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Diabesity: The #1 Cause of Death?


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Obesity, insulin resistance, metabolic syndrome, and type 2 diabetes have reached epidemic proportions. I can confidently assert that every person reading this article is affected by these conditions either directly or indirectly. Yet as ubiquitous as “diabesity” and its related diseases are, few people understand how closely they’re connected with one another.

diabesity and other diseases
Diabesity and related diseases are some of the leading causes of death and disease in the nation. iStock/istanbulimage

It is now clear that not only do these conditions share the same underlying causes—and thus require the same treatment—but they are also 100 percent preventable and, in many cases, entirely reversible.

Diabetes and obesity share the same underlying causes and, in many cases, they’re entirely preventable. Find out how diabesity has grown to the epidemic problem it is today. #healthylifestyle #wellness #chriskresser

What You Should Know about Diabesity

Because of these similarities, many professionals, including Dr. Francine Kaufman, have adopted the term diabesity (diabetes + obesity) to describe them. (1)

Diabesity can be defined as a metabolic dysfunction that ranges from mild blood sugar imbalances to full-fledged type 2 diabetes.

Diabesity is a constellation of signs that includes:

  • Abdominal obesity (i.e., “spare tire” syndrome)
  • Dyslipidemia (low HDL, high LDL, and high triglycerides)
  • High blood pressure
  • High blood sugar (fasting above 100 mg/dL, Hb1Ac above 5.5)
  • Systemic inflammation
  • A tendency to form blood clots

The subjective symptoms of diabesity include (but aren’t limited to):

  • Sugar cravings, especially after meals
  • Eating sweets with no relief from cravings for sugar
  • Fatigue after meals
  • Frequent urination
  • Increased thirst and appetite
  • Difficulty losing weight
  • Slowed stomach emptying
  • Slowed wound healing
  • Sexual dysfunction
  • Visual problems
  • Numbness and tingling in the extremities

The term diabesity is misleading in one respect: it suggests one must be obese to experience the metabolic problems I just described above. That’s not true. Thin people can suffer from the entire spectrum of blood sugar imbalances, all the way up to bona fide type 2 diabetes. The term sometimes used for people who are thin, yet have insulin resistance, hyperglycemia, and dyslipidemia, is “metabolically obese.” In short, their metabolisms behave as though they’re obese, even when physically they’re not.

Is Diabesity the Number One Cause for Deaths in the U.S.?

It’s almost impossible to overstate how serious and far reaching a problem diabesity is:

  • More than 93 million Americans are obese (2)
  • Over 30 million Americans have diabetes (3)
  • Over 84 million American adults have prediabetes, characterized by slightly elevated blood glucose levels (4)
  • Worldwide, diabetes affects 451 million adults, and more than 2.1 billion people are overweight or obese (5, 6)

Diabesity is the leading cause of modern, chronic disease. The “diabese” have increased risk of: (7, 8, 9, 10, 11)

In the United States today, someone dies from a diabetes-related cause every eight seconds. (12) Diabetes and cardiovascular disease have now outpaced infectious disease as the primary cause of morbidity and mortality worldwide.

In Dr. Bernstein’s Diabetes Solution, Dr. Richard Bernstein claims that diabetes is now the third-leading cause of death. But death certificates don’t list diabetes or hyperglycemia as the underlying cause of heart attacks, strokes, or fatal infections. Nor do they consider the role of obesity, insulin resistance, and inflammation in these conditions. If they did, it’s quite possible that diabesity is not only the leading cause of disease, but also the leading cause of death.

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The High Costs of Diabesity

Diabesity is literally bankrupting the American health care system. The direct and indirect costs of type 2 diabetes were $327 billion in 2017, up from $174 billion just 10 years prior. (13) The yearly cost of obesity surpasses $340 billion. (14) So the total cost of diabesity to society can be conservatively estimated at $650 billion per year. To put that into perspective, the health care costs of the United States in 2018 totaled $3.6 trillion. (15) We spend more per person on healthcare than any other developed nation, yet our health continues to decline.

With numbers like these, you’d expect a state of emergency to be declared. You’d think we’d be doing everything in our power to figure out the cause of these conditions and how to treat them successfully.

But the reality is that the conventional treatment of diabesity has been a dismal failure. This is reflected in the shocking growth of the conditions that fall under the diabesity umbrella over the past three decades, not to mention the equally alarming projections for the future.

