How are they related? Why do so many Americans have both?
When you consider the number of people in America who are obese and have diabetes, it begs the question of how the two are connected? Does one cause the other? There are serious health complications that arise from each one individually and collectively. In most cases, we know the diseases and their complications are completely preventable. Why are so people in America suffering from them?
Nearly one-third of all American adults and about 17% (12.5 million) American children between the ages of 2 – 19 are suffering from obesity. The number of children affected has tripled in the last four decades. We know that people with a BMI above 30 are 80 times more likely to develop type 2 diabetes than people with a BMI under 22. This is why almost 90% of people with type 2 diabetes are overweight or obese. Currently, about 25.8 million Americans (8.3%) are affected by type 2 diabetes with 18.8 million having been diagnosed and 7 million not even realizing they have the disease. All of these account for 95% of the cases of diabetes in America. It is also important to note that 70% of people who have pre-diabetes will develop diabetes. So, this means as the number of obese people continues to rise, the number of people with diabetes will too.
With the number of people who are obese and have diabetes continuing to increase, the concern for the health of these individuals becomes paramount. It isn’t just the diseases themselves, but about all the complications that can arise because of them. Obesity is killing many more Americans than we realize. While it has transitioned to a population-wide problem at a startling speed, it is like observing a catastrophe in slow-motion because it takes years for the complications to arise. Currently, it is estimated that diabetes is killing around four times as many people than is actually reported. This is attributable to the fact most death certificates don’t list diabetes as the cause of death, but some complication of it, such as kidney failure or heart disease. According to information from the Center for Disease Control (CDC), diabetes is the seventh leading cause of death in United States. If you multiply the number of deaths by four, it becomes the third leading cause. The number one and two causes are heart disease and cancer. Since obesity is a major factor in the development of all three of these, it is most likely the top killer of American people.
The most important factor in the development of insulin resistance is obesity. Being obese can lead to type 2 diabetes in a very short period of time. There are several factors that contribute to this quick progression, such as eating a high calorie diet, not getting enough physical exercise, genetics, medical conditions and certain medications. If diabetes isn’t controlled, it can lead to serious complications that affect your vision, kidney function and nerve function that put you at increased risk for heart attacks, strokes, and decreased blood flow to your legs. Due to these complications, people with diabetes are twice as likely to die of a heart attack or stroke than someone who doesn’t have it. Also, they are 17 times more likely to require an amputation of limbs from the decreased blood flow.
In order to understand the link between obesity and diabetes, we need to take a more in-depth look at them. A person is considered obese when they have accumulated so much body fat that it most likely will have a negative impact on their health. Whereas, overweight means the extra weight could come from muscle, bone, fat or body water. If you weigh at least 20% more than your ideal weight, you are considered obese. Body fat can be classified in a couple of ways. One is based off of where it is stored in the body. Visceral body fat is stored inside the stomach area and wraps around the walls of internal organs. These means it can’t be easily removed by typical diets or exercise causing an increased risk for developing serious health problems. Subcutaneous body fat, or love handles, is found right beneath your skin and is what you physically measure when taking your waist circumference. Another way body fat is classified is by the type of adipose (fat) tissue. Brown adipose tissue is dark brown in color and linked with many blood vessels, which means it is associated with calorie burning, heat production and energy balance. White adipose tissue is responsible for storing energy and, unfortunately, accumulates excessively in obesity. In a healthy body, your muscles, fat tissue and liver absorb glucose from the bloodstream and your white adipose tissue supports this glucose regulation process. This actually reduces your risk of obesity and diabetes. However, during obesity, when white adipose tissue becomes excessively thick, its ability to regulate glucose levels is disrupted.
In obese people, the high fat, high calorie diets with sedentary lifestyle cause the adipose tissue cells to have to process more nutrients than they can manage. This causes the cells to become stressed, which leads to several things happening in your body. The stress triggers an inflammatory response causing the release of proteins (cytokines). The cytokines block the signals of your cell’s insulin receptors making them less sensitive to the insulin your body produces by disrupting the function of insulin responsive cells and their ability to respond to insulin. Over time, this causes the cells to become insulin resistant. In addition, the stress triggers abnormal glucose production (gluconeogenesis) in your liver. This is when your liver creates glucose for fuel and it usually occurs only in times of fasting. Typically, the “fasting switch” only gets turned on when glucose levels are low during periods without food. Due to the stress placed upon the cells when someone is obese, this switch seems to become stuck in the on position causing them to produce significant amounts of glucose that isn’t absorbed by the cells due to insulin resistance. When this happens, your body can’t convert glucose into energy and you are left with high blood glucose levels. Another important factor in insulin regulation is sleep. When you are sleeping, your body is working to repair and replenish what it needs to so it can function every day. So, when your sleep is disrupted, it can cause significant issues with your body’s ability to use insulin. Obese people are more likely to have problems with sleep because they typically have excess fat in their pharynx (area of throat behind mouth and nasal cavity), which can lead to their airway becoming temporarily blocked, otherwise known as sleep apnea. Unfortunately, this lack of good quality sleep results in a disturbance to your body’s ability to process blood glucose. Further adding to high blood glucose levels.
