Diabesity

Obesity is a very common problem in the United States.  What is even more shocking is that Arkansas has been named one of the most obese states in the country! Many complications, including diabesity can stem from obesity. Diabesity is a term coined in the 1970s for someone who is obese and has developed diabetes.Diabetes related to obesity falls into the Type II diabetes category.  What does Type II diabetes mean? It simply means that the body does not utilize insulin to its fullest potential.  Is it reversible? How do I treat it?

Type 1 diabetes is usually diagnosed in children and in young adults. Type 1 diabetes is an autoimmune disorder in which one's body cannot produce insulin. This being said, learning how to live with injections of insulin and other therapy is possible. Researchers have been looking for possible ways to reverse type 1 diabetes. One study was done to determine if type 1 diabetes could be reversed with antibody therapy. The study has been done on mice, and signs of type 1 diabetes being reversed were shown. This study, as of 2014, had not been done on humans yet. Researchers are very hopeful in that this antibody could reverse or even cure type 1 diabetes.

Though both types of diabetes can be very critical, research has proved that type 2 diabetes is in fact reversible. As we know, type 2 diabetes is developed later is life and is usually associated with people who are obese. One of the first hints researchers found that led them to believe type 2 diabetes was reversible was bariatric surgery. In a research study done over centuries ago, people that had type 2 diabetes and underwent bariatric surgery were 90% close to being and remaining diabetes free. Researchers also found that type 2 diabetes could be reversible by diet alone. This has been concluded due to the fact changes in metabolism occur following bariatric surgery. These rapid changes occurred as a consequence of the the quick change in calorie balance. Because of this change in calorie balance, researchers say that the defects to both insulin secretion and hepatic sensitivity of type 2 diabetes could and should be correctable through diet.

While diabesity is traditionally found in the adult population, it’s becoming a growing problem for children as well. How can such a life threatening condition affect the youngest population? The Center for Disease Control and Prevention (CDC) reports that diabetes is one of the more common diseases that can affect children. While most cases are Type-1, the occurrence of Type-2 diabetes is on the rise as well as the obesity rate.  The CDC also reports that approximately 151,000 individuals have diabetes and are under the age of 20. Children with Diabesity often experience decreased quality of life as well as biological, psychological, and medical complications. While diabesity rates are high currently, they are expected to drastically increase in the following years if immediate action is not taken. Michelle Obama and her “Let’s Move!” program are currently in line to offer community resources and plans to help reverse childhood obesity rates. Some tips to deal with childhood diabesity from Dada in Today’s Dietitan, “don’t talk about child obesity- labels can create negative feelings, provide don’t deprive- provide healthier options without restricting too much, and optimize feeding and parenting to let children be children- encourage activity and other childish activities.”

The primary goal of the Diabesity diet is maintain glycemic control in order to prevent complications of the disease. This is done by keeping blood sugars within normal limits and lowering the patient’s hemoglobin A1c to less than 7%. The next goal of the Diabesity diet is weight reduction toward a healthy BMI.

Carbohydrates are macronutrients that dictate blood glucose levels in the body. So, no more carbs? False. Carbohydrates are also the bodies preferred choice of energy. In patients with diabetes, either type, maintaining a consistent intake of carbohydrates throughout the day can help to maintain glycemic control. This is called a consistent carbohydrate diet. Patients are encouraged to consume a specific amount of carbs per meal and at snack time to meet their bodies carbohydrate needs. By eating a consistent calculated amount at meal times and snacks, glucose levels typically stay within healthy limits, helping to lower A1c.

By monitoring carbohydrates at each meal, patients are more likely to eat a consistent number of calories as well, leading to weight reduction. It’s important also to encourage intake of lean protein and controlled amounts of heart healthy fats to promote further weight reduction.

Treatment options for diabesity do exist, but not always without complication. Sometimes improving an aspect of one disease can have adverse effects on the other. Insulin, which is commonly used to lower blood sugar in patients with type 2 diabetes mellitus (T2DM) can cause both weight gain and fluid retention. Insulin sensitizers like Metformin are more insulin-efficient and produce less of the hormone which tackles the issue of weight gain, and may even promote weight loss. The hope for diabesity patients does not end there.