Kids Are Impacted by the Diabesity Epidemic Too

Reports suggest that more than one-third of Americans born in the year 2000 will develop diabetes within their lifetimes. (15) What is particularly horrifying about this statistic is that many of those who develop diabetes will be kids. Type 2 diabetes used to be a disease of the middle-aged and elderly, but those days are long gone:

  • The prevalence of type 2 diabetes in kids rose by 30 percent between 2000 and 2009 and continues to climb (16)
  • The number of new cases of type 2 diabetes in kids is expected to quadruple in the next several decades (17)

Each year, kids are gaining more weight. Childhood obesity has more than tripled since the 1970s: (18, 19)

  • Among American children two to five years of age, almost 14 percent are now obese
  • From ages six to 11, 18 percent of children are obese
  • 20 percent of adolescents and teenagers ages 12 to 19 are obese

Most alarming is the rise of obesity in children under five years of age. Research shows that early childhood obesity rates have doubled since 1980. (20) And this isn’t because babies are eating more donuts and cheese doodles while cutting back on their workouts, either. Let’s look at why there’s more to the diabesity story than eating junk food and not exercising enough.

Why We Need to Change Our Behaviors and Lifestyles

From 1993 to 2017, the number of people in the world with diabetes increased 12-fold from 35 million to 450 million and is expected to rise to 690 million by 2045. (21) This is roughly 18 times the number of people affected by HIV/AIDS worldwide. In the United States, the incidence of diabetes is projected to increase to 60 million by the year 2060. (22)

What accounts for such an explosion of new cases? One reason is that the standard treatment for diabesity is not only ineffective, but it’s also contributing to the problem.

Once they have developed, diabetes and obesity are characterized by insulin resistance, which in turn results in carbohydrate intolerance. Yet prominent organizations such as the American Diabetes Association have been recommending a low-fat, high-carbohydrate diet as a treatment for diabetes for decades. It didn’t work in 1985, and it still doesn’t work today. Einstein once defined insanity as doing the same thing over and over again and expecting a different result. Clearly, we need to shift our thinking away from the conventional approach, challenge our current beliefs, and embrace more unconventional options, like:

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Join the conversation

  1. I’m not sure if I have questions yet but am eagerly following this series. As one already suffering from diabesity Ilike both my parents) I’m hoping I’m not too far gone to be able to reverse some of the damage done over the years, and to prevent or slow down future damage. I’ve made a start – losing 110 pounds so far on a low carb diet. Yeah, I do have high LDL, alas – but my HDL is good (66) and so are my triglycerides (49). Probably my biggest problem is *depression* caused by reading all these articles about how I’m going to die young and soon because I’m a diabetic.

  2. I am thoroughly confused….will somebody out there help me. I am not diabetic but am overweight,and just cant seem to deal with it. I have the fear of diabetes or diabesity. i was an overweight kid…then lost all my weight on a low carb diet…kept it off for 12 years…got married and started eating like my husband..and wham….I look like a balloon.Now I just cant seem to cut it…I want to stabilise my blood sugar,lose some weight.I keep wondering if I have some kind of metabolic syndrome…I just dont know.I dont touch wheat and sugar.I eat almost no grains,potatoes etc. What else needs to go ?

  3. Thank you Chris for your quick and thoughtful answers. I think you’re absolutely right on re the kinds of people that respond to low-fat diets. I had not thought of THAT.  For someone like me it was a disaster, I ate all day and was still hungry most of the time. Then I kept losing weight I couldn’t afford to lose.

    To your questions:

    Cortisol test: No – I had requested it (per Schwarzbein Principle) but the lab didn’t do it. I did a saliva test later at my healthfood store but it did not address cortisol specifically. . What is the best type of test for cortisol?

    Insulin test: No –  is the c-peptide test ok for that?

    Stress: I’ve always been a very anxious type of personality and used to get regular migraines at the first sign of an adversity UNTIL I discovered and started practicing MEDITATION. I haven’t had a migraine in 20 years just by staying calm.

    But my life is somewhat stressful as I am caring for my husband who had a hemorrhagic  stroke 10 years ago (he being 5’11 and I only 5’ – I learned a lot about ‘leverage’! The first year was especially demanding while he was in a wheelchair and rehabilitating from right-side paralysis. Full function of his right side has not come back (but he can now walk with a cane) and so he cannot help me with the work that needs to be done daily in maintaining a home. So all that falls on me and motivates me even more to stay strong and healthy. 

    Incidently, over the last 10 years, my TSH bounced around from 3.5 to a high of 9 (while on low-fat/high-carb) and now back to 3.5 (added thytrophin and kelp). I started taking lowest dose of Synthroid 2 years ago.

