What’s The Connection Between Weight Gain and Type 2 Diabetes?
The prevalence of those who are overweight or obese in the United States has been on the rise for decades. The Centers for Disease Control (CDC) calls obesity an “epidemic” in our nation, and one of the most serious and costly medical conditions. According to Dr. Anders Petersen, a board-certified family practitioner with HealthWorks, the obesity epidemic has been propelled by the “[move] toward a more sedentary lifestyle and the availability of fast food and processed food.” But more than needing to go up a pant size, what are the costs for so many Americans who watch in trepidation as the numbers on the scale continue to rise?
By Joe Dodd
The Costs of Extra Weight
As for the cost in dollars, the CDC explains that, in 2008, medical costs associated with being overweight were estimated at $147 billion. Additionally, the average medical cost for those who are obese is $1,429 higher than those who maintain a normal weight.
Obesity-related medical conditions are another, and in some ways, a greater cost. From heart disease, to stroke, to certain kinds of cancer, it’s no wonder the CDC sees obesity as a serious condition.
Of particular concern is type 2 diabetes. Being overweight or obese is, by far, the number one risk factor for the condition. Researchers from Harvard Medical School report that as many as 8 out of every 10 people with diabetes are overweight or obese. Of this 80%, about 65% will eventually die from heart disease or stroke. Diabetes also damages small blood vessels throughout the body, and can lead to blindness or kidney failure, amputation, and premature death. Several studies show that diabetes also doubles the risk of clinical depression.
Of course, adults aren’t the only ones affected by the epidemic. The number of overweight or obese children is rising, as is the amount of children developing “prediabetes.” A paper published in the journal Pediatrics reports that the proportion of 12-19 year olds with diabetes or prediabetes increased from 9% in 1999 to 23% in 2008.
What is Diabetes? The Basics
Diabetes affects how the body uses and processes blood sugar, or blood glucose. Glucose is a source of fuel used by the body. The pancreas makes insulin, which, in turn, moves glucose from the bloodstream into muscle, fat, and liver cells where it is used as fuel. With diabetes, the body is limited in how well it can process glucose from the bloodstream into useable fuel. Either the pancreas does not make enough insulin, the body does not respond to insulin normally, or there is a combination of both.
People with type 1 diabetes have high glucose levels because their pancreas can no longer make insulin. By definition, these diabetics must eventually take insulin shots to get their diabetes under control. Type 1 diabetes is commonly seen in children where it is diagnosed as a lifelong disease. According to Leslie Roberts, a dietitian with the Hamilton Diabetes and Nutrition Center at Hamilton Medical Center, patients with type 1 are “usually younger, and typically thinner.” Additionally, there is usually a genetic link to their diabetes.
Yet while type 1 diabetes is more commonly seen in adolescents, Roberts explains that there has been an increase in the amount of adults diagnosed as well— this has led to the extinction of the term “juvenile diabetes.” Like adolescents with type 1 diabetes, these adults tend to have a thin physique and a genetic link to their diabetes.
Type 2 diabetes is far more common, making up 90-95% of cases. Type 2 diabetics can still make their own insulin, but their bodies’ cells don’t respond well to it—a situation called insulin resistance. Roberts explains that nearly all of the patients she sees with type 2 diabetes are “overweight and typically live a sedentary lifestyle.” However, there are cases where type 2 diabetes has developed in a patient of a normal weight.
Weight, insulin resistance, and Type 2 Diabetes: What’s the Link?
According to Harvard Health, researchers have only begun to understand why excess weight increases the risk of type 2 diabetes. Many now believe that fat cells— especially those in the belly, where people tend to carry extra pounds—secrete hormones and other chemical signals. Some of these substances can trigger inflammation, which interferes with insulin receptors on cells, leading to insulin resistance and high blood sugar.
If blood sugar levels stay high, your pancreas has to continue pumping out enormous amounts of insulin to force the uptake of glucose in your cells. This only exasperates the issue, because repeated surges of insulin can strip your cells’ insulin receptors even more—cells overwhelmed by surplus insulin will protect themselves by continuing to reduce the number of their insulin receptor sites. Thus, the vicious cycle begins: the more insulin your body has to produce to keep blood sugar down, the more insulin resistant you become. Eventually, the pancreas can’t keep up, and you are left with chronic high blood sugar, a.k.a. hyperglycemia. This is problematic for two reasons:
1) While you may not have type 2 diabetes yet, you are well on the way with all of the stress that this resistance puts on your blood sugar control system. Essentially, your cells are starving for energy, even when plenty of glucose is available in the blood. If it goes on for long enough, the insulin-producing beta cells in the pancreas can “burn out.” If they die off entirely, you’ve got full blown diabetes.
2) Over time, if high blood sugar levels go unchecked, your body will become used to storing the overabundance of glucose as fat. Thus, insulin resistance can potentially lead to even more weight gain.
Of course, the relationship between weight, insulin resistance, and type 2 diabetes is far more complex than this. An article in TIME said that “any scientist who can figure out why Type 2 diabetics are insulin resistant will probably be a candidate for a Nobel Prize.” That there is a connection between weight and insulin resistance is undisputed, but scientists are still left with a “chicken and the egg question”: does excess body fat cause insulin resistance or is it the other way around?
Complicating the issue even more is the fact that many obese people are not insulin resistant, and not everyone who is insulin resistant is overweight. Some people have a genetic predisposition to insulin resistance; scientists have identified specific genes that make people more likely to develop the condition.
