Diabesity - 21st century pandemic

It is not obesity we should be worried about - it is the list of complications that is associated with it that is of global concern. Hence a new word is reluctantly creeping into the medical language, namely diabesity. Nobody likes this trend of playing with sacred words but somehow it does underscore the strong association between a largely preventable lifestyle related disease, namely obesity, with a huge and expensive health crisis, namely type 2 diabetes.

Eighty per cent of type 2 diabetics are obese. Even some quite skinny men who have pot bellies may develop diabetes, which highlights the importance of waist measurement as the best indicator of abdominal or visceral fat that may lead to type 2 diabetes. Add to this glucose metabolism problem other metabolic dysfunction involving lipids, uric acid, urinary albumin, clotting, inflammatory and fertility factors and the significance of the problem grows. Then add in all the mechanical complications such as arthritis, sleep apnoea, stress incontinence, skin complaints etc and we really have a major health concern.

We are not just talking about a disease of affluent countries like Australia which has obesity rates that are catching up with the US. We are also talking of developing countries that are now taking on western lifestyles and going down the same track with diseases that in the future have the potential not only to consume the health budgets of those countries, but ultimately threaten the very survival of their economies and social fabric. The wellbeing of some of our Pacific neighbours are already under threat because of diabesity.

With childhood prevalence of overweight and obesity doubling over the last decade in Australia and the ramifications of that just being realised, it is little wonder our politicians have suddenly decided this issue requires urgent attention. Even quite young people are developing diabetes. The recent NSW Government Obesity Summit held in Sydney was attended by Rob Trigger (see his report page 8). The outcome was a serious look at an environmental approach to the epidemic. It has been fascinating to watch the aftermath of this with scientists from the Garvan Institute suggesting that an environmental approach is absurd and that the real answer lies in genetic discovery to develop drugs to combat this disease. NSW Premier Bob Carr’s response to this as reported in the Australian (24/9) was “ ‘Isn’t it common sense that high calorie food, rich in sugar and fat content, can worsen an inherited position? There is something we can do about the environmental aspect of the problem.”

In the meantime at the recently held 9th International Congress on Obesity held in Sao Paulo (the 10th will be in Sydney in 2006) there were the beginnings of a changing trend from the traditional and dominating force of pharmaceutical companies with a biomedical and metabolic approach, to an enthusiastic tuning in to a totally different environmental approach as exemplified in a plenary session presented by Professor Boyd Swinburn (Professor of Population Health and Nutrition, Deakin University). He favours looking at obesity as an epidemic with environmental and social influences rather than as a curable disease.

Although there are not double blinded controlled trials to support this approach, epidemics are often best dealt with by a “best guess and evaluation” approach using sentinel trials across small populations, particularly looking at small changes that may have a big community effect. If all the GPs in Australia were trained in intervening with childhood weight gain this may have a significant impact on the diabetes epidemic.

On an individual level, rather than a relentless search for the ‘quick fix’ a better use of resources may be to look at the environment of people who have successfully lost weight and kept it off for some years. What is the key to their success and how can this be taught and emulated by others? Some of the answers to this may be found on page 9 in a report on research presented to the International Congress on Obesity by James Hill director of the Centre for Human Nutrition, University of Colorado Health Sciences Centre.

GPs will always be at the forefront of managing obesity and its complications and it is likely to become an increasingly consuming and challenging task. They need all the help they can get from politicians and health planners. GPSpeak will continue to feature articles of relevance to GPs in their management of this epidemic.

Andrew Binns is the medical editor of GPSpeak. He has a particular interest in obesity and has just attended the 9th International Congress on Obesity.

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