    One last thing. Over the years my doctor never said anything about my FG since until only recently 126 was the cut-off number for diabetes and I was always below that. And I didn’t have the usual symptoms. It wasn’t until I started testing my self that I realized that I had spikes beyond normal. (My husband was diagnosed as diabetic as a result of his stroke but later became normal on his own and I started testing myself out of curiosity.)

    You’ve already shed more light on my situation than anyone else and I’m looking forward to your indepth write-up.

    Thank you so much! (sorry for this long answer)

  4. REgarding skinny diabetics, this can happen due to decreased insulin production, and especially for I diabetics. Because insulin stimulates fatty acid synthesis and TGL uptake into the cell for storage. SO if your body lacks of insulin, fatty acid synthesis and metabolism is impaired and therefore diabetics can be skinny. But this is more applicable to I, as most type II at least at the early stages produces too much of insulin.
    ALso want to point out that high levels of fatty acids and TGL in the blood stream can reduce insulin sensitivity which can explain that people after high fat low carb meal still have high sugar levels. Moreover, sometimes those fats stay in the blood longer than the next meal and so they could be mixing todays carbs with yesterdays fats which raises blood sugar and over period of time cause matabolic syndrom.

  5. Yes, please do include skinny people. I’ve been prediabetic for at leat 10 years that I know of with fasting BG between 110-120 and spikes after carb meals  to 180 or beyond.
    But I don’t fit the usual pattern:  I’m 67 have no aches or pains and lots of energy – been slender all my life, low BP, TC around 250 but  low triglycerides (35-50) HDL in 70-80….There is no diabetes in my family and I’ve been very health conscious all my life doing exercise, cooking my meals from scratch – never “dieting” – but eating whole foods with whole fats. No junk food and no liking for pastries etc. But I DID – and still do- love FRUITS and ate lots of it – grapes, oranges, apples etc on a daily basis. Maybe that was it – too much fruit.
    There is one question I wish you would address (I’ve asked it many times elsewhere but not gotten an answer).  How can it be that doctors like McDougall, Barnard, Anderson, Ornish, Fuhrmann etc. – having treated thousands of diabetic patients – all have their success stories using exactly the diet you say doesn’t work – low-fat/high carb. I just don’t understand it – except maybe it IS a metabolic thing? I tried McDougall but had to quit because I lost too much weight (I too am just under 5 feet tall and weigh 88 lbs now) and my BS did not go down much.
    I do appreciate the time and effort you put forth in bringing us so much useful and new information.

    • The vast majority of the patients that get put on those diets were doing every single thing wrong that you could do wrong before starting them: eating tons of refined flour, grain, fructose and other dietary toxins, as completely sedentary lifestyle, high levels of stress, etc. etc. Then they go to one of those doctors, or pick up one of their books, and they eliminate many if not all of these triggers. You bet they’re going to see improvement. But that doesn’t mean these diets are optimal, or that they wouldn’t see more improvement adopting a paleo-type diet with fat as the primary energy source.

      In your case, it’s not clear what’s happening. Stress is a huge factor – whether emotional, psychological, or physiological (chronic low-grade infections, gut dysbiosis, etc.). Environmental toxins can be a factor. And certainly a high fructose intake alone is quite capable of causing non-alcoholic fatty liver, which could in turn cause metabolic dysfunction without overweight or obesity. Genetics also play a role, although I believe that role to be quite small in those following a healthy lifestyle such as yourself.

      Have you had your cortisol levels tested? That would be my first thought. High cortisol can cause dysglycemia on its own. Have you had your fasting insulin tested?

  6. Hi Chris,
    We were talking about broken metabolisms with my MIL.  She’s 75 yo, obese, intolerant to carbohydrates (she has just begun to restrict herself to non-starchy veggies in order to maintain normal blood glucose levels).  She has osteopenia, osteoarthritis, is a breast cancer survivor, and has poor thyroid function.
    My MIL moved from the countryside in Mexico to Mexico City in her early 20s.  It was there she raised nine children.  They were very poor and often got by on rice, beans, and tortillas. By her 40s, she was already quite overweight.
    When we look at her history, and try to speculate on what broke her metabolism, in her case we can rule out soft drinks and typical bagged or boxed processed foods.  We’re guessing relying on corn oil to cook with did a lot of damage.  And, lack of nutrient-dense foods causing a level of “starvation” (I’m not counting rice, beans, and tortillas as nutrient dense).  We’re also wondering if nine pregnancies took a major toll & robbed her own body of much needed nutrients.  And, there was also the stress of raising a large family under difficult conditions.
    I hope when you talk about diabesity, you’ll be able to address other causes beyond just the SAD.
    Thank you for the great blog, Maggie

