Let’s Talk About Obesity And Type 2 Diabetes Mellitus — Ng Yit Han & Prof Dr Moy Foong Ming

Obesity is a risk factor for type 2 diabetes mellitus and other non-communicable diseases such as hypertension, heart disease, and certain types of cancers.

The prevalence of obesity on a global scale is increasing at an alarming rate. According to a World Health Organization (WHO) report, it has climbed approximately three times since 1975. 

The WHO report in 2022 highlighted that at least one billion people were obese, with two-third being adults.  A similar obesity trendhas also been 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 i2019 reported that the prevalence of obesity increased from 15.1 per cent to 19.7 per cent, in-line with the increment of T2DM from 7.2 per cent to 9.4 per cent in 2011 and 2019 respectively. 

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 have been hypothesised to induce insulin resistance through the release of tumour necrosis factor (TNF-alpha), an inflammatory cytokine which can impede beta-cell functions. In addition, a high accumulation of free fatty acids from the obese individuals also can trigger the liver to produce more glucose into the bloodstream.

This condition will not only desensitise the body’s organs to react to insulin adequately (insulin resistance), but also will also put stress on 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 behaviours (such as prolonged sitting), being physically active, avoiding alcohol, improving diet quality by consuming more plant-based foods, cutting down on high-fat or 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 disease, and certain types of cancers. 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 lifestyles that put us at risks for obesity, T2DM, and non-communicable diseases.

Ng Yit Han and Prof Dr Moy Foong Ming are from the Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya.

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