Most overweight people have diabetes

The independent diabetes portal DiabSite

The diabetes portal DiabSite in conversation with Prof. Dr. Hans Hauner

Prof. Dr. Hans Hauner, DDG diabetologist and DAEM / DGEM nutritionist, is Professor of Nutritional Medicine at the Technical University of Munich, Director of the Else Kröner Fresenius Center for Nutritional Medicine and an internationally recognized expert in these fields. Even during his training as a specialist at the University of Ulm, internal medicine and metabolic diseases were among Hauner's main topics. In many functions - member of the Scientific Advisory Board of the German Obesity Society, the Board of Directors of the German Diabetes Society and the Board of Trustees of the German Diabetes Foundation for the creation of evidence-based guidelines - he devoted himself to questions of diabetology and obesity.
In an exclusive interview with the diabetes portal DiabSite, Prof. Hauner informs about the connections between diabetes and obesity.

DiabSite:
Prof. Hauner, the motto of this year's World Diabetes Day is: "Combat obesity, prevent diabetes". So if you are too fat you should lose weight to avoid diabetes. But when is a person actually overweight?
Hauner:
Overweight means too much fat mass. Usually adipose tissue makes up about 10 percent of total body weight. A higher percentage is unhealthy. In medicine, we use the so-called BMI (body mass index) as a measured value. A BMI between 18.5 and 24.9 is normal, anything above is overweight. From a BMI of 30 and above, we speak of pathological overweight, obesity, because the risk of many diseases is then significantly higher. This is especially true for type 2 diabetes mellitus (formerly known as old-age sugar). Women with a BMI of 30 have a 20 times higher risk of developing diabetes. Even if the risk of diabetes does not increase that much in men, the direct connection between body weight or fat mass on the one hand and diabetes risk on the other becomes clear.
DiabSite:
How is the body mass index calculated?
Hauner
The formula for the BMI is: body weight in kilograms divided by height in meters squared. For example, I weigh 76 kg and I'm 1.82 m tall. That means: 76 divided by 1.82 squared (= 3.24). If I divide 76 by 3.24, that results in a BMI of around 23. (And with our BMI calculator you can calculate your personal body mass index, editor's note).
DiabSite:
So you have ideal weight. But you are not a diabetic either. Are all diabetics really too fat?
Hauner:
Not all, but around 80 to 90 percent. People with type 2 diabetes are primarily overweight. Most type 1 diabetics are not overweight. In the case of the few type 2 diabetics who are rather slim, an insulin deficiency is in the foreground in contrast to the overweight ones. They therefore usually have to be treated with insulin at an early stage. The vast majority of type 2 diabetics, however, are clearly overweight with the typical trunk or abdominal fat distribution and enlarged fat deposits in the abdominal cavity itself. With this type of fat distribution, a few kilos more are often enough to significantly increase the risk of developing diabetes to increase.
DiabSite:
Are weight and fat around the abdomen alone important for the risk of diabetes?
Hauner:
No, another important point is whether the weight will be maintained or increased over the years. On average, people in Germany put on around 13 to 15 kilograms between the ages of 18 and 50, which increases the risk of diabetes five times. If people kept the weight they had as young adults, we could probably prevent 80 percent of all diabetes cases. Body weight therefore plays a decisive role in the development and, of course, in preventing diabetes.
DiabSite:
Type 2 diabetes and obesity therefore belong together. Is the big belly meaningless in all other forms of diabetes?
Hauner:
No, obesity is also unfavorable for other forms of diabetes. For example, we have noticed in recent years that gestational diabetes is also on the rise. In addition to the fact that women become pregnant later and later, this is often due to being overweight. Obesity also increases the risk of gestational diabetes.
DiabSite:
Does this mean that all fat people suffer from diabetes?
Hauner:
No, fortunately not all, but according to the latest studies it is 30 to 40 percent. Obesity alone does not necessarily lead to diabetes. A disease only occurs when so-called diabetes genes, i.e. a familial diabetes burden, are added at the same time. These genes are likely responsible for preventing the pancreas from being able to compensate for insulin resistance through increased insulin production. This works for an overweight but metabolically healthy person. Diabetes only occurs when the excess insulin can no longer be produced due to the diabetes genes. It is interesting that many - even slim people - have these diabetes genes in them. The genes can remain completely harmless for a lifetime. Only under unfavorable living conditions, especially if you are overweight and lack of exercise, does this pre-stress come into play.
