The Diabesity Crisis: Tackling Obesity and Type 2 Diabetes in Canada and Beyond

Obesity and type 2 diabetes mellitus (T2DM) are not just rising independently—they're forming a dangerous duo. Together, these two conditions are driving what’s known as the "diabesity" crisis, a term used to highlight their interconnectedness. As the global rates of obesity soar, the prevalence of T2DM is following suit, putting millions of lives at risk. Understanding the intricacies of this connection is essential for combating both.

The Growing Epidemic: A Global and Canadian Health Crisis

The numbers are hard to ignore. Globally, obesity and T2DM are reaching pandemic proportions. In Canada, 1 in 3 adults were classified as obese in 2022—up from 21% in 2003.

This is alarming, especially when the World Obesity Federation predicts that over 51% of the global population will be overweight or obese within the next 12 years. With this surge in body fat comes a rise in T2DM diagnoses, potentially doubling to over 1.3 billion cases in the next 30 years.

What is Obesity and Why Does It Matter?

Obesity, defined as the accumulation of excess fat that impairs health, is measured through BMI—a ratio of weight to height. According to Health Canada, a BMI of over 30 is classified as obese. Interestingly, not everyone with obesity will develop diabetes, but the risk is significantly higher in those with excess weight, particularly around the abdomen.

In general in Canada, the accumulation of excess fat around the abdomen is notably more prevalent in women (51%) than in men (37%). This type of obesity becomes more common with age, rising from 31% in both men and women aged 18 to 39 years to 58% in those aged 60 to 79 years.

How Obesity Leads to Type 2 Diabetes

Obesity fuels T2DM through a complex web of factors. Extra fat, especially around the abdomen, leads to insulin resistance—when the body’s cells fail to respond properly to insulin, the hormone that regulates blood sugar. Over time, this resistance forces the pancreas to work overtime, leading to high blood sugar levels and eventually, diabetes.

Obesity linked to other disease states

The Real-World Impact of "Diabesity"

The overlap of obesity and T2DM is not just a health issue—it’s a societal one with far-reaching consequences:

✅Health Complications: Those with diabesity are at higher risk for cardiovascular disease, kidney failure, nerve damage, and more.

✅Economic Strain: Healthcare systems are under increasing pressure, facing higher costs for medications, treatments, and long-term care.

✅Workforce Impact: Health-related absenteeism and reduced productivity are economic burdens felt nationwide.

✅Psychological Toll: The stigma around obesity and diabetes can lead to mental health challenges, including depression and anxiety, worsening the overall quality of life.

✅Health Inequities: Despite similar obesity rates, women in Canada disproportionately higher rates of hiring bias, lower pay, and workplace judgment compared to men with obesity, according to Obesity Canada.

Genetics and Diabesity: Not All Obesity Leads to Diabetes

Clinicians have observed a long-standing link between obesity and a significantly increased risk of T2DM. However, the fact that 10-30% of obese individuals remain diabetes-free, while around 30% of those with a healthy weight develop T2D, presents a paradox.

The IMI project SOPHIA has delved into this mystery by exploring genetic differences. Their research, featured in Nature Metabolism, compared the genetic profiles of obese individuals with and without T2DM, identifying 67 single nucleotide polymorphisms (SNPs), the most common human genetic variation. The study pinpointed 48 SNPs associated with the co-occurrence of obesity and T2D, and 19 SNPs linked to obesity but protection from the disease, suggesting a crucial genetic component in the development of "diabesity."

A Multifaceted Approach to Managing Diabesity

When lifestyle modifications don't lead to adequate weight loss, clinicians should look for other contributing factors, such as medications that may promote weight gain, including certain antidepressants, antipsychotics, insulin, and steroids. For patients with a BMI over 30 or those with weight-related health issues like hypertension, diabetes, or sleep apnea, pharmacotherapy can be an important part of the treatment plan.

Medications such as phentermine-topiramate, GLP-1 receptor agonists (like semaglutide), or orlistat are commonly used to aid in weight loss and improve glycemic control. These treatments are typically combined with intensive lifestyle interventions, which include dietary changes and exercise.

For patients who don't respond to medical treatment, surgery, such as gastric bypass or sleeve gastrectomy, may be recommended. These surgical options are effective for achieving sustained weight loss and improving metabolic health. Monitoring of patients on medications or those who have undergone surgery is essential to assess efficacy and prevent complications.

👉 It is important that healthcare teams, including dietitians, endocrinologists, nurses, and surgeons, collaborate to provide comprehensive care and adjust treatments as needed to optimize patient outcomes.

Clinical Significance

Obesity is a major risk factor for T2DM and can exacerbate its severity. Early screening and aggressive treatment of obesity are essential in preventing the onset of T2DM and managing existing cases. Weight loss can significantly improve glycemic control, reduce insulin resistance, and even lead to remission of diabetes in some patients. Effective management of T2DM through weight loss can prevent or reduce complications like diabetic neuropathy, retinopathy, cardiovascular disease, and kidney damage.

Additionally, achieving a 5-10% weight reduction has been shown to have positive effects on blood pressure, cholesterol levels, and overall metabolic health. The interdisciplinary approach to managing obesity and T2DM, which includes healthcare professionals from various specialties, ensures that patients receive comprehensive care, tailored treatments, and continuous monitoring for long-term success.

👉 With proper management, patients with obesity and T2DM can experience significant improvements in quality of life, as well as reduced healthcare costs due to fewer complications and hospitalizations.

A Path Forward: Hope for Canadians

The National Framework for Diabetes Act and the Framework for Diabetes in Canada, a national strategy launched by the government in 2022, is paving the way for transformative change by focusing on improving access to prevention and treatment for all types of diabetes.

This collaborative effort, shaped by extensive consultations, is addressing key areas such as innovative prevention strategies, enhanced care pathways, cutting-edge research, comprehensive data collection, and expanded access to life-changing devices and medications. By embracing fairness, person-centered care, and fostering innovation, this unified approach promises to reduce the impact of diabetes in Canada.

With a progress report set for 2027, the country is poised to celebrate the significant advancements made through government initiatives and partnerships. These efforts offer renewed hope for Canadians living with or at risk of diabetes, with exciting breakthroughs in type 1 diabetes research, earlier diagnoses, and a future filled with healthier, longer lives.

While the rising tide of obesity and type 2 diabetes is undoubtedly a challenge, there is reason for hope. Through innovative strategies, research breakthroughs, and a collaborative national effort, we can work towards reversing the "diabesity" crisis that has affected millions globally and in Canada. The growing recognition of the link between obesity and T2DM has led to more targeted prevention efforts, weight management solutions, and personalized care approaches.

Stay up to date:

✅Government of Canada - Framework of Diabetes in Canada

✅Obesity Canada - Clinical Guidelines, Education, Awareness

✅T2D Network - Your Resource Hub for T2D in British Columbia

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