Diabesity: It’s more than you think

In today’s fast-paced world, two chronic conditions—obesity and type 2 diabetes—are rising in tandem, creating a dangerous health phenomenon known as ‘diabesity’. This term reflects the deep and complex connection between obesity and diabetes, and it’s far more than just a catchy label. Diabesity is a metabolic storm, driven by biological, psychological, social, and environmental forces that go well beyond lifestyle choices.¹

The stigma around interlinked diseases and the science behind it
Cardiometabolic diseases such as type 2 diabetes (T2D), obesity, and cardiovascular disease (CVD) are deeply interlinked, often coexisting and compounding each other’s risks.² Yet, despite their biological complexity, individuals living with these conditions frequently face stigma and misunderstanding, which can lead to delayed diagnosis, inadequate treatment, and poorer health outcomes. Research shows that obesity and diabetes together significantly increase the risk of heart failure, stroke, and kidney and liver disease, with their combined impact on cardiovascular biomarkers and mortality being greater than either condition alone. The ‘blame-on-biology’ mindset, rooted in stigma, not only affects individuals but also undermines public health efforts, as bias in healthcare settings can result in under-treatment and missed opportunities for early intervention.³


Diabetes and obesity: A metabolic partnership
Obesity is one of the strongest risk factors for developing type 2 diabetes. Excess fat, particularly visceral fat (fat surrounding internal organs in the abdomen), disrupts insulin signalling and leads to insulin resistance—a key driver of diabetes. In fact, nearly 90% of people with type 2 diabetes are either overweight or obese.⁴ Indians might appear to be thin but have proportionally more fat and less muscle mass than Caucasians, which explains the “thin fat” Indian body composition. Obesity cutoffs are also different for Indians.

This isn’t just correlation—it’s causation. Fat tissue acts like an endocrine organ, releasing inflammatory molecules and hormones that impair glucose regulation. Over time, the pancreas struggles to keep up, insulin production drops, and blood sugar levels rise.

Reframing diabesity as a chronic disease
Leading organisations such as the European Association for the Study of Obesity (EASO), the American Diabetes Association (ADA) and the Endocrine Society of India (ESI) recognise both obesity and type 2 diabetes as chronic, relapsing diseases.⁵

This reframing is essential. It shifts the focus from blame to biology, and from shame to science. It also opens the door to personalised care, where treatment plans are tailored to the individual—not just their weight or blood sugar numbers.

Managing diabesity: A holistic approach
Treating diabesity requires more than just diet and exercise. It demands a multidisciplinary strategy that includes:

• Consultation with doctor for interventions

• Mental health support to address emotional eating and stigma

• Nutrition counselling tailored to metabolic needs

• Physical activity plans that are sustainable and enjoyable

It’s time to rethink diabesity early
Diabesity is not a failure of willpower—it’s a complex, chronic condition that deserves empathy, research, and resources. By reframing how we understand and treat obesity and diabetes, we can move towards a future where care is inclusive, science-driven, and personalised.

It’s time to stop blaming and start supporting. Because when it comes to diabesity, it’s more than you think.

References:

1. Cleveland Clinic – Diabesity and the Connection Between Obesity and Diabetes
2. Piché ME, Tchernof A, Despré JP. Obesity phenotypes, diabetes, and cardiovascular diseases. Circulation Research. 2020;126:1477–1500. doi:10.1161/CIRCRESAHA.120.316101
3. Bias and Inadequate Treatment Threaten Heart Health for Millions at Obesity and CVD Risk | WHF
4. Borgharkar SS, BMJ Open Diabetes Res Care. 2019 Jul 14;7(1):e000654
5. Stephen A. Brunton; Diabesity. Clin Diabetes 14 October 2022; 40 (4): 392–393. Link

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