Obesity and Type 2 diabetes are diseases that can substantially decrease life expectancy, diminish quality of life and increase healthcare costs. The incidence of obesity and diabetes continues to rise by epidemic proportions. The term “diabesity” has been coined to describe obesity dependent diabetes. According to the American Diabetes Association, in 2002 18.2 million people, or 6.3 per cent of the population, had diabetes. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2000. The direct and indirect cost of diabetes in the U.S. in 2002 was estimated at $132 billion. It has been estimated that the annual cost of overweight and obesity in the U.S. is $122.9 billion. This estimate accounts for $64.1 billion in direct costs and $58.8 billion in indirect costs.
What is Diabetes?
Diabetes is a disease characterized by high levels of blood glucose resulting from defects in insulin production, insulin action or both. Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for only five to 10 percent of all diagnosed cases of diabetes. Risk factors for type 1 diabetes include autoimmune, genetic and environmental factors. Type 2 diabetes accounts for some 90 to 95 percent of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.
Treating Obesity Will Treat Type 2 Diabetes?
Weight-loss is an important goal for overweight or obese persons, particularly those with type 2 diabetes. Moderate and sustained weight-loss (five percent to 10 percent of body weight) can improve insulin action, decrease fasting glucose concentrations and reduce the need for some diabetes medications. A program of diet, exercise and behavior modification can successfully treat obesity, but pharmacotherapy and/or surgery may be warranted.
Weight-loss occurs when energy expenditure exceeds energy intake. Creating an energy deficit of 500-1,000 calories per day will result in a one to two pound weight-loss per week. Writing down the food, portion size and calorie amount has been found to increase awareness and will provide objective evidence of calorie intake.
Regular physical activity helps maintain weight-loss and prevent regain. It also improves insulin sensitivity and glycemic control, may decrease the risk of developing diabetes and reduces mortality in patients with diabetes.
There are several medications intended to treat diabetes, insulin resistance and obesity. A full review of these medications is beyond the scope of this article. However, metformin is one medication that has been found helpful in reducing the risk of type 2 diabetes in patients with insulin resistance. Metformin reduced the rate of progression to diabetes in obese persons with impaired glucose tolerance. Men treated with metformin who had central obesity and other features of metabolic syndrome (insulin resistance, hypertension, hyperlipidaemia) had slightly more weight-loss and slightly lower fasting blood glucoses that those given a placebo.
Preventing and treating obesity will help in the prevention and treatment of diabetes. Promoting a healthy lifestyle in children and adolescents will put them on a path that will decrease their risk of diabetes and its complications. Helping adults at high risk for diabetes to change their diet and lifestyle may prevent them from developing diabetes and its consequences.