  7. A bit of mythbusting as it relates to health would be nice!    For example
    1)  the whole calories in = calories out, where spending an hour on a treadmill burns very few extra calories that doing nothing.
    2) net carbs – should carbs from fiber (in/soluble) be lumped in as other carbs
    3) high intensity training / vo2 max – is this for real?
    4) subcutaneous fat vs. visceral fat
    5) fat burning / weight loss supplements – niacin, hgh, etc
    6) fructose vs. sucrose – is one better than the other

  8. I am really looking forward to this series.   My family is plagued with this disease and it’s accompanying obesity. I am particularly interested in your take on inflamation and it’s role in the disease process.  .   I especially enjoyed your articles on heart disease and cholesterol and the videos you included.  

    This blog has meant a lot to me and I thank you for the effort you put into it.   Please keep up the good work as there is just not much help out there with ‘mainstream’ medicine.   We need folks like you who can help us to help ourselves

    Congratulations on your recent graduation.   I wish you all the success in the world as you begin your own practice.   Just please don’t forget humble cyber “patients” who live too far away to ever consult you in person.   We are all in your debt for taking the time to share.

  9. Yes, a site-wide comments RSS. Without having to comment on each post first if that’s what you’re talking about. It’s easy to do this for blogs on blogspot even if they don’t provide a link, but I couldn’t figure out how to do it for yours.

  10. Hey Chris, I’d love it if you added a feed for comments. You write great responses to everyone so I don’t like to miss them, and it’s nice using Google Reader to search for info on a specific topic from some of my favorite sources. Thanks.

    • Justin: are you talking about a site-wide comments feed? There is a comments feed for each individual post.

  11. Ah, I see what was happening now.  I fixed the links in the post.  It should take you to the right reference now.  I’ll fix the link in the comments next.

    More than half of Americans are overweight – reference.

    One-third are obese – reference.

    I’m not as certain as you that overweight isn’t a problem.  It doesn’t necessarily put you at risk, but the prevalence of metabolic problems is certainly higher in those who are overweight and obese.  It’s also true that obesity is not common in traditional, hunter-gatherer peoples that experience much lower rates of the modern diseases that plague us. I don’t think obesity is a normal, healthy state for humans and I believe it does indicate dysfunction – regardless of whether it is necessarily associated with frank disease states.

  12. Yes, that’s the link I’m referring to.  It takes me to a PDF of an article on environmental toxins and type 2 diabetes in Canadian Aborigines by Donald Sharp (both from the post and from your comment).  I read through the article several times now and I’m not finding anything that estimates the health care costs of obesity or diabetes.  Am I missing that content somehow?  I suppose it could also be a technical issue of some kind on my end.

    I appreciate the clarification of your interest in abdominal obesity and its associated problems.  Maybe I’m not reading close enough, but the specificity of that focus didn’t come across to me in the original post.  I guess I’m confused by the scope of a statement like: “More than half of Americans are overweight, and a full one-third are clinically obese.”  Again, not sure where that estimate comes from, what definitions it’s using, and why it’s relevant if you’re interested in metabolic problems associated with a specific kind of obesity, particularly if being overweight, as you said, does not necessarily put you at risk.  Again, though, thank you for the clarification.  I’m not trying to nitpick, I just have an interest in (and, admittedly, a bias against) health writing that seems to imply or assume a simplistic relationship between weight and health.

  13. Hey Chris.  I would also like to know how you are defining the term “obesity.”  Are you depending on BMI? Are you speaking more generally of a certain percentage of body fat?  What studies are you looking at to assume a correlation (or a causative relationship) between increased weight and increased risk of death and disease?  I feel pretty sure that you are aware of all of the criticism that’s been launched at the epidemiological analyses that have claimed that overweight causes illness (by, for instance, Paul Campos in The Obesity Myth).  I love your writing and I particularly value the critical stance you take towards accepted wisdom about health, so I’m really interested to know what sources you’re using to inform your idea of what constitutes a healthy weight. 

    Also, I tried to follow up on the numbers you cited as to the health care costs of “diabesity,” but your 4th footnote links to an article that seems unrelated to that topic – “Environmental Toxins, A Potential Risk Factor for Diabetes Among Canadian Aboriginals.”  I would love to look at the actual source for that estimate.

