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Obesity and Diabetes

“Diabesity” is a new term coined to describe obesity-related diabetes. Obesity is a medical condition characterized by excess accumulation of body fat and is often diagnosed by a Body Mass Index (or BMI) of 30 or greater. This increase in BMI poses a higher risk for the development of many other obesity-related conditions, with diabetes being the most significant.

Diabetes

Diabetes, or diabetes mellitus, is a chronic disease characterized by high levels of glucose in the blood. Glucose is a sugar obtained from the food we eat and is a major form of energy for all body functions.

Physiology

A hormone called insulin, which is secreted by the pancreas, regulates blood glucose levels by signaling the liver, fat cells and muscles to take up glucose. Carbohydrates in the food we eat are broken down to form glucose, which is either used immediately by the muscles and liver as energy or stored for later use. When levels of blood sugar start rising after a meal, insulin transports the sugar into the cells. If the pancreas fails to produce sufficient amounts of insulin or the body’s cells are insensitive to the hormone, glucose starts accumulating in the blood stream, leading to diabetes.

Types

The different types of diabetes are:

  • Prediabetes: blood sugar levels are higher than normal, but not too high to be diagnosed as diabetes. At this stage, the condition can potentially be reversed.
  • Type 1 diabetes: insufficient production of insulin. Many people with Type I diabetes are diagnosed as children, and it is typically not related to obesity.
  • Type 2 diabetes: insufficient production of insulin or the inadequate response of the body’s cells to the presence of insulin
  • Gestational diabetes: occurs during pregnancy and usually resolves after child birth

Causes

The exact cause of diabetes is not very clear, but there are various factors that can increase your risk:

  • Immune system attacks the insulin-producing pancreatic cells in cases of Type 1 diabetes
  • Pregnancy hormones make your body’s cells more resistant to insulin
  • Family history of diabetes
  • Environmental factors such as viral infections and medications
  • Aging
  • Polycystic ovary syndrome
  • High blood pressure
  • Low levels of HDL and high levels of LDL cholesterol
  • Being obese
  • Living a sedentary lifestyle

Symptoms

Prediabetes and early Type 2 diabetes may not show any symptoms. Symptoms of Type 1 diabetes typically occur suddenly and may be severe. Some of the common signs and symptoms may include:

  • Increased thirst and hunger
  • Unexplained weight loss
  • Frequent urination
  • Irritability
  • Fatigue
  • Blurred vision
  • Frequent infections
  • Delay in healing of wounds

Although diabetes can occur at any age, Type 1 diabetes is often diagnosed in children and young adults, while onset of Type 2 diabetes is commonly after the age of 45.

Complications

Diabetes is a chronic disease and is associated with disabling and sometimes life-threatening long-term complications such as:

  • Cardiovascular diseases including heart attack, coronary artery disease, angina, stroke and atherosclerosis
  • Nerve damage (neuropathy), which can lead to numbness, burning, pain or tingling sensation, and eventually loss of sensation if left untreated
  • Kidney damage (nephropathy), potentially resulting in end-stage kidney disease or kidney failure
  • Eye damage (retinopathy), which can result in cataracts, glaucoma and even blindness
  • Foot damage due to poor blood flow to the feet, which can lead to serious infections that do not heal properly, frequently necessitating amputation
  • Skin conditions, such as bacterial and fungal infections
  • Urinary Tract Infections
  • Hearing problems
  • Alzheimer's disease or vascular dementia
  • Large babies due to gestational diabetes, necessitating cesarean section birth
  • Hypoglycemia or low blood sugar in babies immediately after birth
  • Death in babies if left untreated
  • Preeclampsia, characterized by high blood pressure, and swelling in the legs and feet in pregnant women, which can be serious or even fatal to both mother and baby

Diagnosis

When you present to your doctor with the above symptoms, your doctor will order a few tests to diagnose diabetes:

  • Fasting blood glucose test: The fasting blood glucose test is the preferred test for diagnosing diabetes. A sample of blood is drawn after fasting overnight and tested for levels of glucose. Levels of 100 to 125 mg/dL is inferred as prediabetes, while levels more than 125 mg/dL on two or more separate tests on different days indicates diabetes.
  • Random blood glucose test: A blood sample is taken randomly, at any time of day (regardless of whether you have eaten or not). Blood glucose levels of 200 mg/dL or higher indicates diabetes.
  • Oral glucose tolerance test: It is commonly performed for diagnosing gestational diabetes, diabetes and pre-diabetes. In this test, a sample of blood is taken to determine fasting blood sugar level. Following this, a standard amount of sugar is provided orally and blood samples are taken at specific intervals within 2 hours to measure the blood glucose. Levels more than 200 mg/dL indicates diabetes, and levels 140 to 199 mg/dL indicates prediabetes.

Treatment

Treatment of diabetes involves diet, exercise, medications and other lifestyle improvements. These will help to maintain normal blood sugar levels, and prevent or minimize complications.

  • Diet: Eat a consistent, well balanced diet that is high in fiber, and low in saturated fats and concentrated sweets. Meals should be taken on a regular schedule and avoid long periods between eating.
  • Exercise: Regular exercise in any form can help maintain a healthy weight and blood sugar levels within a normal range.
  • Smoking and alcohol use: Stop smoking and limit consumption of alcohol.
  • Medical treatment: Treatment varies depending on the type of diabetes. Treatment for Type 1 diabetes and gestational diabetes usually involves multiple daily injections of insulin. Treatment for Type 2 diabetes can frequently involve a combination of oral medications and insulin injections in order to control blood sugar levels.
  • Treating comorbidities: Your doctor will also include medications and treatments to prevent, control, and treat other associated conditions, such as high cholesterol and hypertension.
  • Pancreatic transplantation: This method can be indicated for Type 1 diabetes. If the pancreas transplant is successful, insulin supplementation may no longer be needed.
  • Bariatric surgery: This is a weight loss surgery that has been shown to improve both weight and blood sugar levels associated with Type 2 diabetes. Bariatric surgery is not a treatment method for those with Type 1 or gestational diabetes.

