Diabesity – The Rising Obesity Epidemic?
The prevalence of both obesity and diabetes continues to rise at an alarming rate. Given the comorbidity between diabetes and obesity, researchers have coined a new portmanteau of these two words in ‘diabesity.’ Specifically, diabesity is defined as diabetes occurring in the context of obesity. It is also commonly referred to as ‘obesity-dependent’ diabetes.
In recent news, concern is mounting as towards the health as well as economic impact of diabesity. Youssef M.K. Farag, M.B.,B.CH., a research fellow in Medicine at Brigham and Women’s hospital and Harvard Medical school recently coauthored a review of the latest epidemiological, economic, and health impact of diabesity .
For this review, Dr. Youssef included a total of 83 recent peer-reviewed publications. In the reviews introduction, Dr. Youssef cites some alarming statistics including the world’s prevalence of diabetes being currently at 284 million people or 6.4% of the world’s population. The projections cited in his review suggest that this prevalence will rise to 439 million individuals by 2030 or ~7.7% of the world’s population at that time.
What’s the economic burden of obesity and diabetes? Currently, Dr. Youssef’s review cites numbers as high as $376 billion in 2010 for diabetes which is projected to rise to $376 billion in 2030. In the United States, diabetes consumes 14% of healthcare expenditures while obesity itself consumes 5.7%. When the costs of being overweight are added to obesity, the costs rise to 9.1% of USA’s total healthcare expenditure.
Dr. Youssef wrote:
This century is the unprecedented diabetogenicera in human history. It is thus urgent to take steps including screening, prevention and early management in an attempt to control this evolving epidemic of diabesity.
Epidemiology of Obesity?
Data cited from the WHO report that the global presence of overweight adults [BMI 25-29.9 km/m(2)] was 1.6 billion in 2005 while the of obese adults [BMI >30 kg/m(2)] was at least 400 million in 2005. In total, that number represents one-quarter of the world’s population. As such, Dr. Yousseff notes that 1/4 of the world’s population is at an increased risk of cardiovascular disease, diabetes, and eventually chronic kidney disease.
Why is the Prevalence of Obesity Increasing?
One explanation offered in this review included the presence of genes that favor storage of fat being maladaptive in our modern environment which favors minimizing physical activity and maximizing high energy intake.
Another explanation included research that obese children are more likely to become obese adults. This risk is magnified if one or more parents are obese.
Health Impact of Obesity:
Associated with an increased risk of :
- hypertension (high blood pressure)
- heart disease
- colon cancer
- liver diseases: non-alcoholic liver disease, cirrhosis, cancer
- reduced quality of life
- risk of death increased by 20-40% in overweight individuals and 2-3 fold in obese individuals compared to normal controls.*
For point of clarity, there is some ambiguity between the mortality rates associated with obesity and simply being overweight. The data cited by Dr. Youssef is inconsistent with a recent meta-analysis which found that obesity is indeed associated with an increased risk of all-cause mortality while the data for those who’re simply ‘overweight’ is not conclusive.
In yet another meta-analysis, they summarized the comorbidities of obesity and overweight as follows :
The meta-analysis determined statistically significant associations for overweight with the incidence of type II diabetes, all cancers except esophageal (female), pancreatic and prostate cancer, all cardiovascular diseases (except congestive heart failure), asthma, gallbladder disease, osteoarthritis and chronic back pain.
- Farag YM, Gaballa MR. Diabesity: an overview of a rising epidemic. Nephrol Dial Transplant. 2010 Nov 2. [Epub ahead of print]
- Lenz M, Richter T, Mühlhauser I. The morbidity and mortality associated with overweight and obesity in adulthood: a systematic review. Dtsch Arztebl Int. 2009 Oct;106(40):641-8. Epub 2009 Oct 2.
- Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009 Mar 25;9:88.