Diabetes. Overweight and obesity.

How are they linked? Does one cause the other? And if so, which one comes first?

This week we try to unravel this. So that we can find a starting point for a solution.

Which comes first - overweight or Type 2 diabetes?

These 2 problems do influence each other - However, it’s not such a simple issue as ‘cause and effect’.

So let’s look a some statistics:

Type 2 Diabetes Mellitus (T22DM)

7% of men and 5% of women in the UK were diagnosed with T2DM in 2009 (up from 3% men, 2% women in 1994. So the number of people with a diagnosis of T2DM has more than doubled in 25 years.

Obesity (BMI >30)

In 2021, 26% of adults in England were obese.
A higher proportion of men than women were either overweight or obese (69% compared with 59%).
Obesity prevalence was lowest among adults living in the least deprived areas (20%) and highest in the most deprived areas (34%).
Overweight (BMI 25-30) and obesity has risen from 53% of the population in 1994 to 64% in 2021.

Relationship of obesity to T2DM

11% of obese adults reported that they had had a diagnosis of diabetes from a doctor, compared with 5% of overweight adults and 3% of those who were neither overweight nor obese.

And what proportion of people with T2DM or overweight or obese?

So what does this mean?

We are living through a period when the increase in people with T2DM could possibly overwhelm the health service as we know it.

Being overweight or obese is – in most people - a pre-requisite for developing diabetes.

My conclusion - increasing weight comes first. In around 10% of cases, diabetes follows close behind.

References:

Adults' health: Diabetes - NHS England Digital

Diabetes UK - Know diabetes. Fight diabetes. | Diabetes UK

So having decided that overweight / obesity comes first… what comes next?

Proposal:

The solution to the ‘diabetes problem’ - the doubling of T2DM every 25 years - is to tackle the drivers of overweight and obesity.

And what are the drivers of obesity and overweight in the UK?

Dietary Changes: Shifts towards diets high in processed foods, sugar, and unhealthy fats, coupled with increased portion sizes and reliance on fast food and convenience meals.
Sedentary Lifestyle: Modern lifestyles often involve less physical activity due to desk jobs, increased screen time (TV, computer, smartphone), and reliance on cars for transportation instead of walking or cycling.
Urbanization and Environment: Urban environments may offer fewer opportunities for physical activity, such as parks or safe outdoor spaces, and may have more access to unhealthy food options.
Socioeconomic Factors: Obesity rates tend to be higher among lower-income populations due to factors such as limited access to healthy foods, higher stress levels, and fewer opportunities for physical activity.
Marketing and Advertising: Aggressive marketing of unhealthy foods and beverages, especially targeting children, can influence dietary choices and contribute to overconsumption.
Food Accessibility and Affordability: Healthy food options may be less accessible or more expensive compared to unhealthy alternatives, especially in economically disadvantaged areas.
Cultural and Social Norms: Cultural factors, such as celebrations centered around food or social gatherings, may encourage overeating, while social norms around body image and weight can influence perceptions of what is considered acceptable.
Genetics and Biology: Genetic factors can predispose individuals to obesity, and biological mechanisms such as hormonal imbalances may also play a role in weight gain and regulation.

Addressing this epidemic is not simple - it requires coordinated, multi-agency working, Something that we know is a rarity in our political system - while at the same time it’s challenging in the NHS.

We have a stark choice. We can ignore the problem or we can take action in whatever way we can.

I know of one PCN in West Essex that is looking at ways to take action, real ways to make a difference. Once we’re further along the path, I’ll ask their permission to share our journey.

In the meantime, my uncomfortable challenge to all of us (myself included) is

What are we doing?

Please let me know what you - or your practice, PCN or small business - are doing in this area.

And finally

One of my favourite quotes from the Dalai Lama:

“If you think you’re too small to make a difference… try sleeping with a mosquito in the room."