Dr Jitendra Singh
An epidemic of obesity is currently sweeping the globe. India too is a witness to this worldwide upsurge. Protagonists of economic growth may cite this phenomenon as an indicator of India’s giant strides on the course to prosperity because obesity is also known to be an outcome of economic development and globalization. For the scholars of medicine, however, this could be a matter of grave concern because obesity is now recognised as a disease in itself closely linked to a host of other disorders including Diabetes.
Statistics reveal that the risk of developing Type 2 Diabetes Mellitus is 2-folds in presence of mild obesity, 5-folds with moderate obesity and 10-folds with morbid obesity.
DANGEROUS NEXUS
Obesity and Diabetes together form a dangerous nexus. The situation turns even more ominous if it is in addition also accompanied by other related disorders like high blood pressure, lipid disturbance, etc.
Obesity, in most simple terms, results from an imbalance between energy expenditure and energy intake. Diet, nutrition and changing lifestyle are foremost among the principal drives of obesity. There is an intimate relationship between obesity and diabets mellitus. Even though the mechanisms through which obesity can precipitate or trigger or initiate diabetes remain still not fully defined, International Diabetes Federation has declared obesity as the most preventable and important risk for type 2 Diabetes Mellitus.
Insulin Resistance or decreased effectiveness of Insulin or decreased sensibility of body’s various biologic processes to insulin is perhaps the earliest detectable abnormality in obese persons with type 2 Diabetes.
ABDOMINAL OBESITY POSES HIGHER RISK
Even though the relative proportion of body fat in the upper body versus lower body has been considered a crucial factor for several decades but in the last few years more attention has been focussed on abdominal obesity rather than obesity as such. Furthermore, Asian Indians have been found to be particularly susceptible of developing abdominal obesity and insulin resistance which might account for excessive morbidity and mortality from diabetes in this population.
There are clear indications that not only does the abdominal obesity predispose to Type 2 Diabetes Mellitus but the presence of abdominal obesity in a person who is already a known diabetic might predispose to a host of diabetic complications. Obesity is associated with insulin resistance which is in turn closely linked to diabetes. In addition, it has also been suggested that obesity might cause diabetes by overstimulating the pancreas thereby leading to pancreative exhaustion. A link has also been postulated between obesity and insulin receptors.
In a nutshell, the metabolic consequences of obesity could be varied depending on the cause, distribution and character of the excess fat and adipose tissue. In other words, obesity and adiposity carry a penality in that these lead to worsening of different elements of metabolic syndrome including insulin resistance, hyperinsulinemia, disturbed lipid/cholestrol levels, hypertension or high blood pressure etc.
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