Does Obesity Always Mean T2DM (Type 2 Diabetes mellitus)?

Type 2 diabetes mellitus, also known as T2DM is a chronic metabolic disorder caused by high levels of blood sugar, due to the body’s inability to produce insulin (insulin deficiency) and that of the peripheral organs to respond appropriately to insulin (peripheral insulin resistance).

How does fat accumulate in the body?

The abnormal gain of fat mass is generally due to overconsumption of carbohydrates, sugar, fat, oils, etc. and underutilization of the excess energy obtained in this way (on account of low levels of physical activity). In instances of overconsumption of carbs, a hormone in our body called leptin is triggered to alert the brain to reduce the appetite, to tell the body to exercise and be more physically active, so that more calories are burnt. With an increase in the fat mass in the body, leptin gets stimulated which in turn alerts the brain. This is a natural way to maintain a balance in the body. Prolonged higher levels of leptin in the blood cause leptin resistance, meaning the brain is unable to recognize these high levels of leptin and thus loses the ability to command the body to burn more fat. This results in the accumulation of fats in tissues such as the liver, pancreas, and heart, eventually leading to cardiovascular disease and other complications.

Not all obese people necessarily develop Type 2 Diabetes. This is mainly related to the way in which fat cells get accumulated in the body. There are 2 ways in which excess fat gets stored – one, beneath the skin (subcutaneous) and the other is in the abdominal cavity (viscera/Waist) of obese patients. Compared to the abdomen, fat deposited under the skin is relatively harmless as it does not produce harmful hormones (adipocytokines). The skin has more space to store fat since it is the largest organ in the body. However, the fat that gets accumulated within the abdomen and around internal organs is more toxic. Fat that gets stored here tends to be metabolically more active. Hence these fat cells tend to produce more adipocytokines, the inflammatory hormones which enhances insulin resistance All in all, increased amount of visceral fat is directly and independently linked to several complications such as insulin resistance,   altered glucose tolerance, type 2 diabetes, high cholesterol levels, heart diseases, etc.