DIABESITY: A MODERN EPIDEMIC!!
Diabetes and obesity are modern diseases with serious health implications. When they occur together it is referred to as diabesity. Diabesity now affects more than one billion people around the world and is now considered an epidemic. India sits in the middle of this and regrettably will soon be the biggest contributor to this epidemic.
Obesity is linked with diabetes higher the body weight greater the risk of diabetes. It is estimated that 80% of diabetics are obese. The worldwide prevalence of diabetes alone has increased tenfold, from 1.2% to 12.1% between 1971 and 2000. India is heading for a massive surge in diabetes and estimated number of diabetics in next 20 years will cross the 100 million mark.
Obesity is considered a major risk factor for diabetes. Being overweight places extra stress on the body. Obesity reduces the ability of the cells to use insulin to decrease the blood sugar levels. This insulin resistance can make the control of blood sugar difficult and also affects the ability to lose weight. Diabesity is major cause of heart diseases, stoke, cancer, kidney failure and poor quality of life. Investigations for diabetes are a must for all persons with a craving for sweets made up of refined sugars and carbohydrates particularly if associated with a waist greater than 35 inches in a lady and more than 40 inches in a gentleman.
Obesity is CURABLE. But unfortunately diet therapy without a support system is often ineffective in treating obesity after BMI>32 kg/m2 or more. BMI is calculated by dividing a person’s weight in kilograms by their height in meters squared. Normal BMI range for Indian population is 18.5-24.9 kh/m2. Also there are currently no truly effective drugs available to treat morbid obesity .
When diet and regular exercise do not produce desired weight loss in obese patients a surgical option known as bariatric (weight loss) surgery should be considered. The National Institute of Health states that bariatric surgery is THE most effective approach that provides consistent and permanent weight loss for obesity. Bariatric Surgery is an option for obese patients with BMI 32.5 Kg/m2 and above when associated with Type II diabetes, hypertension, and obstructive sleep apnea. If no associated condition co exists then bariatric surgery should be considered for BMI more than 35 kg/m2.
The aim of surgery is to decrease excess body weight and help control related co morbidities. Our experience shows that bariatric surgery results in 70-85% of excess weight loss over 8-9 months with 95% improvement in Type II Diabetes, 92% in hypertension, 95% improvement in cardiac functions, 97% in high cholesterol. There is a drastic improvement in quality of life. The majority of patients gain control on blood sugar and hypertension without drug. Some may need drug treatment but now at much reduced doses.
With better understanding of diabesity and its implication we can provide targeted support against it. Better investigation, better focused counseling about obesity, dietary requirement, lifestyle changes and treatment options in choosing bariatric surgery will help to mitigate the freighting effect of diabesity
Dr. Deep Goel
Minimal Access, Bariatric & Surgical Gastroenterology
Dr. V. P. Bhalla
BLK Institute of Digestive & Liver Diseases