The Management of Diabesity

Dr. CHOW Wing Sun - Vice President (Medical Chapter), HKOS

Obesity is associated with an increase in morbidity and mortality, and is a major risk factor for the development of type 2 diabetes mellitus, a disease characterized by insulin resistance, relative impairment in insulin secretion, and hyperglycaemia. The term “diabesity” is derived from the words ‘diabetes’, referring to type 2, and ‘obesity’. This hybrid descriptive term is able to convey the message that diabetes and obesity are two closely related disease entities. Clinicians are now fully aware of the intrinsically connected pathophysiology in type 2 diabetes and obesity.

The prevalence of obesity and type 2 diabetes are increasing worldwide. According to International Diabetes Federation (IDF), already 415 million adults are having diabetes in 2016 and this number is expected to rise to 642 million by 2040. Based on our own data, the majority (~80%) of adults with type 2 diabetes are overweight or obese, highlighting the pivotal role of increased adiposity as a risk factor for diabetes.

Whilst the benefits of weight loss in the prevention of the development of diabetes and as a crucial component of glycaemic control and for cardiovascular risk reduction in managing diabetes are well established, weight reduction remains challenging for most overweight or obese individuals. Lifestyle intervention alone is insufficient to achieve a significant weight loss in the majority of individuals as obesity is usually resulted from an array of metabolic and psychological factors. Other alternative options, such as pharmacotherapy or bariatric surgery, need to be considered. However, many traditional antidiabetic agents may paradoxically lead to weight gain. The newly available pharmacological agents can optimize glycaemic control while at the same time induce a significant weight loss.

With the establishment of the Hong Kong Obesity Society, we aim at engaging clinicians from different specialties and various allied health professionals who are involved in the management of obesity or its related disorders in their daily practice, on the utilization of new therapeutic agents or devices in their daily clinical practice.