomes resistant to its own insulin, which means insulin is no longer able to work correctly. This leads to high blood glucose and, eventually, a diagnosis of diabetes.

Risks of Type 2 Diabetes

What places you at risk for type 2 diabetes? Here are the known risk factors for type 2 diabetes.

  • Age. Being over the age of 45 automatically places you at higher risk for developing diabetes.

  • Family history. Genetics do play a role in diabetes, especially if a parent or sibling has the disease. Genome-wide association studies show that if both parents have diabetes, the child has a 70% chance of developing the condition. Researchers study both mice and humans to unlock the secrets of why some people get diabetes when others do not.

  • Sedentary lifestyle. Physical activity improves insulin sensitivity, and those that are active less than three days per week are at higher risk for diabetes.

  • Prediabetes. Prediabetes is a state where blood sugars are higher than normal but not high enough to be diagnosed as diabetes. If prediabetes is detected, the risk for diabetes jumps up significantly.

  • Poor diet habits. Some evidence suggests that having a poor diet with large amounts of added sugars can increase your risk of diabetes even independent of the effects on your weight.

  • Gestational diabetes. If you were told you have diabetes while pregnant, known as gestational diabetes, you are at a higher risk of developing type 2 diabetes after delivery.

  • Obesity. Is defined as a body mass index (BMI) of 30 or higher. Obesity is one of the most significant modifiable risk factors for diabetes, making it an important target to improve.

The American Diabetes Association recommends getting tested for diabetes if you are at increased risk.

Obesity’s role in the development of Type 2 Diabetes

Recall that type 2 diabetes is a condition characterized by insulin resistance and, eventually, insulin dysfunction. Having extra fat can directly lead to both of these issues in a few different ways.

Body fat (also known as adipose tissue) occurs when there is an excess of energy intake, and the body needs somewhere to store this extra energy.

Researchers have found that this adipose tissue also functions somewhat like an organ and is continuously secreting various chemicals. These chemicals, such as inflammatory substances, fatty acids, and hormones such as adiponectin, can interfere with the normal function of insulin.

People with obesity have significantly more adipose tissue and thus will be at greater risk for insulin resistance. The location of adipose tissue also impacts insulin sensitivity.

Fat tissue around the abdominal organs, known as visceral fat, promotes insulin resistance more than does fat in other areas of the body. In fact, waist circumference is used as a marker for a condition known as metabolic syndrome – a precursor to diabetes.

In an insulin-resistant state, insulin is produced as usual, but the action of insulin – that is to bring glucose out of the blood – is impaired.

To compensate for this, the insulin-producing cells of the pancreas, known as the beta cells, secrete more insulin. This is why blood glucose can be normal even when insulin resistance is present.

Eventually, the pancreatic beta cells “burn out,” and the ability to secrete insulin also becomes impaired.

When this happens, the body can no longer keep the blood glucose level normal, and type 2 diabetes will have officially developed. As disease control worsens, medications such as insulin may be required for treatment.

Treating Obesity: Lifestyle changes

The good news is that if you have extra weight to lose, losing just 5% of your body weight can significantly improve many areas of your health.

Besides diabetes, obesity also places you at risk for cardiovascular disease, heart disease, high blood pressure, fatty liver, sleep apnea, cancer, and other metabolic diseases.

The basic prescription to lose weight is simple: you must eat fewer calories than you expend.

Typically, weight loss advice advises reducing daily calories by about 500 per day, which will result in 1 pound per week weight loss. Although this is simple, many people can attest to the fact that it is certainly not easy.

The key is to look at weight loss as a lifestyle change, not as a “diet.” Lifestyle changes take time to develop, but are more sustainable and last longer. The following are evidence-based strategies to consider.

  1. Practice mindfulness. The first step in making a lifestyle change is to identify your current habits. Mindfulness is the act of paying more attention to what you eat. Tracking your food and drink habits using a food journal or phone app is an excellent way to identify areas for improvement. This will help you uncover not only how much you eat but also what leads to problematic eating: boredom? Stress? Cravings?

  2. Manage your surroundings. It is always easier to avoid mindless eating when there are no treats in the home. Keep food out of sight and out of easily accessible areas.

  3. Watch the beverages. Sodas, juices, and sports drinks supply large amounts of sugar and calories, and they do not keep you full. Choose water as much as possible, but unsweetened teas, seltzer waters, and sugar-free drinks are other low-calorie diet options.