DiabSite:
Is there an increased risk of diabetes in overweight people with a genetic predisposition due to insulin resistance?
Hauner:
Correct. If there is too much fat in the body, its own insulin no longer works sufficiently. More insulin then has to be released because the effect is reduced. When the body can no longer manage this excess capacity, type 2 diabetes occurs. Current studies show that fat cells or fat tissue itself release factors that obviously worsen the action of insulin on the muscles. This makes it even clearer that insulin resistance is a direct result of the increased fat tissue.
DiabSite:
Prof. Hauner, please tell us: How do overweight people know that they have diabetes?
Hauner:
In most cases, those affected do not notice it themselves until very late. On average, it takes four to seven years between the onset of high blood sugar levels and the actual diagnosis. The precursor to diabetes, impaired glucose tolerance, does not yet cause any noticeable complaints or symptoms, which is why diabetes or the precursor to it is often only discovered by chance at this point in time. With advanced diabetes, those affected get more thirsty due to high blood sugar levels, have to urinate very often and feel overall tired and unwell. If they then go to the doctor, the diabetes is usually recognized quickly. But a lot of valuable time has been lost until then. Type 2 diabetes is particularly treacherous because it develops so slowly, but the unnoticed high blood sugar levels can lead to long-term damage to the eyes or kidneys.
DiabSite:
Should overweight people therefore have their blood sugar tested regularly so that undetected diabetes does not cause any long-term damage?
Hauner:
That's the way it is. Regular blood sugar checks can help avoid late complications. Every family doctor can do a blood sugar test every two years for patients aged 35 and over, which is paid for by the health insurance company. This fasting blood sugar is not 100 percent meaningful, but an important early detection factor. Blood sugar should be checked regularly, especially in high-risk patients, i.e. those who are very overweight and have type 2 diabetes in the family.
DiabSite:
How high can the fasting blood sugar be? When is there a suspicion of diabetes?
Hauner:
The normal blood sugar level in the capillary blood is between 70 and 95 mg / dl (4 and 5.2 mmol / l). Anything above 100 mg / dl (5.6 mmol / l) is suspect. Then the test should be repeated and possibly a stress test, i.e. an oral glucose tolerance test (OGTT), should be carried out. With OGTT, which is carried out on an outpatient basis in the practice, the patient drinks a glucose solution. A blood sugar test will be carried out before and two hours after drinking the solution. In this way, the doctor can see how the pancreas can cope with this stress.
DiabSite:
What can overweight people do preventively to avoid getting diabetes?
Hauner:
The answer is very simple: anyone who is overweight should try to reduce their weight. In this context, there is a positive message: Even a slight weight loss of five to ten kilograms at the beginning is enough to reduce the risk of diabetes by 60 to 70 percent. However, regular exercise is just as important. Those who exercise a lot in everyday life or even start exercising can almost halve the risk of diabetes. Finally, a healthy diet with plenty of fiber, little fat and little sugar is also helpful. These three factors are important in preventing type 2 diabetes.
DiabSite:
Would you recommend bread, protein, potato or fat diets for weight loss and reducing the risk of diabetes?
Hauner:
No, these diets are not suitable for this. These are more like mayflies. You can lose five to ten kilos with it, but because they are too one-sided, these diets are usually only adhered to for a short time. Those willing to lose weight quickly revert to the old eating habits with the known mistakes and then quickly gain weight again. This phenomenon is known to many under the term "yo-yo effect". Basically, the idea of ​​losing a lot very quickly is based on a mistake in thinking. Permanent weight reduction is only possible if the eating habits change and less fat and high-energy foods are eaten in the long term. If you want to reduce your weight, you don't necessarily have to eat less, but differently. That means: more fruit, vegetables and high-fiber bread.
DiabSite:
What therapy options are there if diabetes has been diagnosed?
Hauner:
If a disturbed glucose tolerance was discovered early on in an overweight person, the first and most important therapy is to try to reduce the weight. As a result, blood sugar levels can often be completely normalized within a short period of time. It is astonishing, but the more overweight a diabetic is at the time of diagnosis, the more success the weight loss promises. In addition, this form of treatment - in contrast to drug therapy - has absolutely no side effects. However, the doctor and patient should allow at least three to six months to switch to a healthier lifestyle with more exercise and significant weight loss. Only then can it actually be assessed whether the measure was successful or not. Losing weight also reduces accompanying risks. Most overweight people have high blood pressure, high blood lipids, etc. Since lowering their weight can also solve these problems, it is by far the best therapy - a really causal treatment that goes to the root cause.
DiabSite:
What does diabetes therapy look like if a healthy lifestyle does not bring the hoped-for success?
Hauner:
Even then, people should exercise a lot and eat healthily. In addition, overweight patients are given special medication. In overweight diabetics, therapy usually begins with the active ingredient metformin. These tablets reduce insulin resistance and at the same time help to reduce weight a little. If the disease progresses, other tablets, combinations of different tablets or tablets and insulin can be given. If all of these forms of therapy fail because the pancreas can only produce a small part of the increased insulin requirement, several insulin injections are required every day.
DiabSite:
Losing weight is difficult. Apart from the positive effects on blood pressure and lipid metabolism, does it still make sense for type 2 diabetics with a longer illness?
Hauner:
I guess so. On the one hand, the further the diabetes progresses and the less insulin is produced, the weaker the positive effect of weight loss. On the other hand, I know many massively overweight diabetics, some with long diabetes duration and insulin therapy, in whom the blood sugar control has significantly improved through weight loss. In most cases, the insulin dose can be reduced, and often the number of blood pressure tablets as well. Seen in this way, diabetics definitely benefit from losing weight.
DiabSite:
Type 2 diabetes is also popularly known as old-age sugar or old-age diabetes. Does that mean children can't get this type of diabetes?
Hauner:
Unfortunately, no. This is wrong. And that's why we no longer use the term "adult diabetes". In fact, we are now seeing this type of diabetes more and more frequently in very overweight children and adolescents. Obesity, combined with a family disposition, can lead to the disease developing even in young people.
DiabSite:
Since type 2 diabetes, as you say, is often diagnosed late, many overweight people are sure to live with diabetes without knowing it. How high is the number of unreported cases among diabetics?
Hauner:
Exact data are not available on this. However, a study of people between the ages of 55 and 74 has produced frightening figures. In this age group, the number of unreported cases is 50 percent, which means that for a recognized diabetic there is someone who does not yet know. So we're talking about two to four million Germans who have undetected diabetes. And here, too, it is likely that around 90 percent of these people are overweight.
DiabSite:
Weight obviously plays a central role in the development of type 2 diabetes, which is spreading around the world. What are the options for getting overweight under control?
Hauner:
You can treat light, heavy and morbid obesity today. The prerequisites are: a correct strategy, professional care from an experienced team and, last but not least, a high level of self-motivation on the part of the patient. Much can be achieved with more exercise and a healthy diet. Formula diets, meal replacement therapies, and weight loss medications can all help with weight loss. Effective surgical procedures are also available today for extremely obese people. The spectrum of "weapons" against obesity is wide, but they must be used optimally. The individual's own motivation is always crucial for success.
Finally, I would like to emphasize once again that nobody has to lose 20 kilograms straight away. As a rule, five to ten kilos less are enough to achieve a significant improvement in metabolism.
DiabSite:
Prof. Hauner, thank you for talking to us.

Author: hu; last edited: 10.11.2004

Caption: Prof. Dr. Hans Hauner
Image source: private

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