The Impact of Rising Rates of Obesity and Diabetes

Greetings,

November was National Diabetes Month, which provides a perfect opportunity to remind us to look again at the associated diagnoses of diabetes for individuals with obesity. In the past two decades, rates of obesity and diabetes have risen significantly among the U.S. adults. Recent data from NHANES shows that the age-adjusted prevalence of total and diagnosed diabetes increased from 9.7% in 1999–2000 to 14.3% in 2021-2023. Mirroring this increase, the prevalence of obesity among adults was 30.5% in 1999-2000 and increased to 40.3% in 2021–2023. The prevalence of diabetes is higher in men than in women- 18.0% compared to 13.7%. 


Obesity has drastic physiological effects on the body that increase the risk of chronic diseases such as diabetes. When BMI increases from less than 18.5 kg/m to more than 35 kg/m the risk of diabetes in men increases from 7% to 70% and in women risk increases from 12% to 74%. Body fat mass is also known to have a significant impact on insulin resistance. Prediabetes is the often overlooked precursor of diabetes in people with obesity; of those diagnosed with pre-diabetes, up to 70% will develop diabetes. Estimates suggest that by 2030, that over 470 million people globally will have diabetes. Because prediabetes is a precursor of diabetes, early detection and treatment can prevent diabetes. Since the 1990s, diagnosed diabetes cases increased from 41% to 83% among individuals with BMI ≥35 kg/m².


Numerous studies have also found an increased risk of gestational diabetes (GDM) among women with obesity. Annual data from the CDC show that approximately 5% to 9% of U.S. pregnancies are affected by GDM. Pregnancy is described as an insulin-resistant condition with a 40–50% increase in insulin resistance during pregnancy compared to pre-pregnancy. Maternal overweight and obesity are also linked with adverse pregnancy outcomes including eclampsia, fetal stillbirth and death, and other long-term adverse health risks for both the mother and child. The presence of obesity among diabetic patients further aggravates these complications and increases the frequency of Cesarean sections. 


Weight gain during pregnancy among women with obesity remains a concern. Most standards of care simply advise women with obesity not to gain as much weight, leaving many unaware of the appropriate care level of weight gain they should seek and what to expect. Women with a BMI of 25 to 29.9 are advised to gain 15 to 25 pounds, while women with a BMI greater than 30 are advised to limit their gain to 11 to 20 pounds. The lack of consensus regarding treatment options for weight control during pregnancy is an area that needs to be further explored. 
 

Further research on various treatment approaches such as obesity medications and how they can benefit diabetes prevention and management in populations with increased prevalence of obesity can be important for early intervention.  Because people with obesity have a much greater risk of diabetes, delivering accessible and quality obesity care and treatment will significantly decrease the rising rates of diabetes. A focus on high-risk groups, such as pregnant women with obesity, will be key to reducing their risk of chronic diseases and preventing obesity in their offspring.