Bariatric, or “metabolic” surgery heads the way for such optimism. The goal of these surgeries is to cause weight loss by lessening the amount of food the stomach can hold. In turn this causes a malabsorption of nutrients.

The most commonly performed bariatric surgery is the Roux-en-Y Gastric Bypass, more simply referred to as just gastric bypass surgery. The procedure involves a separation of the top of the stomach to create a smaller component of the organ, and a division of the small intestine. Together these two steps work to stimulate satiety, or the feeling of fullness, and conquer hunger. Research indicates this procedure may be the most effective in treatment of diabetes in comparison to its counterparts because patients exhibit the ability to maintain normal levels of plasma glucose, insulin, and glycated hemoglobin. Biliopancreatic Diversion with Duodenal Switch, or BPD-DS is a more complex bariatric operation. A portion of the stomach is extracted and the small intestine is divided. The intricacy of the operation does pose a higher risk than other bariatric operations. However, it has been proven to profoundly demonstrate significant weight loss as well as a resolution or improvement in T2DM. While other procedures exist, these two have been proven to yield the best results in the fight against diabesity.

Now that we know what diabesity is, the big question on everyone’s minds is, “how can I prevent it?” While genetics can play a role in the development of diabetes, there are many lifestyle factors that can be modified to greatly reduce your risk. Listed below are 4 simple lifestyle changes you can make on a daily basis to decrease your risk of developing diabesity:

·         Cut the sugar! Decreasing your intake of sugar sweetened beverages and concentrated sweets will help you and your body ward off type II diabetes. These are things like cakes, candy, sweet tea, regular pop, sugary coffee beverages, etc. These cause our bodies to use higher levels of insulin to control blood sugars, which may lead to insulin resistance and type II diabetes.

·         Get up and get moving! Research has shown that 30 minutes of brisk walking per day can decrease your chances of developing type II diabetes by 30%. (1,2)

·         Ditch the muffin top! (and I don’t mean by buying bigger jeansJ) Studies conducted by the Diabetes Prevention Program have shown that those who were overweight, and lost weight, were found to have a 16% reduction in risk of developing diabetes for every kilogram (2.2lbs) lost! (3)

·         Cut out the [cigarette] pack, Jack! Those who smoke are about 50% more likely to develop type II diabetes than non-smokers. (4)

References:

(2015). Facts about Type 2, retrieved from: www.diabetes.org

Dada, J. H. (2010). Diabesity in Children – Epic Proportions of Disease Necessitate Major Action. Today’s Dietitian, 12(5), 14. http://www.todaysdietitian.com/newarchives/050310p14.shtm

Taylor, R. M.D. (2013).Type 2 diabetes: etiology and reversibilty. American Diabetes Association Diabetes             Care,36, 4, 1047-1055. Retrieved from: http://care.diabetesjournals.org/content/36/4/1047.full

Iyer, S. (2014). Type 1 Diabetes Successfully Reversed with Antibody Therapy;Could There Soon be a                   Cure? Retrieved from: http://www.medicaldaily.com/type-1-diabetes-successfully-reversed-antibody-             therapy-could-there-soon-be-cure-288228

Hall, M. (2013) Understanding Advanced Carbohydrate Counting – A Useful Tool For Some Patients to Improve Blood Glucose Control. Today's Dietitian, 15(12), 40. http://www.todaysdietitian.com/newarchives/120913p40.shtml

Arroyo, K., Kini, S. U., Harvey, J. E., & Herron, D. M. (2010). Surgical therapy for diabesity.

            Mount Sinai Journal Of Medicine, 77(5), 418-430. doi:10.1002/msj.20209

Still, C. (2015, May). Treating patients with "diabesity": Challenges and pportunities. Bariatric    

             Times. p. 3-4.

1.   Tanasescu M, Leitzmann MF, Rimm EB, Hu FB. Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Circulation. 2003; 107(19):2435-9. 

2.   Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study.JAMA. 1999; 282:1433-9.

3.   Hamman, R. F., Wing, R. R., Edelstein, S. L., Lachin, J. M., Bray, G. A., Delahanty, L., . . . Wylie-Rosett, J. (2006). Effect of Weight Loss With Lifestyle Intervention on Risk of Diabetes. Diabetes Care, 29(9), 2102-2107.

4.   Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis.JAMA. 2007; 298:2654-2664.