The Link between Obesity and Diabetes

According to the American Diabetes Association, in 2002, 18.2 million Americans, or 6.3% of the total population, had diabetes, the sixth leading cause of death in the US. Direct and indirect costs of the disease at that time were estimated at $132 billion.

At Central Clinic, family medicine specialist Dr. Poonam Malhotra offers comprehensive diabetes care in her Spring Hill, Florida office, everything from prevention to diagnosis and treatment. She particularly wants her patients to know about the link between being overweight or obese and developing this serious condition, so she’s put together this guide.

The types of diabetes

Your body uses the sugar glucose as an energy source to build and maintain its various systems. It’s regulated by the hormone insulin, produced in the pancreas. Diabetes is a disease notable for high blood glucose levels that result from defects in insulin production, from resistance to insulin, or both.

Type 1 diabetes develops when the body’s immune system mistakenly destroys pancreatic beta cells, the body’s only source of insulin. This form of diabetes usually strikes children and young adults, which explains why it was often called juvenile diabetes. Type 1 diabetes accounts for just 5-10% of all diagnosed diabetes cases, and it’s generally managed through daily insulin injections.

Type 2 diabetes is a disease of insulin resistance, a condition in which the cells don’t use insulin properly. And as the need for insulin rises, the pancreas loses its ability to produce the hormone.

The risk of developing type 2 diabetes is associated with some factors that can be modified, and others that can’t. One that can’t is genetics. A first-degree relative of a type 2 diabetes carrier has a risk five to 10 times greater than someone without a family history.

Factors that can be modified are diet and exercise. Many research studies have determined that lifestyle changes, including in diet and exercise, can either prevent or delay the onset of type 2 diabetes among high-risk adults.

At all ages, the risk of developing type 2 diabetes increases with a rise in body weight. Its prevalence is three to seven times higher in obese adults than normal weight adults, and it’s 20 times more likely for people who have a body mass index (BMI) greater than 35.

The third type of diabetes is gestational diabetes. It sometimes develops in women who are pregnant. While glucose levels generally return to normal following delivery, women who experienced gestational diabetes are at an increased risk of developing type 2 diabetes later in life.

The obesity-diabetes connection

So what is it about obesity that can lead to diabetes? There have been several studies done to address that issue.

It’s known that having excess abdominal fat or an “apple shape” (i.e., a large waistline) is a high-risk factor for developing diabetes. Some studies suggest that abdominal fat causes the cells to release “pro-inflammatory” chemicals into the bloodstream, which disrupts insulin-responsive cells’ function, leading to insulin resistance — the primary feature of type 2 diabetes.

Obesity is also believed to trigger changes in the body’s metabolism. Such changes cause adipose tissue to release fat into the blood, again disrupting insulin-responsive cells function.

Scientists have also questioned the role of obesity in causing prediabetes, a metabolic condition that almost always develops into type 2 diabetes. A new study from Harvard University researchers, published in the October 15 issue of the journal Science, has suggested a new pathway that sets in motion the development of insulin resistance. It involves the endoplasmic reticulum, an organelle responsible for processing proteins and fats.

Christopher Newgard, of Duke University Medical Center, explains that "As you enter a state of overnutrition … all of those nutrients that come in need to be processed, stored, and utilized and the ER factory is overworked and starts sending out SOS signals."

These SOS signals direct cells to turn down the function of their insulin receptors. As a result, what’s designed as a short-term adaptive response leads to long-term chronic illness. Insulin soon becomes incapable of helping to clear sugar from the body.

What can be done?

The good news is that shedding the weight can significantly improve the severity of type 2 diabetes. Dr. Malhotra takes a holistic approach to diabetes care, creating a customized treatment plan that incorporates multiple tools and lifestyle modifications. Some items include:

• Losing weight
• Eating a healthy, balanced diet
• Increasing physical activity
• Stopping smoking
• Monitoring blood glucose levels
• Reducing stress levels
• Insulin injections, if necessary
• Oral medications, if necessary

If you’re overweight and suffer from prediabetes or even diabetes itself, contact Dr. Malhotra to learn more about what you can do to regain your health. Call the office at 352-254-5649, or book your consultation online today.