The number of overweight individuals is fast increasing worldwide, which in turn has resulted in a rise in the prevalence of Type 2 diabetes.

The International Diabetes Federation (IDF) has predicted that the number of individuals with diabetes is expected to rise to 552 million by 2030¹, and the World Health Organization (WHO) has called obesity and diabetes the "21st-century epidemic."

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Along with genetic susceptibility, being overweight is the most important risk factor for Type 2 diabetes. The term "diabesity" singles out excess body weight as the major cause of Type 2 diabetes.^{2, 3}

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Obesity: A Worldwide Epidemic

The worldwide prevalence of obesity has nearly tripled between 1975 and 2016.⁴

In other words, more than 1.9 billion adults (39% of the adult global population) were overweight by 2016, of which over 650 million were obese (33% of the overweight adult population).⁵ In Europe, more than half the population was overweight in 2019, and up to 30% was obese.⁶

But as the world deepens its understanding of the disease, there is still a stigma and weight bias associated with obesity, which contributes independently to increased morbidity and mortality.⁷ Misconceptions about obesity being a result of personal choice and lack of self-control unfairly blames and shames those who are living with the disease.⁸

The reality is much more complicated. Obesity is a heterogeneous disease that presents in different ways in different patients. As with any chronic disease, assessment, treatment, and long-term support must be tailored to the patient's individual needs.

Obesity can have a variety of root causes including side effects of certain medications, biological factors, other chronic diseases, sociocultural practices and beliefs, social determinants of health, built environment, and psychological factors such as mood, anxiety, binge-eating disorder, attention-deficit/hyperactivity disorder, and personal self-worth and identity.⁹

The stigma around obesity has a negative impact on the quality of healthcare provided to people living with the condition.^{10, 11} Management of obesity has historically not been effective within healthcare,^{12, 13, 14} and a significant number of healthcare practitioners (HCPs) feel under-resourced to deliver obesity care.^{8, 15, 16}

Prediabetes and Diabetes

The prevalence of prediabetes is also increasing and becoming a major public health issue.¹³ Prediabetes is defined as an intermediate state of hyperglycemia in which glucose levels rise above the normal level, but are below the diagnostic levels of diabetes.

There are no symptoms clearly associated with prediabetes. It is a condition that can remain silent and unidentified for many years, laying the basis for severe complications—but a simple blood sample analysis can easily identify people at risk.¹⁴

The gut microbiota manages host metabolism, Patrice D. Cani, Nature Review, 2013

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Prediabetes will progress to overt Type 2 diabetes in approximately 5–10% of subjects annually, while 70% of individuals with prediabetes will develop overt diabetes within their lifetime, according to the American Diabetes Association.¹⁵ However, prediabetes may also revert back to normoglycemia if the appropriate lifestyle changes are made.¹⁶ That is why it is vital to detect people suffering from prediabetes early, in order to:

• Implement key interventions to get back to normal glycemia
• Prevent the risk of developing Type 2 diabetes.

Diabetes in Numbers

According to estimates by the International Diabetes Federation, in 2021:¹⁶

How to Tackle Diabesity?

Obesity alters the composition and function of the gut microbiota, which in turn impacts the gut barrier's effectiveness as a guardian against unwanted compounds entering the rest of the body.

Some of these compounds are toxins, such as lipopolysaccharides (LPS). These toxins are pro-inflammatory, meaning they activate the immune system and induce chronic inflammation, which, although low level, will often last a long time—up to several years. This chronic low-grade inflammation can induce metabolic disorders such as insulin resistance.¹⁸ Eventually, insulin resistance can lead to the development of Type 2 diabetes. Furthermore, chronic low-grade inflammation is also associated with the development of atherosclerosis, cancers, and neurodegenerative diseases.¹⁹

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References

1. Whiting, D.R., Guariguata, L., Weil, C. & Shaw, J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 94, 311-321 (2011).
2. Shafrir, E. Development and consequences of insulin resistance: lessons from animals with hyperinsulinaemia. Diabetes Metab22, 122-131 (1996).
3. Astrup, A. & Finer, N. Redefining type 2 diabetes: 'diabesity' or 'obesity dependent diabetes mellitus'? Obes Rev 1, 57-59 (2000).
4. Weir, C. B. and A. Jan (2023). BMI Classification Percentile And Cut Off Points. StatPearls. Treasure Island (FL), StatPearls Publishing. Copyright © 2023, StatPearls Publishing LLC.
5. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
6. Eurostat, Overweight and obesity – BMI statistics – https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Overweight_and_obesity_-_BMI_statistics
7. Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci. 2015 Nov;26(11):1803–11.
8. Kirk SFL, Price SL, Penney TL, Rehman L, Lyons RF, Piccinini-Vallis H, et al. Blame, shame, and lack of support: a multilevel study on obesity management. Qual Health Res. 2014 Jun;24(6):790–800.
9. Luig T, Anderson R, Sharma AM, Campbell-Scherer DL. Personalizing obesity assessment and care planning in primary care: patient experience and outcomes in everyday life and health. Clin Obes. 2018 Dec;8(6):411–23.
10. Alberga AS, Edache IY, Forhan M, Russell-Mayhew S. Weight bias and health care utilization: a scoping review. Prim Health Care Res Dev. 2019 Jul 22;20:e116.
11. O'Donoghue G, Cunningham C, King M, O'Keefe C, Rofaeil A, McMahon S. A qualitative exploration of obesity bias and stigma in Irish healthcare; the patients' voice. PLoS One. 2021;16(11):e0260075.
12. Obesity Canada. Report card on access to obesity treatment for adults in Canada 2017. Edmonton: Obesity Canada; 2017.
13. World Obesity. World Obesity Report Card for Ireland. 2020.
14. Health Service Executive (HSE). Model of Care for the Management of Overweight and Obesity. Dublin: Royal College of Physicians in Ireland; 2021.
15. Greener J, Douglas F, van Teijlingen E. More of the same? Conflicting perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers. Soc Sci Med. 2010 Apr;70(7):1042–9.
16. IDF Diabetes Atlas 10th Edition 2021
17. https://diabetesatlas.org/
18. World Health Organization, Obesity and overweight, July 2021
19. Echouffo-Tcheugui JB, Selvin E. Prediabetes and What It Means: The Epidemiological Evidence. Annu Rev Public Health. 2021 Apr 1;42:59-77. doi: 10.1146/annurev-publhealth-090419-102644. Epub 2021 Dec 23. PMID: 33355476; PMCID: PMC8026645.