In addition to the problems with insulin, obesity is also thought to change body’s metabolism and this signals adipose tissue to release fat molecules into the blood stream, which results in it accumulating in your arteries. This means your heart has to work harder to pump your blood throughout your body because the space in your blood vessels that your blood has to travel through is smaller. This puts greater pressure on your blood vessels causing high blood pressure (hypertension). Between the accumulation of fat molecules in your blood vessels and hypertension, you are at an increased risk for heart disease. This is one example of how obesity and diabetes lead to complications of other body systems.
Besides the physical toll of the health complications place on your body, they also put a significant strain on your budget. When you need to go to multiple doctors more frequently and take medication on a regular basis in order to manage your diabetes, this costs money that you could be using for other things. Diabetic patients incur an average medical cost of $7,900 a year for diabetic treatment alone, which means their total yearly medical expenses are 2.3 times higher than those for people without diabetes. Unfortunately, obesity and diabetes are the highest in lower-income, less educated groups that often live in urban areas that have food deserts and littered with fast-food outlets. These individuals already don’t have the extra money to deal with these diseases. More than 1 in 5 healthcare dollars in the United States being spent on diabetes care and half of which are directly attributable to treatment. This doesn’t reflect the indirect costs, including absenteeism, reduced work productivity, inability to work and lost workers due to premature death, all of which account for about $68.6 billion lost yearly.
Obesity and diabetes can successfully be managed. Just a 5% reduction in body weight followed up by regular moderate intensity exercise is thought to reduce your risk of developing type 2 diabetes by more than 50%. Remember, it is key to aim for a healthy weight, not an ideal weight because they aren’t always the same thing. Some ways to accomplish this are through diet by avoiding refined carbohydrates, basing your meals around vegetables, reading food packaging (low fat doesn’t always mean low calorie), not eating processed or take-out meals regularly, being aware of your alcohol intake since it is high in calories and eating smaller portion sizes. The other essential component is getting regular physical activity. It doesn’t have to be anything strenuous, even moderate walking for as little as 20 minutes per day can boost your metabolism. It is also vital to get good quality sleep for 6-9 hours each night. Be sure to consult with your doctor prior to making any diet or physical activity changes to find the right path forward for you.
While we all need to take some responsibility for our lifestyle choices, it is not completely our fault. This is especially true when it comes to children. When the scale of obesity and diabetes is this widespread, it is not just the failure of individual to resist fats and sweets or not getting enough exercise, but a failure of the government to take on the food and soda industries that control the products we have to eat and drink. The obesity and diabetes problem can be prevented through population-wide interventions, the government needs to have the courage, commitment and persistence to follow through. Our current way of living is dictated by international trade policies, agricultural subsidies, heavy advertising (especially geared toward children), politically powerful lobbies and money invested to distort the scientific evidence. All of these things have led to our food system being industrialized with the focus on increasing production while reducing production cost. Agribusiness is a global industrial that is run by a few large multinational companies who influence every stop along the food chain, from seeds, feed, and chemicals to production, processing, marketing and distribution. This is why highly processed junk food is the new global food staple because it is easier and cheaper to make. Due to their power, these companies can resist interference from health agencies, like the World Health Organization, US Department of Agriculture and Food and Drug Administration. Our government needs to prioritize our interests over those of the corporations. They could do this in a variety of ways. One way would be to place an added tax on sugar-sweetened foods/beverages, high sodium content products and highly processed food items that are unhealthy for us. This would make these unhealthy foods more expensive, hopefully, resulting in people buying less of them. In order to have any sort of impact, the tax should increase the price of these items by at least 20%. Another way the government could help is to change the recommended amounts of daily sugar intake. It should be at a maximum of 5% of our total intake for a day. We should also evaluate how much sodium is in the food products we consume. In order to mass produce foods that don’t spoil as quickly (making it cheaper for the manufacturers), salt is added to a large amount of food products. Part of this process should include nutrition labels that not only have total sugars and sodium, but added sugars and sodium so consumers know how much of these have been added to the products that did not occur naturally. We should have the right to transparent and useful information when it comes to the food we ingest.
Every one of us needs to do our part to improve our health, but only by taking a stand against the food manufacturers will truly see the change in the obesity and diabetes epidemic. If we don’t do anything, this epidemic will continue to spiral out of control and many more Americans will end up sick or dead from disease that could have easily been prevented. When you take that into account, how can we not do something to fix the problem?