Is there a Link Between Obesity and Type 2 Diabetes?
Obesity is one of the risk factors for developing type 2 diabetes but isn’t the deciding factor if one will eventually develop the chronic illness or not. There’s much to be discussed about obesity and its role in type 2 diabetes prevention and management. However, these discussions must be done without stigmatizing those with larger bodies. In our interview with Lorena Drago, RDN, CDCES, we talk about the relationship between obesity and type 2 diabetes.
BT2: Hi Lorena. Thanks for joining us. Could you define the term obesity and how it’s diagnosed clinically?
Lorena Drago: Obesity is a chronic and progressive disease, very similar to hypertension or high blood pressure. We should start by becoming aware that obesity goes beyond everything you eat and how much physical activity you do. We are often told, “Well, the solution to obesity is simply to eat less and move more”. But the more we study, which still has a long way to go, the more we learn that it is not as simple as it seems. Obesity is a chronic disease because it has to be managed for life.
Obesity is diagnosed with a Body Mass Index (BMI), which is a measurement that is calculated by dividing the person’s weight in kilos by their height in square meters. That value is compared to the charts. If the person has a body mass index value between 25 and 29.9, they are considered to be overweight. When it comes to obesity, BMI values are between 30 and 39.9, and severe obesity is when this value is equal to or higher than 40. But there may be, for example, people with a BMI of 28 or 30 that are not necessarily obese. You may have more muscle mass, which makes you weigh more without being obese.
We know that there is a direct link between obesity and type 2 diabetes, but we also know that it is not the only cause or risk factor for developing this condition. How are they linked?
Well, it begs the question: what came first, the egg or the chicken? What we know for sure is that there is a link between obesity and type 2 diabetes. We know that not all people who are overweight or obese develop type 2 diabetes, but 90 percent of people with type 2 diabetes are overweight or obese. So, different factors have been suggested that may be causing that link. The American Diabetes Association (ADA) recommends weight loss for everyone with diabetes.
The Diabetes Prevention Program (DPP) showed that people who had prediabetes, meaning a high glucose level that is not high enough to be diagnosed as diabetes, reduced the amount of calories and increased physical activity by 150 minutes. It was found that, by losing 5 to 7 percent of their initial weight, almost 60 percent of the participants were able to reduce the risk of developing type 2 diabetes by almost 60 percent over a period of three years.
So, the body reacts to the advantage of these interventions. The same result was found in people who already had diabetes when they lost weight, which can be 10 percent to 15 percent of the initial body weight.
All this was also found by another trial called Look AHEAD (Action for Health in Diabetes), which had 5000 participants who also reduced their Glycated Hemoglobin A1c.
If a person living with type 2 diabetes loses weight, can they normalize their blood glucose or reverse the diagnosis?
That is a very interesting question. Trials are what guide us to understand this link between obesity and type 2 diabetes and why obesity can lead to it. I am going to reference the Diabetes Remission Clinical Trial (DiRECT). That trial was very interesting and showed that 46 percent of the people who followed an entirely liquid diet went into diabetes remission within a year compared to only 4 percent of the other group, who did not receive a liquid diet but only reduced their calorie intake.
One of the doctors who participated in this study realized that, although many people were able to lose weight on the liquid diet, it was only 46 percent so 54 percent of people did not go into type 2 diabetes remission even after losing weight. The exact reason why it can help some people and not others is not clear yet.
When I was working as the director of the bariatric program, I noticed that bariatric surgery tended to reverse people’s diabetes, even though they had not lost 10 percent or 15 percent of their initial weight. What was very interesting to me was seeing how these people, especially those who had recently been diagnosed with diabetes, tended to have better results when they lost weight or when they underwent bariatric surgery.
What is the role of nutritionists and diabetes educators to promote weight loss in those who need it, as well as to promote a healthier and more active life?
I would say that the most important role is to have a connection with the patient, not only seeing them as eating or not eating, but seeing the whole patient and supporting them to start taking more beneficial steps.
To achieve this, I would say that it is very important to stop thinking about it as black or white, because nothing is totally perfect or totally lost, but to try to find what challenges these patients face, whether it is with food, or an emotional, or physical aspect that may prevent them from participating in physical activities.
Seeing all those factors and working with the social determinants that affect the person so that they can begin these steps. So, our role is to see our patients beyond food, to see the whole person, the aspects that prevent people from succeeding and simply help them remove those challenges. Finding possibilities within each home and within each person.
I should emphasize that we need to find the patient where they are, not what we want them to be because, many times, I mostly see many of my colleagues, in different parts of Latin America, who are still very strict: I gave you a list you had to follow! why didn’t you follow it?! Why did you eat a tamale?! Why did you eat a third tortilla?!.
So, we have to go beyond all those factors. We should become allies and not fathers or mothers to our patients. We have to stay away from all that because it is not easy to do it every day, 24 hours a day, seven days a week. It is impossible.
Follow Lorena Drago on IG: @lorenadragomsrd and on Twitter: @lorenadrago.
