Diabesity in the Young: An Emerging Epidemic in India

Speaker: Dr Subrata Dey

Senior Pediatric Endocrinologist at Apollo Multispecialty Hospital, Kolkata

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Description

Diabesity—the coexistence of diabetes and obesity—is rapidly becoming a major health concern among young people in India. This webinar explores the rising prevalence, underlying risk factors such as sedentary lifestyles and poor dietary habits, and the long-term health implications. Our Expert speaker will discuss early detection, prevention strategies, and the importance of lifestyle interventions. Join us to gain insights into combating this growing epidemic and promoting healthier futures for the younger generation.

Summary Listen

  • Diabetes in the young is an emerging epidemic in India, exacerbated by genetic predisposition, epigenetic factors, and the rise of pediatric obesity. While communicable diseases have been largely conquered, non-communicable diseases, like diabetes, present a growing challenge.
  • Asian Indians have a genetic predisposition to type 2 diabetes, which was historically masked by chronic undernutrition. Burgeoning affluence and associated obesity in recent decades have unveiled this genetic vulnerability, leading to a surge in type 2 diabetes among both adults and children.
  • Obesity promotes type 2 diabetes through the pro-inflammatory, pro-thrombotic, and pro-insulin-resistant environment created by visceral fat. Diabesity, the link between diabetes and obesity, is a global pandemic and a major contributor to chronic disease and mortality.
  • Adipose tissue, once considered inert, is an active organ producing cytokines and pro-hormones that can lead to hypertension, dyslipidemia, atherosclerosis, thrombosis, and type 2 diabetes. Imbalances in adiponectin and leptin levels contribute to insulin resistance.
  • Childhood obesity is a global epidemic, with approximately 33 million children in India living with overweight or obesity. This prevalence is projected to increase significantly by 2035, driven by excessive calorie intake, reduced physical activity, and increased screen time.
  • Overweight adolescents have a high risk of developing pre-diabetes or diabetes, as shown by the CNNS study. Research indicates that a significant percentage of obese children and adolescents already exhibit impaired glucose tolerance or type 2 diabetes.
  • Small for gestational age (SGA) babies in India are more prone to developing insulin resistance and metabolic syndrome due to fetal undernutrition and subsequent epigenetic changes. Maternal undernutrition leads to fetal insulin resistance as a protective mechanism for the brain, which can result in metabolic syndrome later in life.
  • Metabolic syndrome, defined by specific criteria including waist circumference, triglyceride levels, HDL cholesterol, fasting blood glucose, and blood pressure, is a harbinger of future cardiovascular disease and type 2 diabetes. Its prevalence is significant among overweight and obese Indian children.
  • Management of diabetes and obesity in children involves lifestyle modification, psychotherapy, pharmacotherapy, and, in severe cases, bariatric surgery. Lifestyle modification is crucial but often insufficient.
  • Pharmacotherapy options for obesity include orlistat, phentermine, lorcaserin, topiramate, and GLP-1 agonists like semaglutide. Semaglutide has shown revolutionary results in weight loss but is not yet licensed in India.
  • Bariatric surgery, such as Roux-en-Y gastric bypass, can be effective for teenagers with extreme obesity and associated comorbidities. Selection criteria include BMI and the presence of diabetes or hypertension.
  • Prevention of obesity is paramount, emphasizing exclusive breastfeeding, regular meal timings, adequate sleep, and adherence to the "5-2-1-0" rule (5 servings of fruits and vegetables, less than 2 hours of screen time, 1 hour of physical activity, and zero sugar-sweetened beverages).

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