Obesity and diabetes go hand in hand. In fact, over 90% of people with type 2 diabetes are overweight or have obesity. But why is that? What is the connection between obesity and diabetes? And does one cause the other?
The relationship between obesity and diabetes is complex. While obesity is a major risk factor for developing type 2 diabetes, the reverse is also true — having diabetes can lead to weight gain and make losing weight more difficult. Let’s break down what we know about the link between these two conditions.
How Obesity Increases Diabetes Risk
Carrying excess weight, especially around the abdomen, increases your risk of developing type 2 diabetes. But why? There are a few reasons:
Insulin resistance: Fat cells, especially around the belly, can release proteins and hormones that make the body less sensitive to insulin. Insulin is the hormone that allows glucose (sugar) in the bloodstream to enter the cells to be used for energy. When someone is insulin resistant, the pancreas has to produce more insulin to overcome this resistance. Over time, the pancreas can wear out and not be able to produce enough insulin to keep blood sugar levels normal.
Inflammation: Fat cells release chemicals called cytokines that promote inflammation throughout the body. This low-grade chronic inflammation stresses the body and especially the cells that produce insulin. Over time, inflammation can cause decreased insulin production.
Fat deposits in the pancreas: Some research shows that fat deposits in and around the pancreas itself may contribute to decreased insulin production and diabetes risk. This may be due to both inflammation and excess fatty acids affecting pancreas cells directly.
Genetics: Many genes linked to obesity also appear to influence the risk of developing type 2 diabetes. Carrying these genes may predispose someone to weight gain and make it more likely that excess weight will lead to diabetes.
So carrying extra body fat, especially around the midsection, stresses the body in a way that promotes insulin resistance and reduced insulin production over time. This raises the risk for the high blood sugar levels that define type 2 diabetes. Losing weight, especially if someone is obese, can help reverse these issues and lower diabetes risk.
How Diabetes Can Promote Weight Gain
On the flip side, developing diabetes itself can promote weight gain and make effective weight loss more difficult. Here’s why:
Insulin injections/medications: People with type 1 diabetes must take insulin injections to survive. People with type 2 diabetes who cannot control their blood sugar levels through diet, exercise and oral medications alone may also need insulin or other medications that directly help control blood sugar. While life-saving, weight gain is a common side effect of many of these medications.
Increased appetite: High blood sugar levels can damage cells over time, which may promote increased appetite as the body tries to heal itself. High blood sugar also causes the body to release more insulin, which on its own can drive up appetite.
Fat storage: When blood sugar levels are high, the body generates more insulin to compensate. This pushes the body to store more calories from food as fat and to burn less of that fat later on. Over time, this process can gradually increase body fat.
Lower motivation to exercise: The fatigue, joint pain, nerve pain and lower limb circulatory issues that often accompany diabetes can make exercise more difficult and less appealing. Being sedentary obviously contributes to weight gain over time.
So while obesity clearly raises diabetes risk, the development of diabetes itself can promote increased appetite, fat storage, decreased activity levels, and medications that predispose to weight gain. This helps explain why many people gain weight after being diagnosed with type 2 diabetes.
The Vicious Cycle of Obesity and Diabetes
In summary, excess weight — especially concentrated around the midsection — raises diabetes risk by promoting insulin resistance and reduced insulin production. But once someone develops diabetes, the condition itself makes losing weight more challenging. This sets up a vicious cycle where obesity leads to diabetes, diabetes leads to more weight gain, and additional weight gain further worsens diabetes.
This vicious cycle underlies the close relationship between obesity and type 2 diabetes. But it does NOT mean that obesity causes diabetes or diabetes causes obesity in any simple, direct way. Rather, the two conditions promote each other in complex ways that worsen over time.
Does Obesity Cause Diabetes?
Obesity does not directly “cause” diabetes, just as diabetes does not directly “cause” obesity. The human body is far too complex for such black-and-white thinking.
However, carrying excess weight clearly and significantly raises the risk of developing type 2 diabetes. The fatter someone is, the higher their risk. People with severe obesity are up to 80 times more likely to develop type 2 diabetes than those with a healthy body weight. Losing weight can directly lower diabetes risk — for example, every 1 kg (2.2 lbs) of weight lost reduces diabetes risk by 16%.
So obesity could be considered a “cause” of diabetes in that it substantially raises the chances someone will develop diabetes. But keep in mind that:
- Not all overweight or obese people get diabetes. Genetics, lifestyle habits, age, ethnicity and other factors also influence risk.
- Thin people certainly can and do develop type 2 diabetes as well, though at much lower rates than people with obesity.
- Weight loss interventions reliably reduce diabetes incidence but do not eliminate it entirely. Other factors are always at play.
Obesity behaves more like a key risk factor that makes diabetes much more likely, rather than as a sole, direct cause. Think of obesity as pouring gasoline on a fire when it comes to diabetes risk. Gasoline makes a fire more likely and more intense, but it does not create the fire alone.
Does Diabetes Cause Obesity?
Similarly, diabetes does not directly “cause” obesity in any simplistic way. Diabetes does make gaining weight and retaining that weight more likely for the reasons described earlier. However, plenty of people with diabetes manage to successfully lose weight and keep it off through diet, activity and careful blood sugar management.
And of course, people can gain excess weight for many reasons — overeating, genetics, inactivity, age, pregnancy, medications, and diseases other than diabetes.
So while diabetes can promote weight gain and make weight loss more challenging, it is not correct to say diabetes “causes” obesity on its own. It is rather one important factor that can contribute to obesity in some individuals.
The complex interrelationship between diabetes and obesity does not involve one clearly causing the other. Instead, each disease multiplies the risk of developing and worsening the other. The clearest advice to reduce the risk and impact of both conditions is to maintain a healthy body weight through a balanced diet and regular exercise. Easier said than done, of course! But even modest weight loss can have big benefits when it comes to managing diabetes and improving overall health.
Key Takeaways:
- Obesity significantly increases the risk of developing type 2 diabetes, but does not directly “cause” it alone. Other genetic and lifestyle factors are always involved.
- Diabetes makes gaining excess weight more likely and weight loss more difficult, but does not directly “cause” obesity on its own either.
- The conditions promote a vicious cycle where obesity boosts diabetes risk, and diabetes in turn makes obesity more likely.
- While simple cause-and-effect is appealing, the real relationship between obesity and diabetes is far more nuanced and complex.
Losing weight, especially if obese, is one of the most effective ways to reduce diabetes risk and improve blood sugar control if someone already has diabetes.
Conclusion
So while the connections between obesity and diabetes are multi-faceted, the bottom line is clear — maintaining a healthy weight is vitally important for reducing diabetes risk as well as managing the condition. With diabetes on the rise along with obesity, understanding their complicated relationship is key to fighting both epidemics.
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