Did You Know That Abdominal Obesity Can Give You Diabetes?

By Dr Ankia Coetzee

The international community observed World Obesity Day on 4 March. For me, this was an opportunity to share a heartfelt reminder of the critical need to elevate discussions about the risks associated with obesity – especially around abdominal obesity and its impact on holistic health. There is a critical connection between abdominal obesity and its role in influencing conditions such as diabetes. With positive lifestyle choices and awareness, we can reduce the burden of obesity. 

In Africa, obesity is on the rise, and according to the World Health Organization, it is a “ticking time bomb” that, if left unchecked, puts millions of Africans, including children, at risk of living shorter lives. The escalating global prevalence of overweight and obesity is a serious public health challenge, having tripled since 1975.^1,2,3 

In South Africa, especially in urban areas, excess bodyweight is extremely prevalent, and has resulted in a surge of associated non-communicable diseases (NCDs), including prediabetes, Type 2 Diabetes, hypertension and atherogenic dyslipidaemia. These NCDs significantly contribute to the cardiovascular disease (CVD) burden throughout the country, which is incidentally ranked as the unhealthiest country worldwide. 

One of the most dangerous sites for fat accumulation is the abdomen. This is known as abdominal obesity, which can lead to several diseases, such as diabetes, heart disease or stroke, even with a nearly healthy overall body weight.⁴

Indeed, diabetes and the factors contributing to its prevalence in the modern world are highly complicated. However, by increasing awareness, implementing preventive measures and advocating for comprehensive healthcare strategies for diabetes management, Africa can be empowered to mitigate the escalating burden of abdominal obesity and pave the way for a healthier future.⁵

Africa’s two largest economies, South Africa and Nigeria, are seeing rapid increases in obesity. It is expected that there will be a 47.7% rise in obesity among females in South Africa and 23.3% in males by 2025. In Nigeria, approximately 12 million people were estimated to be obese in 2020, with the majority of them in urban areas and with prevalence higher among women. This is primarily accredited to nutritional and epidemiological transitions driven by demographic changes, rising income, urbanisation, unhealthy lifestyles and consumption of highly processed diets such as fast food.^6,7

How does abdominal obesity lead to diabetes and other chronic diseases?

Abdominal obesity is a major challenge, because the excess fat affects the effectiveness of insulin – a critical hormone that regulates blood sugar levels. This hinders the body’s capacity to efficiently use its available insulin, increasing insulin production to manage blood sugar levels.⁸ 

High cholesterol levels and elevated blood pressure are linked to excess insulin production. Over time, as the body struggles to sustain insulin production, blood sugar levels surge, culminating in the development of diabetes.⁹ Abdominal obesity is therefore the starting point of a complex series of events that ultimately leads to diabetes.In people who have abdominal obesity, the excess fat interferes with the action of insulin, a hormone that keeps blood sugar in check. As a result, the body is not able to use the available insulin and must produce more of it to control the blood sugar. The excess insulin produced can lead to an increase in cholesterol and a rise in blood pressure until the body cannot produce insulin, elevating blood sugar levels. Ultimately, this is how abdominal obesity leads to diabetes.⁹

How do you manage abdominal obesity and avoid diabetes?

A “life-course” approach is to addressing obesity and noncommunicable diseases effectively is recommended by the World Health Organization. This holistic approach emphasises preconception and antenatal care as critical to preventing fetal overgrowth as a result of maternal obesity.¹⁰ 

During pregnancy, maternal obesity increases the risk of childhood obesity and Type 2 diabetes even before children enter school. Among these transformative shifts in prevention is the focus on maternal abdominal obesity as a key determinant of long-term health outcomes.¹⁰

Secondly, obesity prevention should be prioritised for children and adolescents. Preventing childhood obesity requires fostering behavioural interventions spanning pregnancy, infancy, early childhood and adolescence.¹⁰ 

For adults who are overweight, it becomes more urgent to take measures to control abdominal weight. Approximately 90% of adults with Type 2 Diabetes are overweight. This statistic highlights the link, and is why most doctors recommend that overweight adults drop their weight by several kilograms as quickly as they can without harming their health.¹⁰ 

