RUNNNING HEAD: Obesity and Type 2 Diabetes 1

The Relationship between Obesity and Type 2 Diabetes: Two Sides of the Same Coin?
i. Abstract
With an alarming prevalence of both obesity and type 2 diabetes in the world, the scientific
community is as eager as ever to find answers into reasons behind this phenomenon. While
discussing possible factors of obesity and type 2 diabetes (such as environmental or lifestyle,
genetics, prenatal, and mental health), this paper will aim to eventually answer the question: are
obesity and type 2 diabetes two sides of the same coin? Are people who are prone to obesity also
prone to type 2 diabetes? Or, should we be considering them as separate diseases altogether?
Finally, we will give some suggestions into what future research on this topic should focus on, so
the general population will be able to broaden their understanding of the diseases, as well as have
prevention knowledge.

ii. Background Information

Obesity
In its simplest definition, obesity is a condition of excess body fat. Obesity can be
measured in a variety of ways; by skinfold thickness, body mass index (BMI), waist
circumference, air-displacement, or the dual energy x-ray absorptiometry (DEXA). Nearly half
of the world’s population is obese, in which it is most common in children and females (Golay,
2005). Because of its recent prevalence, obesity has been a hot topic in the scientific community.
There has been much research on the causes of obesity; some of which include lack of exercise,
poor diets, genetic material, and overlapping diseases or illnesses. An important hormone
involved with obesity is leptin. Leptin is secreted by fat cells, or adipocytes, and regulates body
weight. Research has shown that higher levels of leptin are found in obese people (Ahima, 2008).
However, what makes obesity an even more critical concern is its association with other
comorbidities, such as cardiovascular disease, hypertension, depression, respiratory disease, and
Type 2 diabetes.
Type 2 Diabetes
Levels of type 2 diabetes are currently rising at an all time high. According to the Centers
for Disease Control and Prevention (CDC), of the 30 million Americans who have diabetes, 90-
95% of them have type 2 diabetes mellitus. Per the American Diabetes Association, or ADA,
definition, diabetes is a chronic condition that effects the way that body uses insulin. The insulin
hormone, which is made in your pancreas, allows your cells to use blood sugar as energy.
However, if you have type 2, your cells do not respond to the insulin (insulin resistance).
Eventually, your pancreas keeps making more insulin but your body can’t handle it, and thus it
builds up in your bloodstream and you end up with high blood pressure, which can cause other
chronic diseases like heart disease and kidney diseases. On the other side of the coin, Type 1
diabetes mellitus differs from Type 2 because this is when your pancreas isn’t making any or
enough insulin to begin with. Although Type 2 DM is referred to as the “lifestyle-related”
diabetes, Type 1 is usually developed in younger children and adults and is mostly genetic.
RUNNNING HEAD: Obesity and Type 2 Diabetes 2

Diabesity
What may be a concerning breakthrough, it was found that the current increase in obesity
has matched the current prevalence of type 2 diabetes in North America. Specifically, 90% of
those who have type 2 diabetes were found to be overweight (BMI 25-29.9) or obese (BMI >30)
(Maggio & Pi-Sunyer, 2003). Research has found that the increase of visceral fat, or fat around
the abdominal cavity, is positively associated with insulin resistance, which can lead to type 2
diabetes (Golay & Ybarra, 2005). This research has also found that with every kilogram of
weight gain, we increase our risk of developing type 2 diabetes by 4.5-9%. So we must ask
ourselves, is obesity a risk factor or cause of type 2 diabetes, and vice versa?
Past Research and Importance
Previously, most research done separately on obesity or type 2 diabetes have linked the two
together as either a cause or risk factor of the other. However, is that how we should be looking
at it? The relationship between obesity and type 2 diabetes is complicated and intertwined, thus
it’s important to understand the different causes of each disease individually to deepen our
knowledge of the subject. More people than ever are obese, especially children. Additionally, 1
in 3 Americans are prediabetic, according to the CDC. This is when your blood sugar levels are
higher than normal, but not enough to be diagnosed with diabetes. With these two chronic
diseases on the rise, it’s vital for research to continue so the general public can understand the
“why” to help prevent it.
iii. Discussion

