The prevalence of overweight and obesity on a global scale is increasing at an alarming rate.

According to a WHO report on the prevalence of obesity and overweight status worldwide, it has climbed approximately three times since 1975.

The 2022 WHO report highlighted that at least one billion people were obese with two-thirds being adults.

A similar obesity trend was also reported in Malaysia.

In addition, an equal increment in trends is observed in obesity and type 2 diabetes mellitus (T2DM) over the years.

The National Healthy and Morbidity Survey 2019 reported that the prevalence of obesity increased from 15.1% to 19.7%, in line with the increment of T2DM from 7.2% in 2011 to 9.4% in 2019.

Let’s review the relationship between obesity with the incidence of T2DM by looking into the underlying mechanism triggering this scenario.

Abdominal obesity in comparison to peripheral obesity is one of the culprits causing impaired pancreatic beta-cells and insulin resistance, primarily due to a non-esterified fatty acid (NEFAs) secreted from the adipose tissue among obese people. 

The NEFAs were hypothesized to induce insulin resistance through the release of tumor necrosis factor (TNF-alpha), an inflammatory cytokine which can impede beta-cell functions.

In addition, a high accumulation of free fatty acids from obese individuals also can trigger the liver to produce more glucose into the blood steam.

This condition is not only likely to desensitize the body’s organs to react to insulin adequately (insulin resistance), but also stresses beta-cells to work harder in converting glucose into glucagon.

Consequently, the overstrained beta-cells tend to malfunction or result in cell death.

Fortunately, abdominal obesity can be prevented via lifestyle modifications.

These modifications include reducing sedentary behaviors (such as prolonged sitting), being physically active, avoiding alcohol, improving diet quality by consuming more plant-based foods, cutting down on high fat/fried foods and sugary beverages, having sufficient sleep, as well as learning how to reduce or cope with stress.

Obesity is a risk factor for T2DM and other non-communicable diseases such as hypertension, heart diseases, certain types of cancers. etc.

In concordance with the World Obesity Day on March 4, 2023, we should start taking action by taking care of our health and modifying any unhealthy lifestyle that puts us at risks for obesity, T2DM and non-communicable diseases.

References:

1. Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity : targets and therapy, 7, 587-591.
2. Brown-Riggs, C. Men’s Health: Abdominal Fat and Why it Matters if You Have Diabetes. Retrieved online 1st March 2023. 
3. Institute for Public Health. (2011). National Health and Morbidity Survey (NHMS) 2011: Non-communicable diseases, healthcare demand, and health literacy—Key Findings. In: Ministry of Health Malaysia Kuala Lumpur.
4. Institute for Public Health. (2015). National Health and Morbidity Survey 2015 (NHMS 2015). In (Vol. 2): Ministry of Health Malaysia Kuala Lumpur.
5. Institute for Public Health. (2020). National Health and Morbidity Survey (NHMS) 2019: Non-communicable diseases, healthcare demand, and health literacy—Key Findings. In: Ministry of Health Malaysia Kuala Lumpur.
6. Kahn, S. E., Hull, R. L., & Utzschneider, K. M. (2006). Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature, 444(7121), 840-846. 
7. World Health Organization. (2022). World Obesity Day 2022 – Accelerating action to stop obesity. Retrieved 1st March 2023.
8. Wysham, C., & Shubrook, J. (2020). Beta-cell failure in type 2 diabetes: mechanisms, markers, and clinical implications. Postgraduate Medicine, 132(8), 676-686.

(Ng Yit Han, PhD candidate; Professor Dr. Moy Foong Ming, Department of Social & Preventive Medicine, Faculty of Medicine, Universiti Malaya.)