It poses one of the greatest threats to human health and well-being, costs the world’s healthcare systems billions of dollars, and 90 per cent of sufferers don’t even realise they have it. Diabesity – a term to describe diabetes linked to obesity, where being overweight is a main contributing factor to the onset of the disease – has become a global epidemic, “potentially the greatest epidemic in the history of the world,” according to Professor Paul Zimmet, foundation director of the International Diabetes Institute.
Dramatic though this might sound, a look at the facts shows just how grave the situation is. In 2006 the United Nations General Assembly passed a resolution describing diabetes as an international public health issue – only the second disease after HIV/Aids to achieve that unenviable status – and in the past few decades the number of people with diabetes (the statistics do not differentiate between Types 1, 2 or gestational diabetes, although it is the lifestyle-related Type 2 that is rising most rapidly) has more than doubled across the globe, with it now killing an estimated 4.6 million people per year worldwide according to a 2012 report by the European Commission.
Around 350 million people suffer from the disease globally, which is expected to increase to 552 million by 2030, and the major driving factor of diabetes – obesity – is also at epidemic proportions, with more than one billion adults classed as overweight, at least 300 million of them clinically obese, according to the World Health Organization (Who).
And the epicentre of the epidemic? The Middle East, according to Professor Zimmet. His 2010 research into the nations with the highest rates of diabetes in the world put the UAE second only to the Micronesian island Nauru, with Saudi Arabia, Bahrain, Kuwait and Oman all within the top 10.
A whopping 18.9 per cent of the UAE population are living with diabetes according to the International Diabetes Federation, while Who estimates that almost 20 per cent of the UAE adult population is overweight or obese.
Diabetes is linked to 31 per cent of deaths in both expats and Emiratis aged between 20 to 79 in the UAE, and treatment of diabetes accounts for 40 per cent of the UAE’s overall healthcare expenditures.
“There seems to be a genetic predisposition to diabetes among UAE nationals, suggesting that they have a higher prevalence than other nationalities within the UAE,” says UAE-based Dr Saf Naqvi, consultant diabetologist and deputy chairman of the medical board, Imperial College London Diabetes Centre. “However, it is important to note that tendencies towards an inactive lifestyle, excessive weight gain, an imbalanced diet and a lack of exercise seem to be major contributors.”
Identifying the problem
So how does diabesity affect your health, and what can you do to prevent it?
Diabetes mellitus, or simply diabetes, is a group of metabolic diseases causing high blood sugar. There are three types of diabetes. Type 1 is the kind you’re born with – the body’s immune system destroys the insulin-producing cells (insulin is the hormone that helps your body use the glucose in your blood to give you energy) – and can’t be cured so it must be managed with insulin injections.
Type 2 develops when the insulin-producing cells in the body are unable to produce enough insulin, or when the insulin that is produced does not work properly (known as insulin resistance). It usually appears in people over the age of 40, but it’s becoming more common in children. It is linked to obesity and may be managed with lifestyle changes.
The third form is gestational diabetes, which occurs when pregnant women without a history of diabetes develop a high blood-glucose level. It may precede Type 2 diabetes.
It’s Type 2, which is mainly brought on by an unhealthy, inactive lifestyle, that is the biggest problem. “Type 2 diabetes is more prevalent,” says UAE-based Dr Atul Aundhekar, Chief Medical Officer, iCARE Clinics. “Individuals who are overweight, with a higher proportion of belly fat or abdominal obesity, are potentially more insulin resistant, as it triggers secretion of a group of hormones called adipokines, which may impair glucose tolerance. In the UAE, this forms the majority of the cases due to relatively inactive lifestyles and unhealthy diet patterns.”
A glance at the history of diabetes and obesity shows how dramatically our lifestyles are affecting our health. The term ‘diabesity’ first entered the public consciousness in 2005, with the publication of the book Diabesity: The Obesity-Diabetes Epidemic That Threatens America – and What We Must Do To Stop It by paediatric endocrinologist Dr Francine Kaufman.
