Improve diabetes prevention and care through obesity treatment

For decades, two costly medical conditions have been rising on similar trajectories in America: obesity and type 2 diabetes (T2D). Over the last 40 years, adult obesity rates have more than doubled, with a similar rise in individuals with T2D. The link between these two conditions is further suggested by the fact that 70 percent of Americans are now living with obesity or overweight, and 90 percent of all T2D patients have obesity or overweight.

We also know there are strong medical connections between obesity and T2D. As an individual’s BMI (body mass index) rises, their risk of developing prediabetes and type 2 diabetes also increases. This is especially true with increases in visceral, or abdominal, fat which is less responsive to insulin. The first line of treatment for T2D generally focuses on glycemic control, often with medications that promote weight gain.

Examining the connection between weight and T2D gives reason to look at more than glycemic control.

Going Beyond Simply Controlling Glucose Levels

Addressing obesity for patients with diabetes, however, enables the clinician to do more than simply control glucose levels: they can treat the underlying insulin resistance that drives T2D. Choosing medications that promote weight loss like GLP-1 agonists and SGLT-2 inhibitors over medications that promote weight gain like insulin and sulfonylureas can improve weight status providing added benefit to diabetes treatment. Unfortunately,two-thirds of people with obesity remain undiagnosed. Medical professionals cite lack of time as a major reason for why they don’t discuss weight treatments with their patients, although patients who do receive obesity counselling from physicians trained in obesity medicine report receiving a higher quality of care.

More informed and effective obesity care translates to better diabetes prevention and care. Clinicians evaluating treatment for T2D should also consider obesity treatments ranging from lifestyle interventions to anti-obesity medications to bariatric surgery. For example, the risk of diabetes is reduced by 58 percent with a five to ten percent reduction of weight through lifestyle changes.

A Range of Cost-Effective Interventions

Bariatric surgery, typically associated with obesity treatment, can offer significant benefits for patients with T2D. Noted as a cost-effective intervention by the International Diabetes Foundation, bariatric surgery results in remission for most patients with T2D. Recently,a study published in the New England Journal of Medicine, compared an intensive lifestyle intervention to bariatric surgery and found similar improvements in weight loss and metabolic profile in patients with T2D.

All clinicians can guide patients towards better health outcomes when they understand the connection between obesity and diabetes. The Obesity Medicine Association(OMA) offers a wealth of resources that can help advance that understanding, including specialized continuing education tracks focused on managing adiposity-related diseases and the role of weight management in the treatment of diabetes.OMA’s virtual fall conference, “OvercomingObesity 2020,” will highlight the latest research and best practices related to obesity. Additional OMA resources include The Obesity Algorithm®, Obesity Treatment Proficiency Badges™ and American Board of Obesity Medicine (ABOM) preparation materials.

Health care professionals who embrace an approach to T2D treatment through medical, surgical and especially combined obesity interventions have the potential to make meaningful improvements for patients on multiple fronts.

For more obesity medicine resources or to become an OMA member, visit:www.obesitymedicine.org.

Nicholas Pennings, DO is board certified in Family Medicine and Obesity Medicine and is a fellow of the Obesity Medicine Association (OMA). He is an associate professor and chair of family medicine at Campbell University School of Osteopathic Medicine (CUSOM) and also serves as the director of the Campbell University Health Center. As a champion for advancing the education of current and future health professionals, particularly as it relates to obesity, Dr. Pennings is an executive director of clinical education for the Obesity Medicine Association. He has also infused obesity education into the medical school curriculum at CUSOM and has developed an online obesity education rotation through the OMA for clinicians in training.