Managing Obesity as a Multi-Faceted Chronic Disease

Dr. Ali Zentner, MD, FRCPC, Internal Medicine, Obesity, discusses how obesity needs to be viewed as a multi-faceted chronic disease where patients need to be involved in treatment decisions.

How Are Type 2 Diabetes and Obesity Related?

If you have type 1 diabetes, your body doesn’t produce insulin. Insulin is secreted by the pancreas when food is absorbed, so as food accumulates in the blood in someone with type 1 diabetes, sugar levels get too high. If you have type 2 diabetes, your pancreas doesn’t produce enough insulin, or your body does not properly use the insulin it makes, causing glucose (sugar) to build up in your blood.

If you have type 1 or type 2 diabetes, it’s important to know that the impact goes beyond chronic hyperglycemia. Diabetes can cause diabetic retinopathy (a leading cause of blindness), diabetic neuropathy (nerve damage that can lead to amputation), increase your risk of cardiovascular disease and stroke and more.

Type 2 diabetes can also contribute to being overweight or obese. Nearly 90% of people with type 2 diabetes are overweight or obese. In fact, it may be the single best predictor of type 2 diabetes.

Why Are You More at Risk if You’re Overweight or Obese?

Healthcare providers don’t know exactly why some people develop insulin resistance, but it’s a fact that obesity and lack of physical exercise make it worse.

When you’re carrying extra weight, it puts added pressure on your body, affecting its ability to use insulin to control your blood sugar levels. As the prevalence of obesity has grown in North America, so has the number of people affected by type 2 diabetes.

Type 2 Diabetes and Obesity Treatment

Basically, treating type 2 diabetes will treat obesity, and vice versa. Even a moderate, sustained weight loss of 5-10 percent of a patient’s body weight may reduce the need for some diabetes medications, improve how the body uses insulin and decrease fasting glucose concentrations.

Increasing the amount of fibre might also be beneficial for type 2 diabetes and obesity. High-fibre foods can decrease hyperinsulinemia, improve glycemic control and create a sense of fullness between meals.

For most patients, a diabetes healthcare team will recommend diet and exercise, although some people may also need medication. Behaviour modification is important in the treatment of type 2 diabetes and obesity, so the help of a psychologist or psychiatrist may be needed.

How Can Patients Take Control of Their Health?

  • Type 2 diabetes is largely preventable, and studies have shown that weight loss and lifestyle changes can prevent or delay the development of the disease.
  • Patients may also need medications to lower blood glucose levels, so they should speak to a healthcare provider and pharmacist about options and potential interactions with other drugs.
  • Patients should work with their diabetes healthcare team for optimal blood glucose testing.
  • It’s important that patients with type 2 diabetes are aware of diabetes complications. Regular visits to an endocrinologist, primary healthcare provider, optometrist or ophthalmologist, dietitian or nutritionist, physical therapist and podiatrist may be recommended by the diabetes healthcare team.
  • Behaviour modification may be needed as patients choose healthier foods to lose weight. Patients with type 2 diabetes and obesity may benefit from seeing a psychologist or psychiatrist as part of their treatment plan.