OBESITY AND DIABETES

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MGBEOKWERE CHIBUIKE MICHAEL




You might be wondering how obesity really causes diabetes, the relationship between the two. Obesity is just excess fat and diabetes is as a result of excess sugar so what could be the relationship. Why is it that people who have obesity are always advised to exercise, burn those fats and remain healthy? 

Well, in this article you'll understand what obesity really is, what overweight is, how to check them and their role in diabetes. 

At least 2.8 million people die each year as a result of being overweight or obese and in 2008, over 40 million preschool children were overweight worldwide. 
In 2016,more than 1.9 billion adults were overweight and 650 million were obese. 


WHAT IS OBESITY? 
Obesity is accumulation of fat in your body at a level that exposes you to health and psychosocial problems. Similar definition is given to "overweight " but the difference is gotten from checking the body mass index(BMI). 

Body mass index (BMI) is the body's mass/weight in kilogram divided by the square of the body's height. BMI is expressed in kg/m^2.

Stored fat is required for survival during nutritionally deprived states, however during state of prolonged food consumption, excessive fat storage results in obesity.


Weighing scale



Height checking scale



ESTIMATION OF BODY MASS INDEX, HEALTHY AND UNHEALTHY RANGE. 

So, after checking your weight and height, you can use the above formula to estimate your body mass index. Body mass index tells you whether you are overweight or not. OVERWEIGHT AND OBESITY ARE SERIOUS CONDITIONS THAT CALLS FOR ALARM. 

The table below is an accurate range for your reference.

EXAMPLE: A 25 year old lady by name Angela who is 5 feet tall (1.524 meters) is weighing 55 kg. Her body mass index will be.. 

55 ÷ (1.524 × 1.524) = 23.68 kg/m^2
Therefore Angela has a normal weight and should live happily 😊




It is important to know that overweight and obesity are risk factors for many killer diseases like diabetes, cardiovascular diseases, cancer as well as other health problems like fatty liver disease, arthritis, breathing problems, infertility, gallbladder disease etc. 

BODY FAT DISTRIBUTION:
CENTRAL AND PERIPHERAL OBESITY, APPLE AND PEAR SHAPED APPEARANCE
When fat accumulates around your chest and belly, it makes you have an apple shaped appearance but when fat accumulates from your belly below, example the thigh and buttocks, you have a pear shaped appearance. 
Individuals who are apple shaped have most of their weight around the abdomen (belly) but the pear shaped individuals have most of their weight around the hips and thigh and this is not as likely to be associated with insulin resistance ( type 2 diabetes). 

Females develop the pear shaped appearance as they grow due to the peripheral fat distribution around the hips, thigh and buttocks. But in excessive and uncontrolled accumulation of fat in those areas results in peripheral diabetes and in the abdomen and chest region it's called central diabetes. Men are likely to have apple shaped appearance. 



WHAT HAPPENS IN DIABETES? 
In diabetes, what happens is that blood sugar (Glucose) rises to a deadly extent. Normally, there's a hormone called insulin which takes these glucose into your cells so that you'll have energy to work. 
When your cells doesn't allow entrance of glucose anymore, it will build up in the blood and start damaging important organs. These damages produces the symptoms and signs of diabetes. 

GLUCOSE DOESN'T ENTER THE CELL ANYMORE DUE TO:
  1.  Reduced insulin (Reduced or no insulin to take it in). This is seen in Type 1 diabetes mellitus. 
  2.   Insulin resistance. Here the cells develop resistance to insulin even when there's excess insulin. This is seen in type 2 diabetes mellitus and this is our concern. 
People who have more weight around the tummy are more insulin resistant and may struggle to maintain good diabetes control. 
  

RELATIONSHIP BETWEEN OBESITY AND DIABETES
Normally, adipose tissue (fat cells) produce certain substances among which are non-esterified fatty acids (NEFA's) or free fatty acids (FFA's), glycerol, hormone, cytokins , pro-inflammatory markers etc which all contributes to development of insulin resistance. In obesity and overweight, these are greatly increased. 


NON-ESTERIFIED (FREE OR UNSATURATED) FATTY ACIDS (NEFA's) AND INFLAMMATORY ADIPOKINES (CYTOKINES) 
Following increase of free fatty acids in the body for a long period of time as seen in obesity and overweight, there's resultant toxicity known as lipotoxicity and this stresses the endoplasmic reticulum and mitochondria of the cell. Mitochondria is involved in protein, carbohydrates and fat(lipid) synthesis. It is also involved in detoxification of drugs and toxins and storage of synthesized molecules. 

Stress on the mitochondria results in generation of signal which shuts down insulin actions on the cell and if this happens for a long time, there's resultant insensitivity (resistance). However if non-esterified fatty acids is decreased, there's improvement in insulin function and glucose regulation. 
There's resultant hyperglycemia following insulin resistance and the free fatty acids also decrease utilization of muscle glucose contributing to the hyperglycemia. 

Furthermore, cytokins like TNF-α ( Tumour necrosis factor alpha),  IL-6 (interleukin 6), complement c3 etc along with non-esterified fatty acids results in development of diabetes. 

METABOLIC SHIFT 
In the quest to generate energy, increased fatty acids in the blood causes the liver and skeletal muscle to shift towards oxidation of free fatty acids and relative suppression of glycolitic enzymes. The glycogen storage decreases and triglycerides increased. 


ADIPONECTIN 
This is a protein hormone produced mainly by the adipose tissue, and also produce by placenta in pregnancy, muscle and brain. It is involved in regulation of glucose levels as well as fatty acid breakdown. It is abundant in healthy individuals but greatly decreased in obesity and type 2 diabetes. 
It also promotes memory function and individuals with low adiponectin have reduced cognitive function. 



CONCLUSION
The incidence of obesity and diabetes is increasing rapidly in our society. Obese individuals are highly at risk of developing this deadly disease and a healthy lifestyle will greatly eliminate the development of diabetes. Always check your weight as well as your BMI when possible to maintain healthy living. Weighing scale and height checking scale or tapes can be gotten and kept at your home for ease and convenience. Finally, it is very important you understand your condition before consulting your doctor for effective communication. 









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