Diabesity: obesity and diabetes

The number of overweight individuals is fast increasing worldwide, which in turn has resulted in a rise in the prevalence of type 2 diabetes.

The International Diabetes Federation (IDF) has predicted that the number of individuals with diabetes is expected to rise to 552 million by 2030 ¹, and the World Health Organization (WHO) has called obesity and diabetes the “21st-century epidemic”.

The Akkermansia Company^TM is committed to using Akkermansia muciniphila in the creation of innovative health solutions that target the common threat of ‘leaky gut’.

In so doing, we aim to help prevent the cycle of chronic low-grade inflammation; a root cause of excess weight gain and increased blood sugar that can, in turn, lead to obesity and diabetes.

Regardless of the precise cause-and-effect relationship, the term “diabesity” was coined by Francine Kaufman in 2005 to emphasise the close relationship between diabetes and obesity; obesity and type 2 diabetes frequently occur together, and the vast majority of type 2 diabetic individuals are or have been overweight.

Along with genetic susceptibility, being overweight is the most important risk factor for type 2 diabetes. The term “diabesity” singles out excess body weight as the major cause of type 2 diabetes. ^{2 & 3}

Obesity: a worldwide epidemic

The terms ‘overweight’ and ‘obese’ are both defined as abnormal or excessive fat accumulation that may impair health. A common indicator used to estimate them is the Body Mass Index (BMI). It is based on the weight and the height of an individual: BMI = mass (kg) / height (m²).

In short, a person with a BMI greater than or equal to 25 is considered overweight and above or equal to 30 is considered obese. The worldwide prevalence of obesity has nearly tripled between 1975 and 2016. ⁴

In other words, more than 1.9 billion adults (39% of the adult global population) were overweight by 2016, of which over 650 million were obese (33% of the overweight adult population). ⁵ In Europe, more than half the population was overweight in 2019, and up to 30% was obese. ⁶

But as the world deepens its understanding of the disease, there is still a stigma and weight bias associated with obesity, which contributes independently to increased morbidity and mortality ⁷. Misconceptions about obesity being a result of personal choice and lack of self-control unfairly blames and shames those who are living with the disease⁸.

The reality is much more complicated. Obesity is a heterogeneous disease that presents in different ways in different patients. As with any chronic disease, assessment, treatment and long-term support must be tailored to the patient’s individual needs.

Obesity can have a variety of root causes including side effects of certain medications, biological factors, other chronic diseases, sociocultural practices and beliefs, social determinants of health, built environment and psychological factors such as mood, anxiety, binge-eating disorder, attention-deficit/hyperactivity disorder, and personal self-worth and identity ⁹.

The stigma around obesity has a negative impact on the quality of healthcare provided to people living with the condition. ^{10 and 11}. Management of obesity has historically not been effective within healthcare ^{12, 13, 14}, and a significant number of HCPs feel under-resourced to deliver obesity care ^{8, 15, 16}.

Obesity in numbers

According to the World Health Organization ¹⁷ :

WORLDWIDE OBESITY HAS

NEARLY TRIPLED

NEARLY TRIPLED FROM THE PERIOD OF 1975

UNTIL 2021.

IN 2016,

MORE THAN 1.9 BILLION

ADULTS, 18 YEARS AND OLDER, WERE OVERWEIGHT. OF THESE OVER 650 MILLION WERE OBESE.

39%

OF ADULTS AGED 18 YEARS AND OVER WERE OVERWEIGHT IN 2016, AND

13% WERE OBESE.

MOST OF THE WORLD'S POPULATION

LIVE IN COUNTRIES WHERE OVERWEIGHT AND OBESITY KILLS MORE PEOPLE THAN UNDERWEIGHT.

39 MILLION CHILDREN

UNDER THE AGE OF 5 WERE OVERWEIGHT OR OBESE IN 2020.

OVER 340 MILLION

CHILDREN AND ADOLESCENTS AGED 5-19 WERE OVERWEIGHT OR OBESE IN 2016.

For adults, WHO defines overweight and obesity as follows; overweight is a BMI greater than or equal to 25; and obesity is a BMI greater than or equal to 30.

Obesity is preventable.