Environmental and Lifestyle Factors

In a 6 year study conducted between 1992 and 1998, 50,277 and 68,497 female
participants participated in an obesity and diabetes analysis, respectively ( Hu, Li, Colditz,
Willett, & Manson, 2003). During the 6 years, each participant was required to self-report on the
following factors: their average time spent watching TV, sitting at home or work, and
walking/standing weekly. The hope was that this study would illustrate the effects of a sedentary
lifestyle on diseases such as obesity and diabetes. After 6 years of follow ups, Hu and colleagues
proved to be correct in their hypothesis. According to the participant’s self-reports, time spent
watching TV and sitting at work were positively correlated with both obesity and type 2 diabetes.
However, standing more often at work or at home decreased the risk of obesity by 9% and type 2
diabetes by 34%. Overall, there was a 30% increase of new obesity cases and 43% of new
diabetes cases that could have been prevented by adopting a more active lifestyle. The ADA
recommends <10 hours of watching TV/week and >30 minutes/day of brisk walking and light
intensity exercises. Finally, this study concludes that TV and other media presence easily allows
Americans to get exposed to unhealthy food and diets. Although public health campaigns
promote an increase of exercising, it’s not necessarily promoting the reduction of prolonged
sedentary behaviors like watching TV. And, with media and streaming services becoming more
and more common for the average American, it’s important to emphasize that these sedentary
behaviors can lead to obesity and type 2 diabetes.
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Gender, race, and socioeconomic are specific factors we do not have control over, thus it
is critical to learn the effects they have on specific chronic diseases. In a study that had 9643
participants provide self-reported data on physical attributes (height, weight), sociographic date
(race, gender, socioeconomic status, geographic location), and physician-diagnosed diseases,
interesting results were found (Paeratakul, Lovejoy, Ryan & Bray, 2002). Firstly, it was shown
that the prevalence of overweight and obese Americans is highest in minority populations, most
commonly in African (29%) and Hispanic (18.7%) Americans. Additionally, these populations
were also more likely to develop Type 2 diabetes (10.1% and 9.4%, respectively). Also, females
were more likely to become obese than males (18.6% vs. 16.8%). Interestingly, there was an
overwhelming difference between overweight females and overweight males (27.3% for females
and 42.7% for males). There was also a similar prevalence of type 2 in both genders. Finally, in
terms of socioeconomic status, it was found that individuals with a lower income and lower
education status (regardless of race or gender) were statistically more likely to become obese and
develop type 2 diabetes. It’s important to note that the relationship between socioeconomic
status, race, and gender with obesity and diabetes is not black and white. These factors are
complex because they could be confounding with each other. However, these results indeed
show that, to some extent, obesity and type 2 diabetes (along with other chronic lifestyle-related
diseases) are impacted by race, gender, and socioeconomic status.
To dive into the reasons why diabetes prevalence and socioeconomic status (SES) are
common in deprived areas, a study was done in a small UK town of South Tees to determine the
relationship between the two (Connolly, Unwin, Sherriff, & Bilous 2000). After analyzing the
participants’ self-reported demographics, the researchers assigned a “deprivation score” (1-5) to
each participant. The score was based on employment status, single parent households, chronic
health, disability status, whether or not a car was available, and other SES factors. Results show
a significant trend between type 2 diabetes and the deprivation scores that were given to each
participant that were determined by their socioeconomic status. Prevalence of type 2 diabetes
was higher with a higher deprivation score. Connolly and colleagues concluded that there were
multiple reasons for this. For one, those who are deprived are more susceptible to risk factors,
such as obesity. Additionally, those who belong to a lower social class are more likely to become
unemployed and thus less likely to afford health insurance. This can decrease their use of
primary care services, like blood or urine tests, which would test for early signs of diabetes.
Genetic, Family History, and Prenatal Factors
There has been much research, as well as debate, about the later life effects of low and
high birth weights. In a study that screened 1780 randomly selected children (ages 6 to 18) in
Taiwan for diabetes, obesity, and BMI, it was found that there was a U-shaped relationship
between birth weight and type 2 diabetes (Wei, et al. 2003). Graphically speaking, when two
variables have a U-shaped relationship, it begins on a higher position on the y-axis, descends,
and then once again lands in a higher position, creating a U-shape. According to this study, the
risk of type 2 for children was a stunning 64% greater with those who had a high birth weight
versus those with a low birth weight. A high birth weight is defined as those who have a birth
weight of 4,000g or higher; this is also called macrosomia. These group of children were also
RUNNNING HEAD: Obesity and Type 2 Diabetes 4

