Cases of obesity are on the rise in Canada, and people living with type 1 diabetes (T1D) are also affected. This is a cause for concern because overweight and obesity are risk factors for several illnesses and health conditions, including type 2 diabetes (T2D) and heart disease.
People with T1D who are also obese are at risk for developing additional complications, such as needing larger insulin doses and having high blood pressure and high blood cholesterol. Since these problems are usually commonplace among people with T2D, these cases are referred to as double diabetes.
Prejudices and stereotypes
The latest findings on the causes of obesity show that the condition is the result of a combination of hereditary, biological, socioeconomic, psychological, environmental and hormonal factors, and rarely caused by behaviour only. Certain situations that people with T1D have to deal with can increase the risk of obesity, such as the need to ingest carbs to treat hypoglycemia, limited physical activity due to the risk of hypoglycemia, and eating processed foods to make carb counting easier.
The Canadian Medical Association Journal recently published new guidelines for the management of obesity that describe it as a complex condition that cannot be assessed on the basis of body mass index (BMI) or waist circumference alone. These measurements are reference points only, and aiming for a BMI within the normal range is not necessarily always the right solution.
“There is a recognition that obesity management should be about improved health and well-being, and not just weight loss.”
Canadian Medical Association Journal
This is also what Équilibre, a non-profit organization from Quebec, has been advocating since it was founded in 1991. The organization promotes “a scientific rationale which recognizes that obesity is a multifaceted condition that cannot be managed with a single, one-for-all approach.”
Steps for managing obesity
It is recognized that even in the presence of excess weight, healthy eating and regular physical activity significantly reduce health risks. Other key points include recommendations to healthcare professionals that aim to give case management a better chance of success, including seeking their patients’ consent before discussing weight issues, setting common and realistic goals, and taking a multidisciplinary approach (physician, dietician, psychologist, etc.).
The best strategies for people with T1D have not been established yet, but reducing the number of hypoglycemic episodes seems to be a key factor. In some cases, healthcare professionals can prescribe medications that are usually used by T2D patients or consider certain surgical procedures.
The BETTER registry looks at variables in order to find solutions for people who live with T1D and who are overweight or obese.
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References
- Wharton, S., C. W. Lau, D., Vallis, M., Sharma, A. M., Biertho, L., Campbell-Scherer, D., Adamo, K., Alberga, A., Bell, R., Boulé, N., Boyling, E., Brown, J., Calam, B., Clarke, C., Crowshoe, L., Divalentino, D., Forhan, M., Freedhoff, Y., Gagner, M., Wicklum, S. (2020). Obesity in adults: a clinical practice guideline. CMAJ. 192:E875-91. doi: 10.1503/cmaj.191707
- Mottalib, A., Kasetty, M., Mar, J. Y., Elseaidy, T., Ashrafzadeh, S., & Hamdy, O. (2017). Weight Management in Patients with Type 1 Diabetes and Obesity. Current Diabetes Reports, 17(10). doi:10.1007/s11892-017-0918-8
- Leroux, C., Brazeau, A., Gingras, V., Desjardins, K., Strychar, I., Rabasa-Lhoret, R. (2014). Lifestyle and Cardiometabolic Risk in Adults with Type 1 Diabetes: A Review. Canadian Journal of Diabetes, 38(1), 62-69. doi:10.1016/j.jcjd.2013.08.268
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