Beating the 'Diabesity' Epidemic: A Cardiologist's Guide to Prevention
"Discover how cardiologists are leading the charge in preventing the deadly link between obesity and diabetes, and what you can do to protect your heart."
The term 'diabesity' might sound like a futuristic disease from a sci-fi novel, but it’s a very real and growing health crisis. It describes the dangerous combination of obesity and type 2 diabetes, a condition that's rapidly becoming a leading cause of cardiovascular disease worldwide. For many, obesity acts as the initial spark, setting off a chain reaction that culminates in both diabetes and life-threatening heart problems.
While the prevalence of obesity in the United States hovers around 39% in adults, the diabetes rate isn't far behind, standing at a concerning 14% as of 2017. This raises a critical question: why don't all individuals with obesity develop type 2 diabetes, and conversely, why aren't all those with type 2 diabetes considered obese? The answer lies in the complex interplay of genetics, lifestyle, and individual differences in how our bodies handle insulin, the hormone that regulates blood sugar.
Type 2 diabetes, accounting for over 90% of diabetes cases globally, is far from a uniform condition. It's a highly varied landscape where excess weight often leads to insulin resistance. This is where the body's cells don't respond effectively to insulin, forcing the pancreas to work overtime to produce more. Eventually, in those genetically predisposed or with poor lifestyle habits, the pancreas can't keep up, leading to elevated blood sugar levels and the onset of type 2 diabetes. With research suggesting that up to 80% of insulin-producing cell function may be lost by the time of diagnosis, early intervention becomes paramount.
Why BMI Isn't the Whole Story: Beyond the Numbers
Body Mass Index (BMI) has long been a standard tool for assessing weight, but it has limitations. While BMI is valuable for its simplicity and convenience, it primarily measures excess weight relative to height, not direct body fat. This means it can be less accurate in certain populations, like athletes with more muscle mass or older adults who may have lost muscle mass.
- Waist-to-hip ratio: This measures fat distribution in the abdominal area, a key indicator of metabolic risk. A ratio above 0.95 for men and 0.85 for women suggests increased risk.
- Direct measures of body fat: These include methods like skinfold thickness tests or bioelectrical impedance analysis, which provide a more accurate assessment of body composition.
The Future is Prevention
Type 2 diabetes will continue to pose a major threat to human health for years to come. Primordial prevention, which includes strategies for preventing the obesity tsunami, would be a major approach for reducing the diabetes avalanche. Therefore, it is urgent to take steps including screening, prevention, and early management in an attempt to control this evolving epidemic of diabesity. The most recent guidelines by the European Society of Cardiology in collaboration with European Association for the Study of DM recommend that all patients with ACS should be screened for DM.