more likely to have type 2 diabetes in their family history, a higher BMI (overweight and obese),
and blood pressure.
In another study that used a similar method, 973 Chinese participants proved that, like the
previous study, there was a U-shaped relationship between both diabetes and birth weight, and
obesity and birthweight (Tian, et al. 2006). Specifically, those with a lower or higher birth
weight had a higher risk of developing abdominal obesity, hypertension, and type 2 diabetes. The
reasons for this can be complex. According to the Fetal Origins Hypothesis, low birth weight is
caused by undernutrition of the fetus when it’s developing in the uterus. As a result, these infants
can have an impaired glucose tolerance, and thus an elevated risk of type 2 diabetes when they
reach adulthood. Tian and colleagues stated that birth weight is an independent risk factor for
obesity and hypertension, but both birth weight ad obesity are risk factors for type 2 diabetes.
There is more research that must be done for learning more about the pathologies of micro and
macrosomia. However, it’s clear that infants with low or high birth weights are at a higher risk
for developing type 2 diabetes and obesity than those born at a normal weight.
Although type 2 diabetes has been referred to as a “lifestyle-related” disease, there has
been some evidence to prove that genetic factors could contribute to its development in some
people. Research shows that adiponectin, a protein hormone made in the endocrine system
regulates the body’s glucose levels, thus protects us from insulin resistance- which is key for
type 2 diabetes. Increased levels of adiponectin has other therapeutic properties such as anti-
atherogenic, anti-inflammatory, and some weight loss results (Achari & Jain, 2017). In 2002,
Stumvoll and colleagues sought to discover whether or not having a family history of type 2
diabetes increases your chances of having a polymorphism of a T-G exchange in nucleotide-94
(aka Exon 2), which increases your levels of adiponectin, and thus decreases the risk of type 2
and obesity. Results indeed show that individuals without a family history of type 2 diabetes had
higher levels of adiponectin and less risk for type 2. It’s important to note that although familial
predisposition may cause this polymorphism, it may also be buried by one or more of the infinite
genetic factors possible. Unfortunately, we do not yet have the technology to detect which factor
is causing what.
Mental Health Factors
Mental health and illness is another hot topic in popular culture and the scientific community.
According to the Mayo Clinic, mental illness, or mental health disorders, can be defined as any
mental health condition that affects your mood, thinking, and behavior. People with mental
illnesses are more prone to become obese, which also leads into diabetes and other
cardiovascular diseases. This could be for a variety of reasons; some may turn to food as a
comfort, or maybe their medication has effects that caused the individual to gain weight. A meta-
analysis was done to try to deepen the understanding of mental health patients and their risk of
obesity and type 2 diabetes (Stanely & Laugharne, 2012). The authors concluded that Type 2
diabetes can be more prevalent in mental health patients than the general population. This could
be from the psychotropic medications (like Xanax or Prozac) or antipsychotics that elevate blood
pressure. Antidepressants work by reducing the amount of serotonin in the blood stream, which
also contributes to blood glucose regulation. According to Cohen et al in 2006, of a group of 200
RUNNNING HEAD: Obesity and Type 2 Diabetes 5

