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Obesity is a global issue, which is not an exception for the UK as well. It is estimated that 28% of the adults are obese and other than that, 36.2% of them are overweight, according to the 2019 health survey report of England (Commonslibrary.parliament.uk, 2021). Obesity occurs due to the positive energy balance when the intake of calories is more than expenditure. It is a state of generalised accumulation of excess adipose tissue (adipose tissue is found below the skin, or around internal organs as a protective layer) in the body, leading to more than 20% of the IBW (Ideal Body Weight). Obesity predisposes a person to diseases like diabetes, CHDs (Coronary Heart Diseases), stroke, etc.
In this section, an elaborate discussion will be done to understand the association between obesity and Type 2 Diabetes Mellitus (T2DM). The role of diet in the development of obesity as well as T2DM will be discussed to generate awareness in this regard.
Leptin acts as a hormone that promotes negative energy balance by suppressing hunger and pushing the body for energy expenditure. It binds with specific receptors in the brain and functions as a natural “Lipostat” (it is used to lower blood cholesterol levels, and further reduces chances of a heart attack like complications). Leptin signals when the person is full leptin to restrict the feeding behaviour of an individual. However, in obese people, leptin levels are lower or there is any defect in leptin receptors that dramatically increase the appetite and overeat to the point of becoming massively obese (Sánchez-Jiménez et al. 2019). PI3K/AKT (Phosphoinositide 3-kinase) signalling pathway has upstream and downstream regulation for controlling lipolysis, glucose uptake in skeletal muscles, and liver, and ultimately results in obesity and T2DM (Huang et al. 2018).
T2DM is associated with people who are obese and underactive. Obesity acts as a diabetes inducing factor through increasing resistance to the action of insulin. Following absorption, high sugar-containing foods including junk food, packaged fruit juice, snacks, etc. significantly raise blood sugar levels and the pancreas, releasing insulin hormone needs to put more pressure to release more insulin for compensation. Excess energy accumulation causes obesity which in some cases induce inflammation in the body, stimulating release of TNF-α (Tumour necrosis factor-alpha) as well as IL-6 (Interleukin-6) leading to insulin resistance (Burhans et al. 2018). This results in a significantly higher level of sugar in the body, slowly and steadily giving rise to T2DM. Insulin resistance is a condition where the organs such as liver and muscle do not uptake glucose due to obesity-like reasons.
A sedentary lifestyle along with choosing an unhealthy lifestyle due to lack of knowledge is a major reason for obesity associated with T2DM. People tend to choose preserved fruit juice over fresh fruit juice and think that is to be healthy. They are lacking knowledge that these artificial preservatives containing fruit juices are high in refined sugar to enhance the taste. 100g fresh orange juice has vitamin C, B complex, and calcium, phosphorus like minerals and provides >50 kcal/100ml. However, package juice is high in refined sugar giving <70 kcal energy for the same amount (Aijn.eu, 2020). Moreover, due to processing at high temperatures nutrients get destroyed as well. A higher intake of refined grains, saturated fat, etc. provides a high amount of calories to the body without any nutritive advantages. Most junk food is high in calories because it contains saturated fat, trans fat, and refined flours to enhance the taste. Trans Fats are used in packaged food to increase shelf life and taste but once it enters the body it takes years to come out and thus, over the years gets accumulated in several body parts. Therefore, these foods are responsible for the development of lifestyle diseases like obesity, T2DM, CHDs, etc.
Calorie restricted balanced diet along with regular physical activities for weight loss is the only solution for both obesity and T2DM. Weight loss improves insulin sensitivity and in every aspect, glucose uptake is improved. A weekly reduction of at least 3500 kcal energy significantly helps in slow but steady weight loss. Total calorie intake must not exceed 1500kcal/day. Incorporation of fresh fruits and vegetables provides bulk and fulfils the appetite. The aim must be to eat only home-cooked meals and snacks to avoid excess sugar, calorie and trans fat which to avoid obesity-related complications in future (Leitneret al. 2017). Metformin-like hypoglycemic drugs are prescribed along with a modified diet to lower blood glucose.
Gastric-bypass surgery has already been adopted to reduce the stomach capacity and reduce total calorie consumption. This will be helpful for those who have already gained too much weight and are facing difficulties losing. This surgery will help to lose weight and slowly manage the insulin-resistant problem as well. Thus obesity must be managed to treat diabetes like problems.
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