Prediabetes and diabetes

The prevalence of prediabetes is also increasing and becoming a major public health issue. ¹⁸ Prediabetes is defined as an intermediate state of hyperglycaemia in which glucose levels rise above the normal level, but are below the diagnostic levels of diabetes. ¹⁹

There are no symptoms clearly associated with prediabetes. It is a condition that can remain silent and unidentified for many years, laying the basis for severe complications – but a simple blood sample analysis can easily identify people at risk. ²⁰

The gut microbiota manages host metabolism, Patrice D. Cani, Nature Review, 2013

Prediabetes will progress to overt type-2 diabetes in approximately 5-10% of subjects annually, while 70% of individuals with prediabetes will develop overt diabetes within their lifetime, according to the American Diabetes Association. ²¹ However, prediabetes may also revert back to normoglycemia if the appropriate lifestyle changes are made. ²² That is why it is vital to detect people suffering from prediabetes early, in order to:

Diabetes in numbers

According to estimates by the International Diabetes Federation, in 2021 ²³:

1 IN 10 ADULTS (20-79 YEARS)

HAS DIABETES - 537 MILLION PEOPLE. BY 2045, THIS NUMBER WILL INCREASE TO 783 MILLION. ²⁴

1 IN 2 ADULTS IS

UNDIAGNOSED

- 240 MILLION PEOPLE

OF GLOBAL HEALTH EXPENDITURE WAS SPENT ON DIABETES -

USD 966 BILLION

6.7 MILLION DEATHS

ATTRIBUTED TO DIABETES

541 MILLION ADULTS

ARE AT INCREASED RISK OF DEVELOPING TYPE 2 DIABETES

MORE THAN 1.2 MILLION

CHILDREN AND ADOLESCENTS (0-19 YEARS) ARE LIVING WITH TYPE 1 DIABETES

The role of imbalanced gut microbiota in obesity and prediabetes

For many, modern life is characterised by a poor-quality diet (high in fat, low in fibre) and sedentary habits that can lead to an imbalance in gut microbiota, known as ‘dysbiosis’ ²⁵. This dysbiosis could promote diet-induced obesity and metabolic complications through a variety of mechanisms, including:

Obesity alters the composition and function of the gut microbiota, which in turn impacts the gut barrier’s effectiveness as guardian against unwanted compounds entering the rest of the body. The increased permeability of the gut barrier is sometimes referred to as “leaky gut”, and allows gut bacteria or compounds from a person’s diet to pass from the intestinal lumen into the bloodstream. Some of these compounds are toxins, such as lipopolysaccharides (LPS). These toxins are pro-inflammatory, meaning they activate the immune system and induce chronic inflammation, which although low level will often last a long time – up to several years. This chronic low-grade inflammation can induce metabolic disorders such as insulin resistance. ²⁷ Eventually, insulin resistance can lead to the development of type-2 diabetes. Furthermore, chronic low-grade inflammation is also associated with the development of atherosclerosis, cancers and neurodegenerative diseases. ²⁸

How to tackle diabesity?

Clinical trials have proven Akkermansia reduces low grade inflammation, which is a root cause of excess weight gain and increased blood sugar that can, in turn, lead to obesity and diabetes.

The Akkermansia Company™ is committed to using Akkermansia muciniphila in the creation of food supplements which will increase your Akkermansia levels.

REFERENCES

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2 Shafrir, E. Development and consequences of insulin resistance: lessons from animals with hyperinsulinaemia. Diabetes Metab22, 122-131 (1996).

3 Astrup, A. & Finer, N. Redefining type 2 diabetes: ‘diabesity’ or ‘obesity dependent diabetes mellitus’? Obes Rev 1, 57-59 (2000).

5 https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

6 Eurostat, Overweight and obesity – BMI statistics – https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Overweight_and_obesity_-_BMI_statistics

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17 World Health Organization, Obesity and overweight, July 2021

18 Echouffo-Tcheugui JB, Selvin E. Prediabetes and What It Means: The Epidemiological Evidence. Annu Rev Public Health. 2021 Apr 1;42:59-77. doi: 10.1146/annurev-publhealth-090419-102644. Epub 2021 Dec 23. PMID: 33355476; PMCID: PMC8026645.

19 https://diabetes.org/diabetes/prediabetes

20 https://www.cdc.gov/diabetes/library/features/truth-about-prediabetes.html#:~:text=Prediabetes%20Flies%20Under%20the%20Radar,Being%20overweight

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23 IDF Diabetes Atlas 10th Edition 2021

24 https://diabetesatlas.org/

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HCP – The Prevalence of Obesity and Diabetes

Diabesity: obesity and diabetes

Obesity: a worldwide epidemic