What Does “Diabesity” Mean?

A UHealth physician explains why Hispanics have a greater risk of diabetes and obesity.

In America, the twin epidemics of diabetes and obesity are so common a new term has come into use: “diabesity.” 

In 2021, a report revealed that about 30% to 53% of type 2 diabetes (T2D) in the United States is linked to obesity or having a Body Mass Index (BMI) of 30.0 or higher.  

It’s a growing concern; nearly 42% of adults living in the U.S. struggle with excessive weight, and the problem is worse among Hispanics. According to the Centers for Disease Control, approximately 46% of Hispanic adults are affected by obesity, and they are 70% percent more likely than non-Hispanic white adults to be diagnosed with diabetes. 

Why do Hispanics have a higher risk for diabesity? 

The numbers don’t lie; Hispanics face a greater risk, but why? There are many reasons, says Rodolfo J. Galindo, M.D., FACE. Dr. Galindo is an endocrinologist at the University of Miami Health System and director of UHealth’s Comprehensive Diabetes Center. Along with other researchers, he authored a report identifying some reasons for the disparity: 

• Genetic predisposition – some Hispanics have genetic and epigenetic (changes in gene activity that don’t affect DNA) associated with obesity and obesity-related diseases such as T2D; this is especially true if they live in an area with no access to healthy food or active modes of transportation such as walking 
• Environmental influences – the longer a person of Hispanic ethnicity lives in the U.S., the more likely they are to eat poorly and become sedentary 
• Traditional Hispanic diets tend to be calorie‐dense and high-carbohydrate 
• Food insecurity 
• Gut microbiome factors associated with obesity
• Body image ideals – a larger, curvy body is considered desirable among certain Hispanic groups
• Family dynamics can influence medical decisions
• Differences in socioeconomic status – certain Hispanic groups are more likely to gain excess weight than others
• Disparities in healthcare access – language barriers can interfere with obesity care; uninsured individuals are also less likely to have weight loss (bariatric) surgery
• Patient care guidelines are typically developed for broader populations and may not be appropriate for Hispanics 

Dr. Galindo says that a lack of health insurance is an obvious pitfall. Not only are uninsured individuals less likely to have bariatric surgery or use anti-obesity medication, but finances may require that they choose older, less expensive diabetes medications that cause more weight gain than newer, more expensive drugs.

Culturally sensitive solutions

While these circumstances complicate treatment, Dr. Galindo’s research highlighted several solutions. Increased access to healthy food and encouraging physical activity are essential. Healthcare providers should understand a patient’s family dynamics and involve key family members in treatment discussions and decisions. Patients can also seek out providers who speak their language and understand their culture. 

“Culturally tailored interventions have been successful in managing obesity and related comorbidities in Hispanic people. To implement an individualized treatment plan in this population, healthcare providers must consider the impact of genetic, dietary, cultural, and socioeconomic factors,” Dr. Galindo says. 

When Dr. Galindo sees patients struggling with diabesity, he recommends changes to their diet and lifestyle. Medication helps some patients; others benefit from weight loss surgery. Bariatric surgery is not a quick fix. However, patients may regain weight if they don’t eat healthy and exercise. 

Dr. Galindo’s report also highlighted personalized, culturally tailored approaches to diabesity care:

• Low‐income Hispanic families receiving tailored nutrition education from a bicultural dietitian were likelier to adopt healthier food purchasing habits. 
• Intervening early is important, especially with young Hispanic women who seem more apt to eat a high-sugar, high-fat diet. 
• Culturally tailored programs, such as “Vida Sana/Healthy Life”, help. Vida Sana involved one year of in‐person intervention sessions, an activity tracker, and a diet‐ and exercise‐tracking app.
• Most participants in the Compañeros en Salud program lost weight, and reduced their blood pressure, glucose, total cholesterol, and A1c levels. The 12-week program included classes and home visits from a community-based promotora (facilitator). 
• Promoting physical activity might help alleviate genetic risk factors and prevent the loss of muscle mass associated with T2D. 
• Physicians should discuss surgical interventions with patients who would benefit.
• When developing treatment strategies, healthcare providers should acknowledge that diversity among Hispanic groups can impact their food choices, language preferences, and use of health care. 

Dr. Galindo says the aim of treatment is not to make a person thinner but to prevent and treat obesity-related diseases, such as type 2 diabetes. “Because the prevalence of undiagnosed comorbidities can be high among Hispanic people, healthcare providers should emphasize the importance of screening for obesity‐related conditions, such as T2D.” 

There are several ways to tackle the twin threats of diabetes and obesity. 

“For years, the only well-validated approach for treating T2D and preventing related complications was to reduce glucose levels. In the last few years, we discovered that newer therapies, initially developed for T2D, not only decrease A1c but also prevent heart and kidney disease without creating low glucose levels. Many newer therapies also result in significant weight loss, which can positively impact diabetes or achieve diabetes remission,” Dr. Galindo says.

“That is why we changed our focus from simply lowering glucose to a more holistic approach, which includes weight loss and preventing comorbidities in people with diabetes. Weight loss not only helps with T2D, but also with other conditions associated with obesity such as osteoarthritis, heart disease, and nonalcoholic steatohepatitis (NASH).” NASH is a severe form of nonalcoholic fatty liver disease.

“The recent development in incretin pharmacotherapy, such as popular agents like semaglutide and tirzepatide, helped change the paradigm. These are not new agents; in fact, the first generation of these medications, such as Exenatide (Byetta) or Sitagliptin (Januvia), have been used to treat T2D since the early 2000s but were only approved for treating diabetes and had little or no effect on weight loss. Trizepatide and semaglutide drugs are now as effective as some types of bariatric surgery in terms of body weight. Surgeons often recommend an intensive lifestyle treatment, and these medications initially induce some weight loss that leads to better surgical outcomes. We use these medications, and we work closely with the Bariatric Surgery Center at UHealth for those who need it,” Dr. Galindo says.

Tirzepatide helps control diabetes by stimulating GLP-1 and GIP receptors.

GLP-1 receptors are proteins found in cells of the pancreas and on neurons in the brain. They help control blood sugar by enhancing insulin secretion. GIP also stimulates insulin secretion. “The other popular medication in this family, Ozempic, only stimulates GLP-1,” Dr. Galindo says.

In studies, tirzepatides did a better job reducing weight and controlling A1c than Ozempic in some patients – albeit only in studies using lower doses of Ozempic than what is used for weight loss. Both drugs can cause nausea, vomiting, and abdominal pain, but these side effects generally improve over time. 

While Hispanics are disproportionately affected by obesity and diabetes, Dr. Galindo feels fortunate to practice medicine at this time. “We now have many great options to offer patients, not only focusing on lowering glucose to ‘acceptable levels’ but rather to normal A1c levels. At the same time, we can prevent cardiovascular and renal disease with the added benefit of weight loss.” 

To schedule an appointment with a faculty member of the Comprehensive Diabetes Center, call 305-243-4000.

Nancy Moreland is a regular contributor to the UHealth Collective. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: Comprehensive Diabetes Center, Diabetes care in Miami, Dr. Rodolfo Galindo, obesity