"Belly fat clearest sign of type 2 diabetes risk," The Guardian
reports. This comes as Public Health England publishes a report
highlighting the links between bulging waistlines, obesity and type
2 diabetes risk.
According to a new report, men whose waist size is over 102cm
(40.2 inches) are five times more likely to develop diabetes than
those with a smaller waist size. Women with a waist over 88cm (34.7
inches) are three times more likely to develop the condition.
The report says that being overweight or
obese is the main avoidable risk factor for
type 2 diabetes.
The condition is now a major public health issue, with all types
of diabetes projected to rise to 4.6 million - nearly 10% of the
adult population - by 2030.
Some people may have the misconception that type 2 diabetes is
an inconvenience, like back pain or arthritis, but not especially
serious. This is not the case.
Type 2 diabetes can lead to
blindness (diabetic retinopathy), heart problems and even
reduce blood supply to the limbs, which can lead to the affected
amputated. People with type 2 diabetes are 15 times more likely
to require an amputation than the population at large.
If you are concerned about your weight, it is recommended that
you measure you waist size and ask your GP for advice. If
necessary, they can arrange testing for the condition. The sooner
type 2 diabetes is treated, the less likely it is to cause
The key to reducing the risk of diabetes is losing weight, which
can be achieved through
a healthy diet and being
NHS Weight Loss plan can help you achieve both these goals.
Who produced the report?
The report was produced by Public Health England (PHE), a
government body set up to protect and improve people's health, and
reduce health inequalities. PHE is part of the Department of Health
and came into being in April 2013.
What is the aim of the report?
The report draws together a multitude of facts and figures to
describe the relationship between obesity and type 2 diabetes. Its
aim is to support decisions by public health policymakers and
practitioners. It points out that, currently, 90% of adults with
type 2 diabetes are overweight or obese, and that both conditions
are on the increase in the UK.
The report explains that diabetes is a condition in which the
body does not produce sufficient insulin to regulate blood glucose
levels, or where the insulin produced is unable to work
effectively. There are two main types of diabetes: 1 and 2.
The report focusses on type 2 diabetes, which accounts for at
least 90% of all cases and is
easily preventable by making lifestyle changes. It points out
that obesity is only associated with type 2 diabetes.
Type 1 diabetes is an autoimmune condition that has no
association with obesity or other lifestyle factors, and is not
preventable; people are born with the condition (though symptoms do
not usually develop until around puberty).
Link between obesity and diabetes
The report says that being overweight or obese, with a
body mass index (BMI) of 25 or above, is the main modifiable
risk factor for type 2 diabetes. In England, obese adults are five
times more likely to be diagnosed with the condition than adults of
a healthy weight, with a greater risk among people who have been
obese for longer.
In addition, a recent study found that severely obese people
(with a BMI of 40 or above) are at even greater risk compared to
obese people with a lower BMI (30.0-39.9).
This, it claims, may have significant implications for the NHS,
given the increasing trend of severe obesity in adults.
In particular, a large waist circumference is associated with
increased risk of diabetes. Men with a raised waist circumference
(greater than 102cm) are five times as likely to have
doctor-diagnosed diabetes, compared to those without a raised waist
Women with a raised waist circumference (greater than 88cm)
are more than three times as likely to get the
The precise mechanism for this association remains unclear, says
PHE. Some hypotheses include:
- Abdominal obesity may cause fat cells to release inflammatory
chemicals that disrupt the body's response to insulin.
- Obesity may trigger changes to the body's metabolism that cause
adipose (fat) tissue to release substances involved in the
development of insulin resistance.
It is also uncertain why not all people who are obese develop
type 2 diabetes, and why not all people with type 2 diabetes are
Prevalence of obesity and diabetes
The report states that in 2012:
- an estimated 62% of adults (aged 16 years and over) were
overweight or obese in England (with a BMI of 25 or above)
- 24.7% were obese (with a BMI of 30 or above)
- 2.4% were severely obese (with a BMI of 40 or above)
The prevalence of obesity has increased sharply since the 1990s,
and some forecasts predict that by 2050, obesity will affect 60% of
adult men and 50% of adult women.
The rise in obesity has led, and will continue to lead, to a
parallel rise in diabetes.
In 2013, 2.7 million - equivalent to 6% of the adult population
- had diagnosed diabetes in England, representing an increase of
137,000 people since 2012.
However, when undiagnosed cases are taken into account, it has
been estimated that the true prevalence in England is around 3.2
million, or 7.4% of the adult population.
This figure is projected to rise to 4.6 million, or 9.5% of the
adult population, by 2030.
Approximately a third of this increase is attributable to
obesity, while the rest is due to ageing and the changing ethnic
structure of the population.
Other risk factors
Although obesity and being overweight are the major risk factors
for type 2 diabetes, other risk factors include:
- Increasing age. The National Institute for Health and Care
Excellence (NICE) states that being older than 40, or older than 25
for some black and minority ethnic groups, is an important risk
factor for developing type 2 diabetes.
- Lifestyle factors. Both obesity and type 2 diabetes are
strongly associated with unhealthy diet and physical
- Ethnicity. All minority ethnic groups (with the exception of
Irish) have a higher risk of diagnosed diabetes than the general
population. For example, women of Pakistani ethnic origin are five
times more likely, and those of Bangladeshi or Caribbean origin
three times more likely, to be diagnosed with diabetes compared to
women in the general population. Type 2 diabetes also affects
people of South Asian, African-Caribbean, Chinese or black African
descent up to a decade or more earlier than white Europeans.
- Deprivation. In England, type 2 diabetes is 40% more common
among people in the most deprived quintile (where a sample of the
population is divided into fifths), compared with those in the
least deprived quintile. People in social class V (unskilled
manual) are three-and-a-half times more likely to be ill as a
result of diabetic complications than those in social class I
(professional), while the short-term mortality risk from type 2
diabetes is higher among those living in more deprived areas in
People with diabetes are at risk of a range of health
complications. Uncontrolled diabetes is associated with
cardiovascular disease (CVD), blindness, amputation, kidney disease
It can also result in lower life expectancy.
Life-long diabetes can also have a profound impact on lifestyle,
relationships, work, income, and health and wellbeing.
The report points out that diabetic eye disease is the leading
cause of preventable sight loss in people of working age, while up
to 100 people a week have a limb amputated in the UK as a result of
In England, diabetes is a major cause of mortality, with over
23,000 additional deaths in 2010-11.
In the UK, it is estimated that overweight, obesity and related
illnesses cost the NHS £4.2 billion in 2007, and these costs are
predicted to reach £9.7 billion by 2050.
Wider total costs to society (such as loss of productivity) of
overweight and obesity are estimated to reach £49.9 billion by
2050. To put that figure in context, that would be enough to pay
the annual wages of just under three-and-a-half million newly
A recent economic study estimated that in 2010-11 the cost of
treating type 2 diabetes and its associated complications in the UK
was £8.8 billion. The indirect costs (such as loss of productivity
due to increased death and illness and the need for informal care)
were £13 billion.
What is to be done?
The report itself makes no recommendations for the public, nor
does it encourage people to whip out the tape measure, as some
newspaper reports have implied.
However, according to a BBC report, PHE's chief nutritional
adviser, Dr Alison Tedstone, urged people to "keep an eye on your
waist measurement" as losing weight is "the biggest thing you can
do" to combat the disease.
"People get it wrong, particularly men," she is reported as
"They measure their waist under their bellies, saying they
haven't got fatter because their trouser size is the same,
forgetting they're wearing their trousers lower and lower.
"So the tip is to measure across the belly button."
Read more about how to measure your
waist size and why your waist size matters.