Regular monitoring of blood glucose is necessary to prevent long-term complications of the disease.

Obesity

Obesity is defined as having too much body fat, which develops when the intake of calories exceeds its expenditure. It is measured as Body Mass Index (BMI), with a result of 30 or higher indicative of obesity. According to the Centers for Disease Control and Prevention (CDC), obesity is emerging as an epidemic both in the United States and across the globe.

Childhood obesity

Obesity among children has become not only a serious public health problem, but also a global epidemic. Childhood obesity has serious long-term consequences on morbidity and mortality. Obese children often grow up to become obese in adulthood and have a higher risk of developing many chronic diseases such as heart disease, hypertension, stroke, certain cancers, and Type 2 diabetes.

Causes

Obesity occurs when your intake of calories exceeds its use by the body as energy. There are several factors that can influence your chances of becoming obese:

  • Genetic makeup
  • Overeating and a diet rich in fatty and/or calorie laden foods
  • Sedentary lifestyle
  • Use of some prescription medications

Consequences

Obesity is associated with many serious physiological, psychological, and social consequences, as listed below.

Physiological consequences of obesity are:

  • High blood pressure
  • Heart disease
  • Gallbladder disease
  • Cancer (breast, uterine and colon cancer)
  • Digestive disorders (gastroesophageal reflux disease or GERD)
  • Breathing problems (asthma, COPD)
  • Problems with fertility and pregnancy
  • Urinary incontinence and urinary tract infections
  • Joint problems (arthritis)
  • Shorter life expectancy

Psychological and social consequences of obesity are:

  • Negative self-image
  • Social discrimination and isolation
  • Depression
  • Anxiety

Other consequences include:

  • Difficulty in performing normal tasks as movement becomes more difficult
  • Feeling tired more quickly
  • Experiencing shortness of breath
  • Difficulty in using public transportation seating and driving cars
  • Difficulty in maintaining personal hygiene

Diabesity

Obesity is the single best predictor of Type 2 diabetes. Apart from the amount of excess weight, the region of excess body weight also determines your risk of developing insulin resistance. The risk of Type 2 diabetes is higher if you have an apple-shaped body (having excess body weight

concentrated around your waist) as opposed to a pear-shaped body (where the hips and thighs carry most of your weight).

Until recently, Type 2 diabetes was considered a disease of the middle aged and elderly. Sadly, now Type 2 diabetes is seen among children and adolescents in association with obesity.

If you have an increased body weight, you are at a higher risk of developing diabetes. While diabetes is not always avoidable, obesity can be prevented by maintaining a healthy weight. A moderate and sustained weight loss of 5-10% of your body weight can not only treat obesity and its comorbidities, but also improve the action of insulin in maintaining normal blood glucose levels.

Treatment

Weight loss can be achieved through surgical or non-surgical methods.

Non-surgical treatment

Non-surgical treatment involves comprehensive lifestyle management. It includes diet, exercise, and medication, which have long been regarded as the conventional methods to achieve weight loss. These treatments show short-term success, but for the morbidly obese the results rarely last. For many, this can translate into what's called the “yo-yo syndrome,” in which you continually gain and lose weight with the possibility of serious psychological and health consequences.

When it comes to permanent weight loss, recent research reveals that conventional methods of weight loss generally fail. When you diet, exercise, or take medication you lose about 10% of your body weight but tend to gain two-thirds of it in one year and almost all of it within five years.

Surgical treatment

Weight loss surgery or bariatric surgery has proven to be a successful method for the treatment of morbid obesity. You may be advised to strongly consider bariatric surgery in the following cases:

  • BMI ≥ 40
  • BMI ≥35 with one or more related co-morbidities such as Type 2 diabetes (T2DM), heart disease, hypertension, or sleep apnea
  • Other forms of weight loss methods have failed to achieve a sustained healthy weight

Bariatric surgery works on the principle of:

  • Restriction: amount of food intake is limited with a smaller stomach
  • Malabsorption: absorption of food is reduced by bypassing a section of the stomach and small intestine
  • Combination of restriction and malabsorption

Some of the surgical procedures performed to treat obesity include:

  • Intragastric balloon: An inflated silicone balloon is inserted into the stomach to take up space and reduce the amount of food it can hold.
  • Gastric banding (or lap band): A band is placed around the upper part of the stomach to form a small pouch and limit the stomach’s capacity to hold food.
  • Sleeve gastrectomy (or gastric sleeve): A portion of the stomach is stapled, reducing the size of the stomach and it’s capacity to hold food
  • Roux en Y gastric bypass: A small portion of the stomach is stapled and attached to the small intestine, bypassing the first section of the small intestine.

The use of laparoscopy for performing these procedures is the biggest advancement in bariatric surgery. The laparoscopic procedure is a minimally invasive procedure where the surgery is performed through small incisions. You will experience minimal discomfort and a more rapid recovery with this approach.

Prevention

Adopting a healthy lifestyle will help prevent obesity and the development of Type 2 diabetes. This can include eating healthy, balanced food and engaging in moderate to intense physical activities, such as walking. Parents can teach healthy eating habits to children, reduce their intake of sweetened beverages, fast food, and foods high in sugar and fats. Encouraging an active life of play and sports, and limiting TV, tablet, and computer time, are critical in maintaining a healthy weight.