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Does Obesity Always Mean T2DM?
March 12, 2020

Type 2 diabetes mellitus, also known as T2DM is a chronic metabolic disorder caused by high levels of blood sugar, due to the body’s inability to produce and utilize insulin in the peripheral organs (peripheral insulin resistance) and metabolize sugar. Apart from being called a disease of “impaired glucose metabolism”, it is also less commonly known as disease of “impaired fat metabolism”. Research in recent times has shown that obesity could cause Type 2 Diabetes in this way. Let’s see how this happens.

1.How does fat accumulate in the body?

Abnormal gain of fat mass is generally due to overconsumption and underutilization of carbohydrates, sugar, fat, oils, etc. In instances of overconsumption of carbs, a hormone in our body called leptin is triggered to alert the brain to reduce the appetite, to tell the body to exercise and be more physically active, so that more calories are burnt. With increase in the fat mass in the body, leptin gets stimulated which in turn alerts the brain. This is a natural way to maintain a balance in the body. Prolonged higher levels of leptin in the blood causes leptin resistance, meaning the brain is unable to recognize these high levels of  leptin and thus loses the ability to command the body to burn more fat. This results in accumulation of fats in tissues such as the liver, pancreas and heart, eventually leading to cardiovascular disease and other complications.

Not all obese people necessarily develop Type 2 Diabetes. This is mainly related to the way in which fat cells get accumulated in the body. There are 2 ways in which excess fat gets stored – one, beneath the skin (subcutaneous) and the other is in the abdominal cavity (viscera/Waist) of obese patients. Compared to the abdomen, fat deposited under the skin is relatively harmless as it does not produce harmful hormones (adipocytokines)the skin has more space to store fat since it is the largest organ in the body. However, the fat that gets accumulated within the abdomen and around internal organs is more toxic. Fat that gets stored here tends to be metabolically more active. Hence these fat cells tend to produce more adipocytokines, the inflammatory hormones which enhances insulin resistance. Fat cells in the abdomen are under constant pressure in instances of cough, exercise, etc where they tend to rupture resulting in lipolysis. Ruptured adipose cells are again known to result in inflammation. All in all, increased amount of visceral fat is directly and independently linked to several complications such as insulin resistance, T2DM, altered glucose tolerance, high cholesterol levels, heart diseases, etc.

 The best way to detect excess visceral fat is by measuring the waist circumference or the waist to hip ratio. High waist circumference and waist-to-hip ratio increase the risk of diabetes.

. Research has shown that over-weight or obese people with reasonable waist circumference and waist-to-hip ratio have betterprospectscompared to normal weight people with unusual belly fat who showed higher risk of Type 2 Diabetes. Further, the greater the muscular mass in the body, the higher the sugar metabolizing capacity and thus, lowered risk of T2DM.

Let us see how that happens.

A. Waist-to-hip ratio

B.  AbdominalFat

2. All obese need not havediabetes

The above data shows that the risk of developing Type 2 Diabetes does not fully depend on whether an individual is thin or fat. What matters more is where the excess fat is deposited (visceral or subcutaneous). Higher the amount of abdominal fat, the higher is the risk of developing Type 2 Diabetes mellitus. People who are overall thin, but have high quantities of visceral fat are called metabolically unhealthy lean patients. At the same time, people who are obese or havehigh BMI but little abdominal fatare not at a higher risk of T2DM. These set of people are otherwise called metabolically healthy obese people.

3. Obesity may not be the one and only cause of diabetes:

Obesity need not be the only cause of T2DM. Other causes of diabetes mellitus are family history and genetics, sedentary lifestyle, unhealthy eating habits, aging, gestational diabetes, high BP and cholesterol. Let us take up only a few common aspects for discussion now.

A. Family history and Genetics:

Children both of whose parents have diabetes have close to 100% risk of developing diabetes and children with one parent having diabetes are at almost 50% risk. Further,individuals belonging to ethnic groups such as Asians, African Americans andNative Americans are at increased risk of developing type 1 diabetes  as compared to Europeans.

There are also some types of diabetes other than Type 2 Diabetes Mellitus for which obesity is not a risk factor. These include type 1 diabetes (in which the pancreatic beta cells are destroyed), monogenic diabetes (due to genetic defects of the pancreatic beta cells) and pancreatic diabetes (due to damage to the pancreas for various reasons).

B. Sedentary Lifestyle:

Another cause of diabetes mellitus is Physical inactivity along with excess weight due to unhealthy eating habits (more fatty food, low in fibre and protein rich food). Having more

muscle mass will reduce the risk, since muscles have more insulin receptors, so they utilize more sugar during physical activity, thus help in maintaining glucose balance.

C. Aging:

As we grow old, every cell in the body undergoes a change and will shrink in size and so will many organs. Pancreas is one such organ which ages with us and reduces the insulin production as compared to younger pancreas. And thus there could be deficient production along with impaired function.

To know your risk of developing T2DM or not, please schedule an appointment with a healthcare professional or a diabetes specialist and get to know more.


Dr. Mohan’s Diabetes group awarded as Excellence in Quality of the year 2020 by Tancare and FCCI. Dr. V. Mohan was awarded as Lifetime Achievement Award  of the year  2020 by the Indian Academy of Diabetes. Dr. R.M. Anjana was awarded as Young Innovators of the year 2020 by World India Diabetes Foundation. Dr. R.M. …

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