Diabetes + Obesity = Diabesity: The Enemy Within You

New Delhi [India], December 23 (ANI/Mediawire): Imagine a secret enemy base, living and operating from your home territory! Seemingly inactive and harmless, but quietly working round the clock on executing deadly attacks on your city. The excess fat in obesity patients is similar.
Obesity is a "trojan horse". It causes malfunction of entire human body and brings a battalion of ailments, which are most detrimental to our health. The imbalance between energy intake and energy expenditure results in an oscillating weighing scale. Obesity has become another epidemic in the country which needs attention.
A complex spectrum of factors contributes to obesity and is associated with co-morbidities like diabetes type-2, hypertension, coronary heart disease, mental illness, depression, infertility with PCOS (Poly-cystic Ovary Syndrome), colon and endometrial cancer. Obesity is a social stigma. Because of which one wants to go into hibernation and with increasing stress, tries to binge on food, making the person get caught in a vicious cycle which leads to weight gain. Obesity is a burden on society which has a potential to destroy nations - medically and economically.
The Story of the Hyperactive Fat:
For a long time, the medical science thought that the fat cells are like phone batteries - just store and release energy. But the recent studies proclaim fat triggers inflammation in the body.
Weakening our defense: Our body has immune cells to fight bacteria and viruses. Obesity causes a state of chronic inflammation, and sabotages your immune system, leaving it permanently triggered, making you more vulnerable to other diseases.
Triggering diabetes: In healthy people there is a switch that tells the liver to produce glucose only when the body is fasting. In obese people, liver abnormally produces glucose whether the person is fasting or not. This is the path to insulin resistance. This insulin resistance can convert to full blown diabetes due to impaired function of pancreas to produce insulin. Dr Francine Kaufman coined the term diabesity (diabetes + obesity) to describe them. Diabesity can be defined as a metabolic dysfunction that ranges from mild blood sugar imbalance to full-fledged type 2 diabetes.
Diabesity is a constellation of signs that includes:
* Abdominal obesity
* Dyslipidemia (low HDL, high LDL and high triglycerides)
* High blood pressure
* High blood sugar (fasting above 100 mg/dL, Hb1Ac above 5.5)
* Systemic inflammation
* Increase formation of blood clots
Conquering the Enemy
The first step is to understand how obesity is defined. Obesity is diagnosed by determining one's Body Mass Index or BMI. BMI is the ratio of your weight in kilogram divided by height in meters squared.
World Health Organization (WHO) considers a BMI more than 30 as Class 1 obesity. BMI above 35 is Class II - serious obesity, and BMI above 40 is class III - severe obesity. According to the Asia-Pacific Obesity guidelines, normal weight is BMI 18.5-22.9 kg/m2, overweight is BMI 23-24.9 kg/m2 and obese is BMI>25 kg/m2.
The second critical step is to recognize that obesity as a chronic disease manifesting into metabolic syndrome that needs medical intervention. The future challenge is the identification of obesogenic environment and to create an impact for adoption of healthier choices.
The final vital step is to seek appropriate medical help. The pyramid of management of obesity include, lifestyle modification, pharmacotherapy and minimal invasive bariatric surgery (weight loss surgery). Lifestyle and behavior modifications are the foundation for treating obesity. The lifestyle modification is a combination of diet, physical activity and behavior therapy. BMI more than 32.5 is associated with diseases like diabestes, hypertension, osteoarthritis, obstructive sleep apnea, etc.
Patients who are morbidly obese i.e with a BMI > 40 Kg/m2 (or greater or equal to 37.5 kg/m2 for Asians) with or without co-morbidities are indicated for weight loss surgery. Weight loss surgery performed on patients having BMI- 32.5-37.5 kg/m2 with severe co-morbidities like diabetes, heart disease, hypertension, deep vein thrombosis, has also shown improvement in their co-morbidities with complete resolution in some patients.
Obesity is well recognized to be a pro-inflammatory condition. This directly contributes to the worst outcomes of COVID-19 infection in obese patients. The American Society for Metabolic and Bariatric Surgery has proposed that bariatric surgery can help reduce obesity and related diseases, which increases the risk of worse outcomes, if COVID-19 were to strike obese patients, and should be a surgeon's priority during this pandemic.
Doctors and healthcare workers have taken a pledge to be frontline warriors throughout the Corona virus pandemic. All measures are being taken for maintaining a line of communication with patients during this period of uncertainty which is essential for continuity of care. With the advent of technology, patients can also utilize various online platforms to guide their weight and manage co-morbidities. Online social support group gatherings and tele-medicine implementation have brought a radical change in the healthcare sector.
The need is to make the society aware about obesity as a metabolic disorder, and to control and improve the co-morbidities associated with the combined approach of medical and surgical intervention. The rise in obesity has put the entire generation at risk. The steering wheel is in our hands to balance the risks of intervention against the benefits of improved long-term health, longevity, and wellbeing. The obesity terrorism can be exterminated with lasting results.


Disclaimer: This article is sponsored by J&J in public interest. The views and opinions expressed in the article by participating doctors are based on their independent professional judgement. J&J (P) Ltd., BCCL and its group publications disclaim any liability for the accuracy or consequences flowing from adherence to their expert views.
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