What is the relationship between obesity and diabetes? ======================== How does obesity lead to type 2 diabetes? One of the strongest and most scientific links known in medical science is the relationship between obesity and type 2 diabetes. Type 2 diabetes, also called "non-insulin-dependent diabetes", is often the result of a complex and gradual process that begins with excess weight, especially abdominal obesity, and ultimately leads to widespread metabolic disorders. Meanwhile, insulin resistance, fat accumulation in organs, and changes in hormones and body chemical messengers are the three key factors that link obesity to diabetes. ### The role of insulin resistance: One of the key mechanisms linking obesity to type 2 diabetes is insulin resistance. Under normal conditions, insulin helps the body's cells absorb glucose from the blood and use it for energy, but in obese people, especially those with a lot of fat around the abdomen, cells gradually become indifferent or resistant to insulin. This resistance makes glucose unable to enter the cells and as a result, blood sugar increases. In response to this disorder, the pancreas tries to control glucose by releasing more insulin, but in the long run, this effort leads to fatigue of pancreatic beta cells and reduced insulin production, and finally, type 2 diabetes appears. Insulin resistance usually begins years before diabetes is diagnosed and remains asymptomatic, so it is very important to identify and prevent it. ### Fat accumulation in the abdomen and organs: Body fat has different effects on metabolic health depending on where it accumulates, and abdominal or visceral fat is the most dangerous type of fat that is directly related to type 2 diabetes. This type of fat accumulates deep in the abdomen and surrounds internal organs such as the liver, kidney, and intestines. Visceral fat, unlike subcutaneous fat, is more active and secretes inflammatory substances, free fatty acids and hormones that reduce the sensitivity of cells to insulin. Also, the accumulation of these fats in the liver leads to non-alcoholic fatty liver disease, which itself is a factor in creating insulin resistance and increasing the risk of diabetes. Research has shown that even in people of normal weight, having a high waistline can be a serious warning sign for the onset of metabolic disorders and diabetes, so focusing on losing belly fat is critical. ### Function of hormones and chemical messengers: Adipose tissue in the body is not only an energy store, but also acts as an active endocrine gland, secreting a series of hormones and chemical messengers that have a direct effect on the body's metabolism and blood sugar control. In obese people, this hormonal balance is disrupted; For example, the level of the hormone leptin, which is responsible for controlling appetite and satiety, increases, but the body becomes resistant to it and this causes overeating. On the other hand, the amount of adiponectin, which is an anti-inflammatory hormone and increases insulin sensitivity, decreases. At the same time, the secretion of inflammatory cytokines such as TNF-alpha and IL-6 increases from visceral fat, which causes chronic inflammation and increases insulin resistance. These hormonal changes, along with other obesity factors, provide the basis for the development of type 2 diabetes, even if a person's blood sugar is within the normal range at first. The role of abdominal fat in increasing the risk of diabetes This section specifically emphasizes the dangers of concentrated fat in the abdominal area, which is considered one of the most important background factors for type 2 diabetes. ### The difference between visceral fat and subcutaneous fat: Human body fat is divided into two main categories: subcutaneous fat and visceral fat. Subcutaneous fat is the layer that collects immediately under the skin and is felt when touching the body. This type of fat is found in the thighs, arms, sides, and abdomen, and although its excessive increase can cause problems, it is less dangerous than visceral fat. In contrast, visceral fat, which accumulates deep in the abdomen, surrounds internal organs such as the stomach, intestines, liver, and kidneys, and is much more metabolically active. Visceral fat plays a destructive role in the secretion of hormones and inflammatory substances and is directly related to the occurrence of metabolic diseases, especially type 2 diabetes, high blood pressure, and cardiovascular disease. The worrying thing here is that visceral fat is not easily visible from the outside and even relatively thin looking people may have a large amount of this fat in their body. ### The effect of abdominal fat on insulin: Abdominal fat, especially visceral fat, plays a very prominent role in reducing the sensitivity of cells to insulin and is considered one of the main factors in creating "insulin resistance". When visceral fat increases, the body begins to secrete large amounts of free fatty acids and inflammatory cytokines such as TNF-α and IL-6. These substances reduce the response of cells to this vital hormone by causing chronic inflammation in the body and disrupting the function of insulin receptors. As a result, glucose cannot enter the cells and remains in the blood, which is a factor in the rise of blood sugar and the beginning of the process of type 2 diabetes. Also, an increase in abdominal fat can lead to the accumulation of fat in the liver (non-alcoholic fatty liver), which is one of the key factors in blood sugar and insulin dysregulation. These damaging effects of abdominal fat on the body's metabolism show that reducing it is one of the most effective ways to prevent diabetes. ### Waist index: In recent years, many health professionals have come to the conclusion that waist measurement can be a more accurate measure of diabetes risk than weight or even body mass index (BMI). Because BMI only shows the relationship between weight and height and cannot determine the amount and location of body fat accumulation. For example, two people with the same BMI can have very different body compositions; One may have a lot of muscle, while the other has accumulated a lot of fat, especially in the abdominal area. On the other hand, a high waist circumference is a strong sign of visceral fat accumulation, and several studies have shown that an increase in waist circumference is directly related to an increased risk of insulin resistance, increased fasting blood sugar, and the occurrence of type 2 diabetes. Therefore, assessment of metabolic health should be based on a combination of waist circumference, waist-to-height ratio, and other metabolic factors, not just weight. Do all