    • First of all, diabesity can occur without obesity. I know the word is a little misleading that way, but as I said in the article it’s possible for thin people to be “metabolically obese”. It’s also possible for people to be significantly “overweight” without metabolic dysfunction. The problem we’re concerned with in particular is abdominal/visceral obesity, which is strongly associated with metabolic problems that increase morbidity and mortality.

      I’m confused by your comment about the 4th footnote. When I click on (4), I’m taken to this PDF, which is the correct reference.

  14. Oh, and when you talk about carbs, any chance you could be explicit? I see ‘flour’ was mentioned a few times, and while most people are still eating white wheat flour, there are also many people now eating other kinds of flours, both refined and ‘whole’. Likewise, do you differentiate between whole grains and refined grains (eg brown rice and white rice)? The Glycemic Index seems to treat foods solely on the basis of carb content, but does the relative presence or absence of other nutrients also affect metabolism?
    And where do milk sugars fit into all this? (and is there any difference between say raw, whole milk and pasteurised, homogenised milk?).

  15. Hi Chris, I’m looking forward to this series too. I have some questions:
    – can you please define ‘obesity’? Many fat people are now saying that fat doesn’t automatically equate to unhealthy or unwell (fat people can have healthy diets and exercise and still be ‘fat’), and apparently there is research to back this up (I haven’t gone looking yet). Do you think all fat people are obese?
    – can you put up the statistics of fat people who don’t have diabetes?
    – can you look at the role of increased body fat in middle aged/menopausal women, and whether this is normal/healthy because of hormonal changes (specifically that the fat cells take over some of the hormonal functions)?
    – are diabesity and metabolic syndrome different things or the same or what?
    I’m also looking forward to the information on stress too.
    thanks 🙂

  16. I found that lowcarb did not work unless I ditched the ‘fake’ foods like low carb ice cream.  I could not lose even an ounce when still eating that dang low carb ice cream!  Ditched it and the pounds came off.  Now I sub coconut milk and fruit for the ice cream.  Still lotsa calories and fat and even carbs, but yet I can still lose weight.  Those on LC with no weight loss, be wary of milk sugars, nuts, and cheese as any one of those can block LC effectiveness in some people.  Also try ditching all processed foods, low carb or no and also all grain oils.  Other oils are just as tasty if not more so.   There are some things we still don’t understand totally about LC and why it does and does not work at times but it seems certain things can trip up the system, even if they are lowcarb things.  

    Anyway, about the Kitavans, should be interesting.  I suspect metabolic probs result from a variety of sources.  Could be high intake of starches mixed with heavy exercise and no other risk factors might not alone be enough to majorly damage the metabolic system.  But add stress, grain oils, processed food, hormones in the food, sedentary lifestyle, less sunshine, easy access to food, etc, and put that on top of the same high starch diet, then maybe there would be more problems.  PLus I suspect there is also a certain amount of genetic tolerance or lack thereof to be considered.  At some point, I suspect there is a tipping point and where that tipping point is and what exacty most easily triggers it will vary from person to person.

    As for skinny diabetics, I don’t know if there is any research on it, but the skinny ones I have known have also been the ones with the worst cases.  They are the ones that easily pass out and have raging hard to control glucose numbers.  From a scientific perspective, I find that interesting.  I have heard some say that your body puts on fat as a protective measure to help store the excess glucose.  If so, it would make sense that the skinny ones have worse cases.          

  17. I wonder if you will be addressing gastric bypass surgery and why it seems to reverse T2DM. I am one of four children in my family of origin. We all became diabetic inspite of being very active people. My eldest sister (67) just had gastric bypass one year ago and is off all meds and now has no symptoms of diabetes. She is now a size 6.

    I know that it has something to do with Incretins….and some diabetes medications are based on the Incretins.

    My own situation is that I thought I might be diabetic about ten years ago. I found Dr Atkins Book and followed his advice. Lost over one hundred pounds had it off for quite a few years. Then an upheaval happened and I was not able to cook for my self for some months and had to resort to restaraunt food. It took very little time for the weight to start piling back on.

    I still eat very low carb. I was subsequently diagnosed as diabetic. As long as I eat little or no carbs my lipid profile is fine. Inspite of all my efforts now I can not get the weight to budge. Since 2007 I have been on Lantus…as my BG levels began to steadily climb. So my Beta Cells must be just about shot. Gluconeogenesis must have been one of the reasons for the steady climb in BG. Perhaps I was eating too much meat and not enough fat.