patients that suffered from schizophrenia and were taking medication for it, 7% of them had
hyperglycemia and 14.5% had a form of diabetes. As for obesity, these medications that are
prescribed to people with mental illnesses (like psychotropic medications) have major side
effects such as drug-induced weight gain. This is caused by metabolic disturbance in the body
due to the medication. Other risk factors that this meta-analysis found for mental health patients
were lack of exercise and diets high in saturated fats, or “comfort food”. However, when
working with patients with mental disorders, scientists are not certain whether obesity and type 2
diabetes cause the illness, or if it’s the other way around.
iv. Conclusion
Overall, there has been ample research on the specific causes of obesity and type 2 diabetes,
both together and as separate diseases. The causes discussed in this paper
(environmental/lifestyle, genetics, prenatal, and mental health factors) are just some of the many
reasons why obesity and type 2 diabetes can develop. The aim of this paper was to try to deepen
our understanding of the reasons to why obesity and type 2 diabetes occur, as well as if we
should be considering both the diseases to be looked at as two sides of the same coin or as totally
separate conditions. Based on much research, I believe it’s safe to assume that there is a strong
correlation between obesity and type 2 diabetes. However, we must understand that they are two
separate diseases and it’s not certain that if an individual has one, they will inevitably be
diagnosed with the other. To prevent these diseases from developing, it’s vital to have a diet low
in saturated fats, added sugars, and sodium content, and rich in fruits, vegetables, whole grains
and lean protein. The ADA also recommends 30 minutes of light to moderate intensity exercises
a day, as well as weight-bearing exercises at least twice a week. If you are unsure of what to next
or are concerned about your health, be sure to check with your primary care physician or
dietitian. With levels of both of these conditions rising at alarming rates, it’s more important than
ever to continue to conduct research on not only causes that we already have linked, but also
those that haven’t been thoroughly researched. Additionally, future research should also look
into longitudinal studies to determine long-term effects of specific factors such as artificial
sugars, certain medications, or technology-based habits on obesity and type 2 diabetes.
RUNNNING HEAD: Obesity and Type 2 Diabetes 6

References
Achari, A. E., & Jain, S. K. (2017). Adiponectin, a therapeutic target for obesity, diabetes, and
endothelial dysfunction. International journal of molecular sciences, 18(6), 1321.
Ahima, R. S. (2008). Revisiting leptin’s role in obesity and weight loss. The Journal of clinical
investigation, 118(7), 2380-2383.
Centers for Disease Control and Prevention. (n.d.). Retrieved from https://www.cdc.gov/.

Connolly, V., Unwin, N., Sherriff, P., Bilous, R., & Kelly, W. (2000). Diabetes prevalence and
socioeconomic status: a population based study showing increased prevalence of type 2
diabetes mellitus in deprived areas. Journal of Epidemiology & Community
Health, 54(3), 173-177.
Golay, A., & Ybarra, J. (2005). Link between obesity and type 2 diabetes. Best practice &
research Clinical endocrinology & metabolism, 19(4), 649-663.
Hu, F. B., Li, T. Y., Colditz, G. A., Willett, W. C., & Manson, J. E. (2003). Television watching
and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in
women. Jama, 289(14), 1785-1791.
Maggio, C. A., & Pi-Sunyer, F. X. (2003). Obesity and type 2 diabetes. Endocrinology and
metabolism clinics of North America, 32(4), 805-22

“Mayo Clinic.” Mayo Clinic, Mayo Foundation for Medical Education and Research,
www.mayoclinic.org/.

Paeratakul, S., Lovejoy, J. C., Ryan, D. H., & Bray, G. A. (2002). The relation of gender, race
and socioeconomic status to obesity and obesity comorbidities in a sample of US
adults. International journal of obesity, 26(9), 1205.
Stanley, S. H., & Laugharne, J. D. (2012). Obesity, cardiovascular disease and type 2 diabetes in
people with a mental illness: a need for primary health care. Australian Journal of
Primary Health, 18(3), 258-264.
Stumvoll, M., Tschritter, O., Fritsche, A., Staiger, H., Renn, W., Weisser, M., ... & Häring, H.
(2002). Association of the TG polymorphism in adiponectin (exon 2) with obesity and
insulin sensitivity: interaction with family history of type 2 diabetes. Diabetes, 51(1), 37-
41.
Tian, J. Y., Cheng, Q., Song, X. M., Li, G., Jiang, G. X., Gu, Y. Y., & Luo, M. (2006). Birth
weight and risk of type 2 diabetes, abdominal obesity and hypertension among Chinese
adults. European journal of endocrinology, 155(4), 601-607.

“Type 2 Diabetes - Symptoms, Causes, Treatment.” Type 2 Diabetes - Symptoms, Causes,

Treatment, www.diabetes.org/diabetes/type-2.
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Wei, J. N., Sung, F. C., Li, C. Y., Chang, C. H., Lin, R. S., Lin, C. C., ... & Chuang, L. M.
(2003). Low birth weight and high birth weight infants are both at an increased risk to
have type 2 diabetes among schoolchildren in Taiwan. Diabetes care, 26(2), 343-348.