Diabesity – best management with diet, drugs and more


By Regina Bates

Diabesity is not yet an official medical diagnosis but it has become a dual epidemic in many countries, with adverse effects on health and quality of life. It’s the term doctors are increasingly using to describe the co-existence of type 2 diabetes and obesity.

There are multiple bodily pathways through which both diabetes and obesity are interlinked.

Firstly, diabetes is often a metabolic consequence of obesity, as visceral adiposity leads to insulin resistance and increased blood sugar levels. On the other hand, patients with diabetes can struggle with managing their weight.

The pathophysiology of diabesity is complex. However, the bottom line is that these chronic conditions feed into one another. For this reason, many medical specialists say that both should be tackled as co-morbidities.

When it comes to best treatment and management options, the diet-versus-drugs debate has become a perennial one. Research shows that really is no such thing as a one-size-fits-all-diet, as the concept of bioindiviuality clearly shows. An aggravating factor is that several classes of anti-diabetic medication, such as sulfonylureas and meglitinides, can alter appetite and metabolism.

Fortunately, there are effective lifestyle changes and pharmacological measures that can help manage body weight, insulin function, and blood sugar all at once. Here are some of them:

Mediterranean diet

Understanding how your dietary choices affect blood sugar levels is key to managing diabetes. Since diabetes is primarily linked to carbohydrate digestion and absorption, patients with diabetes must be mindful of how much carbohydrates they consume so as not to place heavy demands on the insulin-producing cells in the pancreas.

Evidence is growing for the modified Mediterranean diet – a relatively low-carb diet that focuses on fish, vegetables, legumes, whole grains, and fruit. Robust research points to benefits of this way of eating: it can improve glucose control and reduce cardiovascular risk, it can also aid in weight loss by cutting down the excessive calories from refined carbs from sugary and processed foods like soda, pasta, and pastries.

Intermittent fasting

The dietary and nutritional management of diabesity involves not only what and how much you eat but also when you eat. This is why, on top of monitoring your carb intake, more doctors these days also recommend intermittent fasting. This limits meal intake to control the release of glucose into the bloodstream and thus delay diabetes progression.

Meanwhile, along with intermittent fasting, that has become a buzzword on the health and diabesity fronts, there are plans that help lower calorie intake by focusing on larger, satisfying meals. According to Dr Jason Fung, a Canadian nephrologist and author of The Complete Guide to Fasting, diet is key. But just as important, he says, is timing – when to eat, when to refrain from eating and for how long.

Research also shows that eating balanced meals composed of protein, healthy fats, fiber and complex carbs can boost satiety and reduce the temptation to overeat.

The reality is, however, that some patients can’t or don’t want to change their dietary habits drastically, even for the sake of their health. Reasons given vary widely – and wildly – and may include religious and spiritual imperatives. In many cases, patients simply don’t want to give up some of their favourite foods.

For recalcitrant cases of both obesity and type 2 diabetes, bariatric surgery is an option. However, it is invasive, with a low success rate and a high complication rate.

Luckily for diabesity patients, there are other options.

The role of medication

At their core, diabetes and obesity are chronic medical conditions, meaning they can be effectively managed clinically through medication. The good news is that the new class of anti-obesity medications available on the market, and approved by the Food and Drug Administration (FDA) in the US, can tackle both at the same time.

For example, semaglutide and liraglutide are known as GLP-1 agonists that mimic how gut hormones help with blood sugar control by boosting the amount of insulin. At the same time, GLP-1 for weight loss activates the receptors in the brain and the gut responsible for appetite control. This can lead to satiety (increased feelings of fullness) while minimizing the risk of overeating.

Medical experts stress that these medications (under brand names such as Wegovy and Saxenda) must be prescribed appropriately and used under specialist supervision. They also say that doctors should recommend these drugs only to patients who meet BMI (Body-Mass Index) requirements and have qualifying weight-related conditions, such as diabetes.

Always consult your doctor first if you plan on using them for diabesity management.

Physical activity

Lastly, while physical activity on its own is no magic bullet, it can reinforce the effects of diet, nutrition, and medication on improved blood sugar and body weight. Specifically, doctors may often recommend that patients with diabetes and concurrent obesity do combined exercise, which involves aerobics and resistance training.

Regarding diabetes, specialists say that combined exercise can induce insulin sensitivity not only during the workout but also during muscle recovery. Meanwhile, research shows that it can also reduce body mass index among overweight and obese individuals by stimulating metabolism for fat loss and maintaining lean mass for muscle strength.

Overall, the coexistence of type 2 diabetes and obesity can create a vicious cycle that puts individuals’ insulin function and metabolism at risk. However, there are evidence-based ways to address these comorbidities.

Through proper diet, nutrition, exercise and appropriate medication, individuals with diabesity can achieve and sustain improvements in their blood sugar, body weight and eventually, overall health.


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