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When You Have Diabetes and Obesity

If you have diabetes and obesity, you may hear your combined conditions referred to as “diabesity.”

In the WebMD webinar “Diabesity: When You Have Diabetes and Obesity,” Robert F. Kushner, MD, explained what diabesity is, what raises your risk, and how weight loss, lifestyle changes, and medications can help. 

Kushner is medical director of Northwestern Center for Lifestyle Medicine in Chicago and professor of medicine and medical education at Northwestern University’s Feinberg School of Medicine. He’s also a founder of the American Board of Obesity Medicine.

“Historically, we’ve treated diabetes as an isolated condition,” he said. “But now we know that having excess body fat, or obesity, is one of the major factors in developing diabetes – controlling your weight may be the key to improving diabetes.”

More than 1,000 attendees were asked during the webinar about lifestyle habits and weight loss efforts. 

Over a third said getting more exercise would be the hardest lifestyle habit for preventing belly fat and diabetes. Just under a third said it’d be hardest to improve their diet.  

In another poll, nearly three-fourths of respondents said that in addition to dieting, they’ve exercised in efforts to lose weight. 

Can you get diabetes just from eating too much sugar?

For someone who takes injected insulin for diabetes, why is there more focus on carbs than proteins?

Is there a certain diet, like the Mediterranean Diet, that’s best for both weight loss and blood glucose control?

It’s unlikely you’d get diabetes from just eating too much sugar. For most people, we think you have to have a genetic factor. That’s why your doctor usually asks if anyone else in your family has been diagnosed with diabetes.

Your genetics boost the likelihood of developing diabetes. Then it depends on things like your activity, your diet, what you’re actually eating, and other medications you’re taking.

In terms of insulin, how well it works is going to depend, in large, on how many carbohydrates you’re ingesting. 

If you eat a lot of carbohydrates, you’re going to need a lot of insulin to clear your blood sugar. If you’ve eaten a low amount of carbohydrates, it’s easier for insulin to clear your blood sugar.

Where people may run into trouble is when you’re on a fixed dose of insulin, and the carbohydrates in your diet are going up and down. You’re at risk of suffering hypoglycemia, which is low blood sugar, or hyperglycemia, which is high blood sugar.

So to regulate a normal blood sugar with constant insulin, it’s very important to focus on dietary carbohydrates, so they both work together.

For weight loss, there’s no diet that’s better than another, as long as your diet is calorie controlled and balanced and sufficient in nutrients, vitamins, and minerals. The best diet is the one you’ll follow and enjoy.

But for diabetes, it varies a little bit more because it’s not just about weight loss. 

For this, the best diet actually is the Mediterranean Diet. It’s plant-based with high amounts of healthy oils, fats, fish, cheese, and nuts. It’s very low in simple carbohydrates, like bread. 

If you have any questions about diet, see a registered dietitian.

Can lifestyle changes alone keep prediabetes from progressing to diabetes?

What do you recommend for those who want to make these lifestyle changes but lack motivation?

We now know that if you focus on a healthy diet and healthy body weight — especially if you have more upper body weight — you can reduce or delay the development of diabetes.

Metformin (Glucophage) has also been shown to do that, which may be prescribed by your doctor.

Finding motivation to make lifestyle changes is really a mindset problem. It’s dealing with daily stressors and the need to develop new habits. 

My recommendation is, first identify targets that are short-term, achievable, and realistic.

That could be a healthy breakfast every day, changing your nighttime routine to get more sleep, or getting a little more physical activity.

Don’t bring enticing food into your home. Talk to family members about having a meatless dinner or more plant-based food.

Second, get help if you need help. Either by talking to a friend, getting social support, talking to your health care professional, or reading a helpful book.

What’s the difference between “having obesity” and “being overweight?”

Does the risk for diabetes increase with age? Is that also true for the risk of diabesity? 

Right now, body mass index (BMI) is the standard way of measuring body size, but it’s problematic. You may have a larger body but no medical problems. We’re trying to do away with BMI and get to a much better definition of what obesity really is.

But if you use BMI, obesity is defined as a BMI of 30 or greater. Whereas, overweight is defined as a BMI of 25 to 29.9. It varies, though, among different ethnic groups.

In terms of your risk with age, weight gain usually happens in your 20s, 30s, 40s, and 50s. This is because as we become adults, we start a career, have a lot of time restraints, we’re thinking about other things. But when you turn 50, 60, and 70, your obesity risk starts to go down. 

However, diabetes risk climbs as time goes on. So the risk of diabetes continues to go up, but the risk of obesity does not.

If we combine the two, the risk of diabesity probably peaks more in our 50s and 60s and likely starts to drop as we age.

If you have belly fat, it may be because of your genetics. Your body shape can be different, based on things out of your control. Risk factors you may be more able to control include:

  • Lack of exercise of activity
  • Low fitness level
  • Unhealthy diet (very processed foods, sugar-sweetened drinks, high calorie options)
  • Stress
  • Smoking
  • Not getting enough sleep

“If you’re looking for things to get your weight under control that would also have an effect on your diabetes, these are the behavioral targets that you want to work on,” said Kushner.

Studies show that weight loss improves your insulin levels, which then improves your diabetes.

Similarly, weight loss through lifestyle changes can lower your risk of developing diabetes. This is especially important if diabetes runs in your family or if you have pre-diabetes.

One study focused on people with diabetes and weight loss. Some people took only metformin, while others focused on lifestyle changes.

It found that metformin lowered diabetes risk by 31% for those with prediabetes. But those who made lifestyle changes reduced that risk by 58%.

“Because of this study, we now work with people who have pre-diabetes using lifestyle management, weight reduction, and possibly other medications,” said Kushner.

Other research shows that weight loss improves your health (if you already have diabetes), whether the weight loss results from medications or lifestyle factors alone.

Another study showed that some people may reach diabetes remission. This is when your blood sugar is under control and you’re not on diabetes medication anymore. 

“The more weight loss you achieve, the greater likelihood of going into remission,” said Kushner. “Over 80% of people who lost 33 pounds or more reached remission.”

But people in this study were diagnosed with diabetes for only 4 years and they weren’t on insulin. 

“The less time you’ve had diabetes and the easier it is to control, the more likely it is you can achieve remission,” he said. 

Watch an online replay of “Diabesity: When You Have Diabetes and Obesity.”

Watch other free WebMD health webinars by leading experts on a variety of topics. 

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