The metabolic syndrome, of which type 2 diabetes mellitus is a hallmark disease, affects
more than 25% of the adult population in the United States (U.S.) (
1
). Specifically, type 2 diabetes currently exhibits a U.S. prevalence of 9.3%, while
prediabetes is currently estimated to be present in up to 40% of adults. It is assumed
that the epidemic rise in obesity is the cause of this upswing in the rate of type
2 diabetes. However, there are 4 separate reasons to doubt this thesis.
- 1)Although obesity prevalence and diabetes prevalence correlate, they are not concordant; there are countries in which populations are obese without having diabetes (such as Iceland, Mongolia and Micronesia), and there are countries in which populations have diabetes without being obese (such as India, Pakistan and China, which manifest a 12% diabetes rate). This lack of concordance is further reinforced by looking at years of life lost because of diabetes as opposed to obesity (3).
- 2)People forget that 20% of morbidly obese individuals are metabolically healthy and have normal life spans (4,5,6), while up to 40% of normal-weight adults harbour metabolic perturbations similar to those that occur with obesity, including hypertension, dyslipidemia, nonalcoholic fatty liver disease and cardiovascular disease (7,8).
- 3)The trend of diabetes in the U.S. between 1988 and 2012 has demonstrated a 25% increase in prevalence in both the obese and the normal-weight populations (9)
- 4)The aging process does not explain the prevalence of type 2 diabetes; children as young as 1 through 10 years of age now manifest these same biochemical processes (10,11). Thus, although obesity may be a marker for the pathology, it is clearly not the cause because normal-weight people have type 2 diabetes too. So what is the cause, a cause that everyone is exposed to? And how is it that children experience this degree of metabolic dysfunction?
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Article info
Publication history
Published online: May 20, 2016
Accepted:
January 28,
2016
Received:
December 16,
2015
Identification
Copyright
© 2016 Canadian Diabetes Association.