Type 2 Diabetes & Normal Weight
While those who are overweight or obese are far more likely to have type 2 diabetes, studies show that around 15%- 20% of people who suffer from type 2 diabetes are of a normal weight.
For these people, the disease can be even more dangerous than it is for someone who is overweight. A study in The Journal of the American Medical Association found that those who contracted diabetes when of a normal weight were twice as likely to die during the period of the study than those who were overweight or obese.
This plays into an interesting phenomenon discovered by researchers called the “obesity paradox.” The concept is that people who carry excess weight and suffer from certain chronic diseases have a lower mortality rate than someone of a normal weight.
The Fasting Glucose Test
If you think you might be in danger of being prediabetic or contracting type 2 diabetes, ask your health care provider about getting a fasting glucose test. Diabetes tends to start quietly and move slowly, often taking years before it is noticed. According to the CDC, as many as one in three people with pre-diabetes doesn’t know it.
The fasting glucose test measures your blood glucose level after you have gone without food for eight hours, so it’s usually done in the morning. A healthcare provider will take a sample of your blood, and then send it to a lab for analysis.
Your results will show how much glucose is present in your blood in milligrams (mg) per deciliter (dl). According to the Mayo Clinic, fasting glucose test results can be categorized as follows:
• Normal: below 100 mg/dl (that’s 100 milligrams per deciliter)
• Prediabetic: 100 mg/dl to 125 mg/dl
• Diabetic: 125 mg/dl or higher
Those who fall into the prediabetic range should understand that they are in serious danger of contracting diabetes within the next four years. However, with proper management, the condition is potentially reversible. Studies have shown that most people with prediabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7% of their body weight by making changes in their diet and level of physical activity.
This has been proven through the NIH led Diabetes Prevention Program study, which followed 3,000 men and women between the ages of 25 and 85 who had prediabetes and were considered obese. Of the 11% of participants who did nothing to prevent their condition from worsening, one-third developed diabetes. However, among those who switched to healthier diets and lost weight, there was a 58% reduction in the overall incidence of the disease.
According to Dr. Petersen, one of the best things we can do is to educate people when it comes to weight gain and diabetes. “We need to know what’s going on in [our] bodies and how to change it,” he says. It’s important for patients to “take ownership of what they’re eating,” and to know that “even a small reduction in foods high in sugar and fat” can be of great benefit. According to Harvard Health, losing 5-10% of your body weight can help in the management of diabetes and even reverse prediabetes.
For many Americans, the first step is simply to care. A 2009 study conducted by the University of Chicago showed that of 909 overweight adults, less than 25% saw their own weight as a serious or very serious problem. However, Americans who care about their weight and where their health is headed are far more likely to succeed in preventing the onset of diabetes. Diet and exercise are some of the best tools for warding off the development of diseases like diabetes.
Regular Exercise. Exercise can not only help you lose weight, it can help to lower your blood sugar by forcing your muscles to use the glucose in your bloodstream for fuel. This, in turn, can lower your body’s resistance to insulin by making your cells work harder to use up the available glucose. Exercise can also boost your number of insulin receptors.
Proper Diet. If you don’t watch your calories, the benefits of exercise will be limited. Plus, many studies have found that cutting calories can improve insulin sensitivity and reduce levels of circulating insulin (your body needs less insulin if it’s more sensitive to it).
But perhaps just as important as caloric intake are the kinds of foods you’re getting those calories from. Those who are at risk for diabetes may greatly benefit from a high-fiber, low-glycemic diet. Eating foods that keep blood sugar levels stable can be key to preventing or reversing insulin resistance. Fiber slows the speed at which your stomach empties after a meal, which also slows the rise in blood sugar that happens after you eat.
For many Americans, diet and exercise programs have not given them the results needed to manage and cope with their type 2 diabetes. In these cases, more extreme measures may be considered. One of these is bariatric surgery, which involves the removal of parts of the stomach and small intestines to induce weight loss.
Bariatric surgery may be considered a specific treatment for type 2 diabetes since morbidly obese people who’ve undergone gastric bypass (a type of bariatric surgery) usually see significant improvements in their blood sugar levels. In fact, two widely-cited studies published earlier this year in the New England Journal of Medicine show that many patients will see diabetes go into remission after bariatric surgery.
According to Dr. Sanborn, those eligible for bariatric surgery must have a BMI of at least 35, and most will have diabetes or another weight-related medical condition. But this alone is not enough; three additional criteria make a patient a good candidate for a bariatric surgery procedure. The first is motivation. “A motivated patient [is] probably the biggest key, because [bariatric surgery] is not something we do to you, it’s something we do with you. It’s not magic.” The second criteria involves effort. “We want a patient to have tried diet and exercise and those aren’t working,” he says. Finally, Sanborn looks at patient expectations, because “the surgery needs to fix more than just the numbers on the scale.”
Opting for a bariatric surgery procedure is a commitment that must be taken seriously. Those who are interested should speak with their doctor to determine if such treatment would be an overall beneficial choice. It takes motivation towards major lifestyle change for such procedures to be as effective as possible in treating obesity and type 2 diabetes.
While the outlook for obesity and type 2 diabetes may be grim, the potential for positive change in individuals is well within reach. With proper diet and exercise, we can significantly improve our health and reduce the chance of developing type 2 diabetes. Taking small steps every day to combat the disease can be as easy as a walk each day and spending the time to enjoy a meal that is beneficial to your health. It’s the simple steps we take that, in the long run, can produce the most favorable outcome.
Joe Dodd is a freelance writer residing in Lookout Mountain, Ga. He graduated from Covenant College with a degree in English, and currently works in publishing as an editorial assistant.