In the book, she noted that the prevalence of diabetes nearly doubled in the American adult population: to 8.7 per cent in 2002, from 4.9 per cent in 1990. She also wrote that in her first 15 years as a paediatric endocrinologist, 1978 to 1993, “I never saw a young patient with Type 2 diabetes. But then everything changed.”
In fact, things changed so much that the name of environmentally influenced diabetes – previously called ‘adult-onset diabetes’ – had to be officially changed in 1997 to Type 2 diabetes, to accommodate the growing number of children and teenagers developing the disease.
The rise in childhood obesity in recent years means that the UAE, like many countries, is witnessing increasing numbers of adolescents who have developed diabetes or are at risk of doing so. 2011 figures from the UAE Ministry of Health (MOH) say that among Emirati and expat schoolchildren, 15.5 per cent are obese, 39.2 per cent are overweight and 21 per cent consume fast food three times a day or more.
For Kaufman, the reason this is happening is simple. “Our ancient genes and our modern environment have collided,” she says. We store excess calories as fat. Calories used to be hard to come by and we’d burn them off hunter-gathering, but today, sugar-rich junk food is everywhere. Coupled with our increasingly inactive lifestyle, the result is obesity.
However, you don’t necessarily have to be fat or have diabetes to suffer from diabesity. Dr Mark Hyman, author of The Blood Sugar Solution, defines diabesity as a continuum of metabolic imbalance and disease that ranges all the way from mild blood-sugar imbalance, to insulin resistance, to full-blown diabetes.
“Nearly all people who are overweight (almost 70 per cent of Americans) already have ‘pre-diabetes,’ which, in short, is an earlier stage of diabesity that carries with it significant risks of disease and death,” he says. “Although the word diabesity is made up of the concepts of obesity and diabetes, even those who aren’t overweight can have this problem. These are the ‘skinny fat’ people. They are under lean (not enough muscle) instead of overweight and often carry extra weight around their middle.”
Dr Hyman estimates that around 90 per cent of those with diabesity do not realise they have it – indeed, diabetes is commonly known as ‘the silent disease’, for the symptoms of insulin resistance can be hard to spot until they cause a medical emergency.
If diabetes is not treated, it can lead to some serious health problems. High glucose levels can damage blood vessels, nerves and organs. If you have diabetes you’re at an increased risk of developing heart disease or having a stroke. This is because prolonged poorly controlled blood glucose levels increase the likelihood of atherosclerosis (furring and narrowing of the blood vessels), which may result in a poor blood supply to your heart, and increases the chance that a blood vessel in your heart or brain will become blocked.
Diabetes can also cause retinopathy, where the retina (light-sensitive layer of tissue at the back of the eye) is damaged, which can lead to vision problems; kidney disease; and foot ulcers. Pregnant women with diabetes have an increased risk of miscarriage and stillbirth.
Minimising the risk
While we can’t do anything about certain risk factors such as genetics, age or ethnicity, carrying extra weight is a significant risk factor for Type 2 diabetes.
“Diabesity is on the increase worldwide because of a combination of sedentary lifestyle and poor dietary choices,” says Veronique Droulez, senior nutrition manager at Meat & Livestock Australia. “It is difficult to separate the one from the other and both probably contribute to increased risk in different ways.”
Studies show that making lifestyle changes can prevent up to 80 per cent of cases of Type 2 diabetes, and risk can also be reduced by up to 60 per cent after making some basic lifestyle changes. In fact, if you’re overweight, every kilogram you lose could reduce your risk of getting Type 2 diabetes by up to 15 per cent.
Eating regular meals to keep your blood-glucose levels stable, making sure you have at least five portions of fruit and vegetables a day, limiting unhealthy snacks and processed foods high in salt, sugar or saturated fat will also help reduce your risk of getting the disease.
“If you’re overweight or obese, I would recommend losing weight by following an energy-restricted diet and increasing physical activity to at least one hour a day,” says Veronique. “Once weight is lost, it’s critical to maintain a healthy weight. The Diogenes study [a large European study] found that a higher protein, low-GI diet was the most effective for maintaining weight loss.”
Put simply, if you’ve been diagnosed with diabesity, or if you’re worried you may be at risk, maintaining a healthy weight and lifestyle is the best chance you have to prolong your life.