obese people develop diabetes? This section examines a question that has been on many minds: Is every person who is overweight certain to develop type 2 diabetes in the future? ### Genetic and individual differences: Although obesity is one of the most important risk factors for developing type 2 diabetes, not all obese people will necessarily develop diabetes. This issue is largely related to genetic, physiological and metabolic differences between people. Some people are genetically better able to manage blood sugar and respond to insulin. In other words, the genes that affect insulin secretion, the sensitivity of cells to this hormone, and the function of pancreatic beta cells, act differently in different people. Also, some obese people store more fat under the skin than in the visceral areas (abdomen and around the organs), and this difference in the pattern of fat storage plays an important role in reducing or increasing the risk of diabetes. Therefore, although obesity is an underlying factor, the genetic makeup and individual characteristics play a key role in determining the metabolic health of each person. ### The role of environmental and family factors: Apart from genetics, living environment and family factors also play a decisive role in turning obesity into diabetes. Two obese people with the same body structure may live in two different environments: one in an environment full of stress, unhealthy foods, inactivity, and insufficient sleep, and the other in an environment where a person enjoys healthy nutrition, regular exercise, and psychological support. These factors strongly affect the metabolism of the body and the function of hormones. Also, families' lifestyles, eating habits formed from childhood, and even their views on health play an important role in health-oriented or risky behaviors. Families that have institutionalized a culture of healthy eating and physical activity have healthier children, even if they have a genetic predisposition to diabetes. For this reason, environmental factors can act as a mediator and either accelerate the process of diabetes or, conversely, delay it. ### Survey of obese people without diabetes: A phenomenon that has received attention in scientific research today is the existence of metabolically healthy obese people (MHO). Despite being overweight or obese, these people have no symptoms of metabolic disorders such as high blood sugar, insulin resistance, high blood pressure, or unhealthy blood lipids. In simpler terms, they are obese but do not have diabetes and may live for years without problems. One of the reasons for this situation is the type of fat storage in their body; These people usually have little visceral fat and most of the fat is accumulated under their skin. Also, the level of physical activity, quality of nutrition, low stress and regular sleep can support their metabolic health. However, research shows that even these people, if they do not change their lifestyle, may gradually enter the phases of pre-diabetes and then type 2 diabetes in the future. Therefore, obesity should not be ignored even in the absence of disease symptoms and requires medical follow-up and attention to prevention. Treatment and prevention: weight loss, diabetes control This section shows the audience that by modifying the lifestyle and taking advantage of medical advances, the course of diabetes can be stopped or even reversed. ### Weight loss and its effect on blood sugar control: Losing weight, even a small amount, is one of the most effective ways to prevent and control type 2 diabetes in overweight or obese people. Several studies have shown that even a 5-10% reduction in body weight can dramatically increase the sensitivity of cells to insulin, lower fasting blood sugar levels, and improve the function of pancreatic beta cells. Losing weight, especially from the abdominal area and visceral fat, is more important because of its direct role in insulin resistance. In many cases, people who are in the early stages of diabetes or pre-diabetes can, by losing weight, bring their blood sugar levels back into the normal range and delay or eliminate the need for medication. This positive effect is visible not only on blood sugar, but also on blood pressure, cholesterol and general health of the body. For this reason, basic weight loss is considered one of the main pillars of diabetes treatment. ### The role of regular exercise and healthy diet: Regular exercise and a healthy diet play a vital role in managing obesity and preventing type 2 diabetes. Physical activity, especially aerobic exercise such as walking, cycling, and swimming, increases glucose uptake by muscles and thus lowers blood sugar, even without the need for more insulin. In addition, exercise reduces visceral fat, improves cardiovascular function, and increases the sensitivity of cells to insulin. On the other hand, a healthy diet that includes fresh vegetables, whole grains, low-fat proteins, fruits, and healthy fats such as omega-3 prevents sudden increases in blood sugar and prevents fat accumulation in the abdomen. Reducing the consumption of simple sugars, processed foods and trans fats is also an important part of this diet plan. Combining a balanced diet with regular exercise is not only effective in preventing diabetes, but it can also help people with diabetes reduce the need for medication and maintain a better quality of life. ### New drugs and methods in controlling obesity and diabetes: Along with lifestyle modification, drugs and new medical methods can also play an important role in the simultaneous control of obesity and diabetes. Medications such as metformin, which are usually the first line of treatment for type 2 diabetes, help control blood sugar by reducing glucose production in the liver and increasing insulin sensitivity. Also, newer drugs such as SGLT2 inhibitors (such as dapagregliflozin) and GLP-1 agonists (such as liraglutide and semaglutide) not only lower blood sugar, but also cause significant weight loss. On the other hand, in cases where obesity is severe and chronic and the usual methods are not effective, surgical interventions such as gastric bypass or gastric sleeve are proposed as a treatment option that can lead to significant weight loss and improvement or even reversal of diabetes. Also, technologies such as continuous blood glucose measurement (CGM) sensors and digital applications for health monitoring help patients to have better control over their condition. These advances have provided new hope for millions of people around the world struggling with obesity and diabetes. **To receive a visit (online or in person) with Dr. Yazdan Panah, fill out the form below**