Unveiling Diabesity: The Interconnected Epidemic of Diabetes and Obesity
December 4, 2023
Since I moved out of Kolkata, most of my vacation days were reserved for going home during festivals. I would stay up giddy with excitement the night before my flight and wait eagerly to breathe in Kolkata’s hot and humid air. This year for Diwali, my friend Anuja (29) and I were travelling home together. As I enthusiastically spoke about my plans with family and friends, I realized that she was not quite herself. When I probed her gently, Anuja said, “I am not quite sure how I feel. Though I am a foodie, whenever I am home, I don’t feel like eating. Most people, including my relatives and friends, don’t understand what I am going through. Instead, they pass comments about my appearance.”
When Anuja was six years old, she was diagnosed with hypothyroidism and has been struggling with weight management all her life. Even after taking appropriate medication, being on a strict diet, and exercising, she has remained obese. In fact, she was diagnosed with diabetes a year ago, which further complicated her condition.
“Last year when I visited home for Diwali, I was as excited as you. However, by the end of the evening, my spirits were at an all-time low as my relatives started commenting on my weight at the family gathering. They pointed out how much more weight I have gained and joked about cutting down on sweets,” Anuja lamented.
“Fat shaming is a pervasive issue that often goes unnoticed or gets dismissed as harmless banter, but it doesn’t stop at criticizing the body. It extends to self-worth and confidence, creating a toxic environment. Navigating the world as an obese individual is like riding a relentless mental rollercoaster. The constant barrage of societal expectations leads to internalized shame that has a lasting impact on one’s self-esteem and mental health. Most people justify their behaviour as being a well-wisher,” Anuja said.
While growing up, Anuja was called by nicknames based on her appearance which led to body image issues. For her, buying clothes online is not an option and looking in the mirror rarely brings her joy. She hears the echoes of multiple voices judging her. She seldom indulges in junk food; however, people always assume that her obesity comes from unhealthy lifestyle choices. “My cousins joke about how I should be the last one to eat as I would finish everyone’s share,” she said.
A vicious cycle
After the diagnosis of her diabetes, Anuja’s doctor told her about diabesity, which represents the bidirectional relationship between obesity and diabetes. While obesity increases the risk of developing diabetes, diabetes, in turn, exacerbates obesity through various mechanisms. In fact, recent research suggests that people with obesity are 80 times more likely to develop type 2 diabetes.
This happens because the elevated blood sugar levels in diabetes can lead to increased fat storage, further contributing to obesity. On the other hand, obesity-induced insulin resistance fuels the progression of diabetes, creating a detrimental loop that poses significant challenges for both prevention and management. Both conditions share common risk factors, such as poor diet, sedentary lifestyle, and genetic predisposition. Addressing these shared risk factors is crucial for breaking the cycle of diabesity.
“Whenever I see a sudden increase in abdominal weight among any of my patients, I suggest that they get tested for diabetes. It can be due to stress or even unhealthy eating habits, but it’s better to be safe than sorry,” said Dr. Sushant Patwari, general physician. He further added that management of diabetes often starts with weight management.
“I never heard of the term diabesity before. As I already have hypothyroidism, I assumed my weight issues were due to that condition. If only I knew about this connection between diabetes and obesity earlier, I would have spoken to my doctor about this, as my father also had diabetes,” Anuja said.
Remission is possible
Diabetes cannot be reversed but it can go into remission. Weight loss is the most effective way to achieve this. It is most likely to occur if you lose weight early on in your diabetes journey. Research has shown that even 5% of weight loss can have significant health benefits. However, some individuals have achieved remission even 25 years after their diagnosis. For those with obesity, losing 15kg as soon and safely as possible after diagnosis is more likely to cause remission though this may not be applicable to all. In cases where lifestyle changes alone are insufficient, medical interventions and bariatric surgery may be necessary to manage diabesity effectively.
Diabesity is often the tip of the iceberg. If left unmanaged, it can lead to a variety of complications affecting various organs and systems in the body. It is well established that both diabetes and obesity increase cardiovascular risk and can give rise to complications such as heart attacks, stroke, and kidney dysfunction. Additionally, excess body weight is associated with an increased risk of high blood pressure, which, in turn, elevates the risk of complications.
“I am under a weight management program right now and have been successfully able to lose about seven kg in the first three months. I consider this progress,” Anuja said.
The intricate relationship between obesity and diabetes underscores the importance of addressing both conditions collectively. Diabesity represents a significant public health challenge, requiring a comprehensive and multidisciplinary approach for prevention, early detection, and management. By understanding the complex interplay between obesity and diabetes, individuals and healthcare professionals can work collaboratively to break the diabesity cycle and promote long-term health and well-being.
As communicators, we stand responsible for the barrage of information dispelled and the quality of conversations made. Hence, it is our duty to advocate against fat shaming and tell the world that it is not okay. Instead of perpetuating harmful stereotypes, let’s acknowledge that everyone is fighting battles we may not see. Compassion, not judgment, should be the guiding force. We must recognize that mental health is as important as physical health.