Diabesity: An Unhealthy Relationship

November is National Diabetes Month, created to bring much needed awareness and attention to diabetes and communities at risk from the disease. More than 30 million Americans have diabetes, and among those with type 2 diabetes, 90 percent are overweight or obese, leading to “diabesity.” Given the continued upward trajectory of obesity, combined with a decrease in physical activity and poor food choices or options, the need for awareness is critical as the occurrence of diabetes continues to rise.

Obesity is the single greatest predictor of type 2 diabetes, and the risk increases for those who incorporate only limited activity into their daily routine. Despite the strong connection, however, diabetes can go undiagnosed since obesity can cause insulin resistance while hyperglycemia continues to develop. Adding to the health risk, insulin resistance and diabetes also are predictors of cardiovascular morbidity and mortality.

Since each disease brings its own risks, it is no surprise that the pathophysiology of this duo is complex. Obesity is linked with inflammation, which is marked by hyperglycemia and dyslipidemia. At the same time, diabetics often have hypertension and cardiovascular conditions, such as atherosclerotic disease, which are accelerated by diabetes. The marriage of both of these diseases elevates risk in a number of areas, such as heart disease and stroke.

Weight loss and behavior modification are the first line and most effective solutions to treating both health conditions. Specifically, a Very Low Calorie Diet (VLCD) is shown to be effective in treating persons having obesity and type 2 diabetes, and studies, including one using the New Direction System, demonstrate rapid weight loss, normalization of blood glucose levels, and reduction in plasma lipid levels. The combination of these factors can be very motivating because it can reduce or even entirely eliminate the need for medication. Several randomized controlled trials consistently report weight loss, health improvements, reduction in HbA1c, and lower insulin dependence. (See, for example, Brown et al., 2020; Lean & Leslie, 2018; Guo et al., 2018; and Goday et al., 2016.)

Since diabetes is the seventh leading cause of death in the United States, National Diabetes Month is but a small step in a series of events necessary to addressing diabesity-related factors.