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DIABESITY in India

Let’s make this planet DIABESITY free – it is possible!

(Credit: DasWortgewand)
India stands 3rd in the obese nations only after the USA and China today
From 2012-2030, the economic loss of India due to the disease in the productive age population is predicted to be US$4.58 trillion.

Evolving globalisation, lifestyle changes have really led to deep and long-term impacts on all individuals in all perspectives of life. This, off course, has also impacted healthcare and has created a revolution in medical treatments. Current technical advances are bringing modern and technically high-end treatment options within the reach of the population, but nevertheless the nature of the health-related challenges has changed on a larger scale. And DIABESITY comes as one of the larger challenges.

The author of this article is Dr Jayasshree Todkar Director - JT Obesity Solutions, International Centre of Excellence Bariatric Surgery, Ruby Hall Clinic, Poona Hospital, Pune, India

DIABESITY is the word coined by WHO (World health Organisation) in the 21st century to really indicate the very significant association between obesity and diabetes. WHO has declared DIABESITY as one of the first five largest threats to human life in 21st century and medical science really needs to redefine the clinico pathological and treatment aspects of this disease.

Typically, South Asians and Indians are easy prey to this silent and fatal combination of Obesity and Diabetes. In my perspective these are not two different diseases, but two different presentations of primary pathology that leads to under consumption of the energy by the tissue and hence leading to storage. Unless, and until, we think about the disease pathology with the changing paradigm, it will be difficult to find the right solution.

India is known to be the diabetic capital of world. The number of diabetic and obese patients predicted to be reached by 2030 was already surpassed in 2015. From 2012-2030, the economic loss of India due to the disease in the productive age population is predicted to be US$4.58 trillion.

India stands 3rd in the obese nations only after the USA and China today. But we have the highest rate of growth in this context and will soon surpass them.

Various scientific studies have established the significant correlation between the high fat/adiposity and insulin resistance in an Indian body irrespective of the BMI (body mass index). In simpler words, when we compare the body composition analysis between a Caucasian and an Indian at a similar BMI, Indians are unanimously found with higher fat % age/higher adiposity. The distribution of fat is throughout the body, particularly visceral obesity, which is reflected by a large waist circumference.

In all metabolic related diseases, obesity is found to be the significant player. high adiposity leads to the earlier appearance of various metabolic disorders and also leads to aggression and progression of the disease.

According to a study, incidence of fatal cardiovascular events under the population of 40 years of age is highest in the Indian population. In addition to the rising prevalence of obesity in India.

Before we think of the effective remedy, it is essential to go into the etio-pathology of the disease. DIABESITY is an aggressive and progressive disorder and there is a distinct need of effective treatments at the stages to prevent further course of the disease.

The treatments for obesity and metabolic disorders do have strong impact on the comorbidity reduction of an individual.

Traditional treatments like restrictions in the calorie intake and enhancement of the physical activity do not help after a certain level of the disease. The combination of adiposity with insulin resistance typically leads to yo-yo effect. This will have a significant impact on the economy of the India.

Why do restrictions fail?

It is interesting to know the patient perspective in this regard. In an interview conducted by my unit in India of over thousand patients suffering from DIABESITY, primarily all patients blamed themselves for loss of the control and laziness in keeping the daily physical activity regime. Following further detailed discussion, the following findings were obtained.

Everybody started with sincerity and typically an honest intention towards the goal of weight loss. After a few weeks (ranging between four to 40 weeks) they found difficulty in maintaining the diet and physical activity schedule for the following reasons:

  • Loss of Energy
  • Feeling sick/Irritable/ headache with restricted diet
  • The difficulty to attain satiety and hence facing round the clock thoughts about food - this was a major challenge
  • Tiredness - was one prominent challenge and also the outcomes were varied and not predictable

So as a clinician, I have got some derivations:

  • Probably am I trying to starve the end tissue in an attempt to lose weight.
  • Unless the energy percolation at the end tissue reaches satisfactory level of nutrition, no treatment will succeed.

In my opinion, if we want to treat the disease of DIABESITY successfully we need to locate the weaknesses /deficiencies at the tissue level consumption of the energy.

Few of the enzymes like Insulin are known to us. Likewise, there must be multiple catalysts, which can help the burning of the calories at the tissue level. Thanks to bariatric surgery, we know a few areas of the digestive system that can stimulate/inhibit the action of these enzymes. This new perspective and the changing knowledge in the field of DIABESITY should be discussed with physicians, endrocrinologists, diabetologists and the dieticians to develop the strategies to combat the disease at multiple levels. 

IFSO-APC 2017

IFSO-APC 2017 is particularly themed around this particular aspect of DIABESITY. Bariatric surgery has a very large perspective and neuroendocrine aspects are beyond just restriction and malabsorption, and this needs to be discussed and highlighted.

The newly acquired knowledge of the diseased pathology and the role of digestive system should give us more insight to reach effective solution.

For more information on IFSO-APC 2017, please click here 

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