Losing weight is a matter of achieving a delicate balance between energy intake and energy expenditure. The number of calories consumed should be proportional to the physical activity undertaken. The quality of calories is equally important. Lean proteins such as skinless chicken breast, eggs, pulses and fish, complex carbs such as whole grains, millet, and vegetables and healthy fats such as nuts and seeds are considered good calories. In contrast, simple carbohydrates and unhealthy fats are considered bad calories.⁹ 

For the best results, consulting a nutritionist about the daily quantity of calories and the type of food that is best to eat is recommended. Regular and moderately intensive exercise such as brisk walking, jogging or dancing five times a week for 30 minutes and muscle strengthening activity two to three times a week is recommended to reduce the excess weight.⁹ 

If, despite these measures, it remains difficult to lose weight, a doctor may prescribe medicines that can assist in controlling obesity. In terms of health indicators, achieving a minimum weight loss of 5% is linked with positive impacts on blood pressure, fasting glucose, haemoglobin A1c, cholesterol, and is considered clinically significant.⁹

Self-Monitoring of Blood Glucose (SMBG) is essential for diabetes management. This can be performed with portable glucometers, which are recognised by the ADA, IDF, and the National Institute for Health and Care Excellence. SMBG can help manage diabetes (Type 1 Diabetes or insulin-treated Type 2 Diabetes). Structured self-monitoring of blood glucose (S-SMBG) also shows promise in patients with obesity and Type 2 diabetes who are not insulin-treated by helping them improve their lifestyle.¹⁰

Armed with data from regular self-monitoring of blood glucose (SMBG), doctors can help create personalised care plans that will help achieve optimal blood sugar levels. This, combined with diet and exercise, can help to bring down weight and, in turn, keep diabetes in check.

Today, when we know that abdominal obesity is a significant risk factor for chronic diseases such as diabetes, it is most important to keep our weight within the normal range to live a longer and healthier life.

As we commemorate World Obesity Day, we can fight abdominal obesity and prevent diabetes. Let’s commit to making informed decisions today for a healthier tomorrow.

References:

1. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight 
2. The State of South Africa’s Plate | Unilever Healthhttps://www.unilever.co.za/brands/health/articles/the-state-of-south-africas-plate/
3. Grundlingh N, Zewotir TT, Roberts DJ, Manda S. Assessment of prevalence and risk factors of diabetes and pre-diabetes in South Africa. Journal of Health, Population and Nutrition. 2022 Dec;41(1):1-2.
4. https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916 
5. https://www.afro.who.int/news/diabetes-prevention-care-challenges-africa 
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9564787/#:~:text=The%20rise%20in%20obesity%20poses,males%20by%202025%20%5B1%5D. 
7. https://www.dataphyte.com/latest-reports/7-major-factors-driving-obesity-in-nigeria/#:~:text=However%2C%20their%20study%20pitched%20the,10.3%20per%20cent%20in%20girls. 
8. https://www.cuimc.columbia.edu/news/belly-fat-promotes-diabetes-under-orders-liver#:~:text=The%20fat%20that%20builds%20up,determining%20what%20causes%20the%20inflammation. 
9. Ref: Fornari E, Brusati M, Maffeis C. Nutritional strategies for childhood obesity prevention. Life. 2021 Jun 8;11(6):532.
10. Ref: Kompaniyets L, Freedman DS, Belay B, Pierce SL, Kraus EM, Blanck HM, Goodman AB. Probability of 5% or greater weight loss or BMI reduction to healthy weight among adults with overweight or obesity. JAMA Network Open. 2023 Aug 1;6(8):e2327358-. 
11. Ref: Zou Y, Zhao S, Li G, Zhang C. The Efficacy and Frequency of Self-monitoring of Blood Glucose in Non-insulin-Treated T2D Patients: a Systematic Review and Meta-analysis. Journal of General Internal Medicine. 2023 Feb;38(3):755-64.