‘Weight Loss of 5-10% Could Save Thousands of Kiwis from Diabetes’ – Endocrinologist

More needs to be done to improve obesity messaging and to target those most at risk if we are to stem the impact of a diabetes epidemic on our health system – according to a leading endocrinologist.

Latest government health figures show almost one in three Kiwis over the age of 15 are obese. The national prevalence of obesity has increased in the year to 2019/2020, particularly levels of ‘morbid-obesity’ – defined as having a body mass index (BMI) 40-50 kg/m2.[1][2][3]

The life expectancy of those living with severe or morbid obesity is shortened by approximately 8-10 years.[4]

Obesity affects Maori and Pasifika to a greater degree with prevalence rates of 48% and 63% respectively, is a modifiable risk factor contributing to inequities in health outcomes and unnecessary premature deaths.[5][6]

Obesity and diabetes are closely linked, with 80% of patients with type 2 diabetes considered obese. Obesity is also associated with other comorbidities, including kidney failure, fatty liver, breathing problems, reduced mobility, chronic joint pain, and increased death rates from heart disease and several cancers.[7][8]

In New Zealand, the prevalence of type 2 diabetes is estimated to be 4.7%, however, the prevalence is higher for Maori (5.3%), Asian (5.7%), and Pasifika (11.1%) than European and other ethnicities (4.7%). Pasifika are also set to see the largest increases in type two diabetes, with estimates of up to 16.2% of their people living with the disease by 2040.[9][10]

Maori and Pasifika also make up the largest population group in New Zealand dialysis units.[11]

Dr Ole Schmiedel, Auckland endocrinologist, says he is especially concerned about the rising incidence of type 2 diabetes in children and young adults, as this early presentation causes a more aggressive disease, greater numbers of complications and earlier death from complications of the disease than type 1 or type 2 diabetes diagnosed in older age groups.[12]

He says a report, recently presented to the Ministry of Health, points to the cost associated with type 2 diabetes in young people, which costs the country more than half a million dollars additionally for each person over their lifetime.[13]

“Two decades ago, type 2 diabetes in childhood and adolescents was virtually unknown, however now it is common for patients of this age group to present with the disease.

“One current method of care for super-obesity after exhausting all other options is bariatric surgery, however, each gastric sleeve/bypass costs the government around $9,000-$12,000, and only a very limited number of surgeries are publicly funded per year.[14]

“Consequently, this method does not substantially impact the rising number of people living with obesity and diabetes in New Zealand; and only approximately 0.5% of the eligible population can receive this treatment in the public sector,” he says.[15]

Dr Schmiedel says research shows in adults with type 2 diabetes, weight loss of 5-10% can increase the likelihood of disease remission as well as improving other obesity related comorbidities.[16]

“Talking about weight is not easy and many misconceptions, stigma and denial prevent us from having an open and educated debate.

“It is essential that we never blame and shame those who carry excess weight and struggle with obesity. As a society we need to broaden our understanding that there are many social determinants of health, including our obesogenic environment, which is responsible for this problem.

“In addition, we know that complex mechanisms in the brain play a role in regulating hunger and cravings which can manifest as a further barrier to weight loss,” he says.

Dr Schmiedel says, if we start having conversations with people and their whanau at an early stage we can prevent many complications and may even be able to bring type 2 diabetes into remission.

“It is well proven that modest weight reductions can lead to significant improvements in many of the associated complications, including type 2 diabetes and high blood pressure.

“This is something achievable and we need to aim for realistic and sustainable weight loss,” he says.

Dr Schmiedel says, when we are talking about weight it is not so much about the kilograms lost but more about the reduction of problems related to excess weight.

“When people come to me for management of their weight, they are concerned about weight related problems. People want sustainable weight loss and as clinicians we need to be able to support them on this lifelong journey.”

“It is so important that people have a chance to be understood with respect to their weight problems, that we as a community, address weight without stigmatisation and blame, overcome old misconceptions, and support and help wherever possible.

“I encourage people to find an empathetic healthcare provider they feel safe initiating a conversation with who can tell them about the options available to them.

“It is time that we as society start taking obesity seriously and head off a preventable disease epidemic that we are facing,” he says.


References:

[1] Ministry of Health. Accessible here.

[2] NZ Health Survey Annual Update of Key Results 2019/20. Accessible here. Accessed 15 July 2021.

[3] BMI Classifications. Australia & New Zealand Gastric and Oesophagael Surgery Association. Accessible here.

[4] Whitlock G, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-96.

[5] NZ Health Survey Annual Update of Key Results 2019/20. Accessible here. Accessed 15 July 2021.

[6] Theodore R, McLean R, TeMorenga L. Challenges to addressing obesity for Maori in Aotearoa/New Zealand. Aust N Z J Public Health. 2015 Dec;39(6):509-12. doi: 10.1111/1753-6405.12418. Epub 2015 Aug 10. PMID: 26260663. Accessible here.

[7] Health Outcomes of Severely Obese Type 2 Diabetic Subjects 1 Year After Laparoscopic Adjustable Gastric Banding. John B. Dixon, Paul E. O’Brien. Diabetes Care Feb 2002, 25 (2) 358-363; Accessible here.

[8] Pi-Sunyer X. The medical risks of obesity. Postgrad Med. 2009;121(6):21-33. Accessible here.

[9] Health Quality & Safety Commission of NZ – Diabetes Atlas. Accessible here.

[10] The Economic and Social Cost Of Type 2 Diabetes 2021. Diabetes NZ. Accessible here.

[11] Ministry of Health. NZ Nephrology Annual Report 2018. Accessible here.

[12] Wilmot E, Idris I. Early onset type 2 diabetes: risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014;5(6):234-244. Accessible here.

[13] The Economic and Social Cost Of Type 2 Diabetes 2021. Diabetes NZ. Accessible here.

[14] Gounder ST, Wijayanayaka DR, Murphy R, Armstrong D, Cutfield RG, Kim DD, Clarke MG, Evennett NJ, Humphreys ML, Robinson SJ, Booth MW. Costs of bariatric surgery in a randomised control trial (RCT) comparing Roux en Y gastric bypass vs sleeve gastrectomy in morbidly obese diabetic patients. N Z Med J. 2016 Oct 14;129(1443):43-52. PMID: 27736851. Accessible here.

[15] Murphy, R., Ghafel, M., Beban, G., Booth, M., Bartholomew, K. and Sandiford, P. (2019), Variation in public-funded bariatric surgery intervention rate by New Zealand region. Intern Med J, 49: 391-395. https://doi.org/10.1111/imj.14226

[16] Dambha-Miller H, Day AJ, Strelitz J, Irving G, Griffin SJ. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med. 2020 Apr;37(4):681-688. doi: 10.1111/dme.14122. Accessible here.

Photo credit: Myriam Zilles on Unsplash

About Dr Ole Schimedel

Dr Ole Schimedel
Dr. Ole Schmiedel is a consultant in Endocrinology, Diabetes, and General Internal Medicine at Auckland District Health Board. He also is the Service Clinical Director of Auckland Diabetes Centre. He has been working as physician and endocrinologist in New Zealand since 2009.

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