Obesity among diabetic patients

We appreciate the article by Dr. Yousef A. Al-Turki about obesity among diabetic patients.1 The author has found a very high prevalence of obesity in diabetic patients attending a primary healthcare center in Riyadh. The prevalence of Body Mass Index (BMI) > 25kg/m2 was 76.5% in females and 61% in males. This has a definite relevance with regards to management of diabetes mellitus in these patients. Obesity is a health problem in the majority of developed countries and is emerging as a serious problem in the developing countries. In a study in our tertiary care center we examined 5083 Kashmiri adults (males and non-pregnant females of > 40 years of age) to determine the prevalence of obesity. Out of 5083 study subjects, 2496 were males and 2587 were females. According to BMI, the overall prevalence of obesity in the study population was 15% (males 7%; females 24% P<0.001). Of 5083 study subjects, 216 (4%) were found to have diabetes mellitus on oral glucose tolerance test by World Health Organization (WHO) criteria.2 Of these, 216 diabetic patients, only 24.5% had an ideal BMI of <25kg/m2, the prevalence of obesity being 14.5% in males and 32.5% in females. Like Dr. Al-Turki, we also found a higher prevalence of obesity in Kashmiri females than their male counterparts though the overall prevalence of obesity was much less than found in Saudi diabetics. This may be because Saudi diabetics are more sedentary and more affluent. Higher prevalence of obesity in diabetics is well known, 80% to 90% of people diagnosed with Type 2 diabetes are obese.3 Obesity is a major risk factor for the development of Type 2 diabetes; the prevalence of obesity has increased during the last decade.4 As the prevalence of obesity increases, the incidence of diabetes can be predicted to rise as well. Medical nutritional therapy has been considered the cornerstone of treatment of obese persons with Type 2 diabetes, with caloric restriction to promote weight reduction as the major focus.3-5 Weight loss, or a decrease in the severity of obesity, can (1) improve measures of metabolic control, such as blood glucose and glycosylated hemoglobin levels in persons already diagnosed with diabetes and (2) reduce the risk of developing diabetes in certain individuals. Yet few weight loss successes are evident with current strategies. Given the magnitude of the problem of obesity, the extent of its relationship to Type 2 diabetes, and the benefits of weight loss, it is imperative to examine types of medical nutritional therapy and to determine which is most effective. Obesity is a major health problem and a risk factor for many chronic diseases, in particular, diabetes. Obesity and weight loss are greatly influenced by food intake and dietary habits. Health-care providers must possess a thorough understanding of food consumption and metabolism before they can prescribe the most successful strategy for weight loss. However, many unanswered questions remain related to the most effective dietary approach to prescribe for persons with Type 2 diabetes. An interdisciplinary approach to answering the questions is imperative, and dietitians are key contributors to this endeavor. In addition, the traditional exchange system diet, the diet most frequently prescribed for individuals with Type 2 diabetes, needs to be studied further.