Obesity and diabetes are often related. There’s even a term for when these two conditions happen at the same time: “diabesity.” Studies show that adults with a body mass index (BMI) score in the obese range are between five and seven times more likely to develop type 2 diabetes than those with a body weight in the “normal” BMI range.

If you’ve been diagnosed with obesity, it’s critical to understand your risk for diabetes. Learning to spot the warning signs and reduce your risk can help prevent serious health issues down the line.

How Does Obesity Contribute to Diabetes?

Obesity changes the body in a few ways that are associated with diabetes, including higher levels of inflammation and a greater risk of insulin resistance. The most common form of diabetes (and the type that’s related to obesity) is type 2 diabetes. During type 2 diabetes, the body grows resistant to insulin.

Insulin is a hormone that lets the body move sugar from the blood into the body’s cells. Levels of blood sugar go up after eating and digesting food. Insulin helps the body use this sugar for energy, either right away or stored as fat for future use. Cells of the brain, muscles, and organs take in sugar to fuel different functions.

You can think of insulin as a key. It opens the cells so they can let the sugar in and use it. When someone is resistant to insulin, this “key” gets rusty and doesn’t work as well. As a result, sugar stays in the blood instead of making its way into the cells.

Over time, this high blood sugar is harmful. Delicate blood vessels, like those in the eyes and kidneys, get damaged when there’s too much blood sugar floating around.

Some healthcare providers use the metaphor that high blood sugar is like having shards of glass pumping through your veins because it sort of cuts up the lining of the blood vessels. It’s the reason that people with diabetes are at risk of going blind, developing heart disease, and experiencing kidney failure. High blood sugar also makes it harder for the body to heal from wounds, putting people at risk for infections and amputations.

How Is Obesity Related to Insulin Resistance?

When someone is living with obesity, their body often has higher levels of inflammation. Inflammation affects how hormones function, including insulin.

A cascade of effects happens when there’s high inflammation in the body. As the muscle cells become resistant to insulin, they aren’t getting enough sugar for energy. Then, the liver starts making more sugar (in the form of glucose). This glucose is shuttled to the bloodstream to feed these “starving” muscle cells. But because the cells aren’t responding to insulin, blood sugar levels simply continue to go up.

This causes more inflammation and problems with other parts of the metabolic (energy) system, like the ability to make insulin. The pancreas has special cells called beta cells. These cells are responsible for making insulin. For those with obesity, these cells may not function properly. Sometimes they make too much insulin that the body can’t use. Other times, they don’t make enough insulin.

Both problems can cause blood sugar levels to stay high, damaging the body and increasing the progression of diabetes. Extra fat can also build up in the liver and pancreas, making it even harder for these organs to control blood sugar properly.

People with obesity also have more free fatty acids in their bloodstream. This promotes insulin resistance because the muscles start using readily available fats for energy instead of using insulin to process sugar. Fat tissue, also called adipose tissue, releases chemicals (called adipokines) that induce processes in the liver, pancreas, and gut to increase blood sugar.

Preventing Diabetes

Small changes can make a big difference in your chances of developing diabetes. Research shows that weight loss improves blood sugar levels and lowers the body’s resistance to insulin. Losing 5 percent to 10 percent of your current weight could lower your risk of diabetes and other obesity-related conditions, like high blood pressure.

Changes you can make to reduce the risk of diabetes include:

• Cutting back on processed foods
• Eating more fiber through vegetables, beans, and whole grains
• Getting enough sleep at night
• Reducing stress
• Swapping sugar-sweetened beverages for water
• Taking walks after meals
• Engaging in regular physical activity

Ask your doctor for a referral to a registered dietitian nutritionist who can help you find ways to change your diet and lower your risk of diabetes. If you have early signs of diabetes, you may be able to participate in a diabetes group class where you can learn more about the disease and ways to prevent and manage it.

Managing Diabetes and Obesity

Treating obesity helps with diabetes. In some cases, obesity treatment can put diabetes into remission, meaning it’s no longer a threat to the body.

The first line of obesity and diabetes treatment is lifestyle change. Physical activity, healthy eating, and weight loss all help prevent problems from diabetes and obesity.

Medications such as sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and GLP-1 receptor agonists may be helpful for both conditions. They lower blood sugar levels and promote weight loss, treating obesity and diabetes at the same time.

However, some medications for diabetes may cause weight gain, like insulin. Your healthcare provider can discuss the pros and cons of different diabetes drugs to help you find the right treatment based on your overall medical history and health risks.

Bariatric surgery is another option for people diagnosed with severe obesity. It can also significantly reduce type 2 diabetes, as long as the weight lost after surgery is not regained. Bariatric surgery has long-lasting effects that may offer better weight management and blood sugar control than many medications. If diabetes returns, it’s usually easier to manage than it was before surgery.

Any form of surgery comes with risks, so you’ll need to weigh the decision carefully. Surgery shouldn’t be the first attempt to control obesity or diabetes, but it can be a helpful tool if other treatments aren’t working for you.

Understanding Your Risk

Diabetes is a major health condition that people with obesity are more likely to develop. Discussing this risk with your healthcare provider is crucial. As with most medical issues, catching diabetes early can help prevent serious complications. Given the clear link between diabetes and obesity, most healthcare providers agree that it makes sense to screen people with obesity for signs of diabetes on a regular basis.

One way to check for early diabetes is by testing your blood sugar levels. Your doctor can check how high your blood sugar is in the morning before breakfast. Results that fall outside of the normal range may mean there’s a problem with how the body makes or uses insulin.

Hemoglobin A1c is a blood test that reflects your body’s blood sugar levels over the past three months. Hemoglobin is part of the red blood cells. Glucose or blood sugar molecules attach to hemoglobin. When people have high blood sugar, their percentage of “glycated hemoglobin,” or sugared red blood cells, is high.

Doctors use A1c to check for diabetes. A result between 5.7 percent and 6.4 percent means prediabetes, while 6.5 percent or higher means diabetes. For people already diagnosed with diabetes, the goal is usually to keep A1c below 7 percent to help prevent complications. Your doctor may recheck this test every three to six months to track changes.

Talk With Others Who Understand

MyObesityTeam is the social network for people with obesity and their loved ones. On MyObesityTeam, more than 56,000 members come together to ask questions, give advice, and share their stories with others who understand life with obesity.

Have you been diagnosed with diabetes? Do you have tips for others about managing blood glucose levels and staying healthy? Share your experience in the comments below or on your Activities page.