  4. Eat at home. Foods eaten out are almost always higher in calories than home-cooked meals. People tend to eat more and overindulge when dining out. Practice with some simple meal-planning. Find a few recipes that look good to you and start a grocery list. Start with dinner meals, and use the leftovers for lunch. Breakfast can usually be something easy to grab and go, such as yogurt or fruit. When time is short, use simple sandwiches with eggs, tuna, turkey, or chicken breast in a pinch.

  5. Eat only when hungry. It is common for people to eat at times when not hungry such as while watching TV or engaging in another mindless activity. When feeling like a snack, first, ask yourself if you are truly hungry or if you are fulfilling another need such as boredom or stress. If it’s not hunger, try to find another activity such as listening to music or going for a walk instead. If hunger does strike, did you go too long without eating? Try eating every 5 hours or try a healthy snack that is pre-portioned. Good examples include light popcorn, yogurt, fruit, carrots with hummus, or a mozzarella cheese stick.

  6. Keep track of portions. Try the plate method to help you keep track of portions. Half of the plate should consist of non-starchy vegetables such as greens, carrots, tomatoes, and cauliflower. One-quarter of the plate should include a lean protein such as chicken, turkey, fish, eggs, or tofu. The last quarter of the plate can consist of starchy foods like rice, corn, beans, pasta, and bread. The plate method is designed to be roughly 500-600 calories a meal. Proper portion control will also help to control cholesterol, including low-density lipoprotein (LDL) levels, an essential target for diabetics.

  7. Exercise. As you lose weight, your metabolism naturally slows a bit which makes it harder to continue to lose weight. This is where exercise comes in, being physically active for at least 30 minutes a day and including strength exercises at least two days per week will help you maintain your weight loss. Exercise in any way that feels good to you, even home exercises can work.

  8. Start small. Don’t try to change everything at once; remember the key is sustainable lifestyle changes. Start with a few simple goals that feel realistic. Once these changes become part of your regular lifestyle, you can add additional goals.

Treating Obesity: Alternate options

When lifestyle changes alone aren’t cutting it, there are a couple of other options for the treatment of obesity: medications and bariatric surgery.

  • Weight loss medications: Currently, there are a few weight loss medications on the market, and most require a medical prescription. In general, they can help to supplement diet and exercise and induce modest weight loss. However, they are not magic pills, and they do have side effects.

  • Bariatric surgery: Bariatric surgery is a catch-all term for various weight-loss operations, including the popular gastric bypass and sleeve gastrectomy.

    These procedures are usually reserved for severe obesity or obesity with a complication such as diabetes. People who undergo bariatric surgery can expect to lose up to 80% of their excess weight, and many achieve diabetes remission. Despite these benefits, the procedures require intensive lifestyle changes and are generally irreversible.

Prevention

If treated early, it is possible to prevent both type 2 diabetes and obesity. Preventing these conditions from ever developing is easier than managing them once they occur.

The lifestyle strategies above are great habits to get into before significant weight gain occurs. This is especially true for strength-based exercises and physical activity.

Having more skeletal muscle mass dramatically improves insulin sensitivity and also will raise your metabolic rate.

In addition to lifestyle changes, make sure to attend regular check-ups from a medical provider, especially once you reach the age of 45. This way, even if you start to develop insulin resistance or prediabetes, it can be treated before it develops into full-blown type 2 diabetes.

Conclusion

Obesity and diabetes mellitus are closely related conditions. Obesity directly contributes to the insulin dysfunction that gives rise to type 2 diabetes. Also, extra fat worsens blood glucose control in those already with diabetes and increases your metabolic risk.

Obesity rates continue to show that the prevalence of the condition is not halting anytime soon. This underscores the difficulty of losing weight in developed countries.

Fortunately, obesity is both preventable and treatable. Treatment generally involves lifestyle changes, but medications and surgery are also available.

Sources

  1. Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity : targets and therapy7, 587–591. doi:10.2147/DMSO.S67400
  2. Ali O. (2013). Genetics of type 2 diabetes.World journal of diabetes4(4), 114–123. doi:10.4239/wjd.v4.i4.114
  3. Barnes A. S. (2011). The epidemic of obesity and diabetes: trends and treatments. Texas Heart Institute journal38(2), 142–144.
  4. Who’s at Risk? (2019, August 28). Retrieved from https://www.cdc.gov/diabetes/basics/risk-factors.html

 

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