Many of us have noticed that as we age, it can become more difficult to fit in our jeans. As a doctor, I am also keenly aware that the weight gained around the midabdomen (so-called abdominal obesity) carries certain health risks, including the development of type 2 diabetes.
The number of people in this condition rose sharply along with the waistline, which increased from 1.4 million in the UK in 1996 to over 4.3m in 2024. An additional 136 million people have now been identified as developing cusps with type 2 diabetes. But what exactly does this mean for your health?
What is prediabetes?
Prediabetes can be a precursor to type 2 diabetes. Type 1 and type 2 diabetes have completely different causes.
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Type 1 diabetes is usually diagnosed during childhood or early adulthood, and insulin treatment is required for the rest of your life. It is an autoimmune disease, where the immune system attacks the cells in the pancreas that produce insulin. It has nothing to do with lifestyle.
Type 2 diabetes is primarily related to insulin resistance, similar to prediabetes. If you have prediabetes, your blood sugar level (sugar) will be higher than normal, but it is not yet sufficient to diagnose type 2 diabetes.
Insulin is the most important hormone for controlling blood sugar. If you have type 2 diabetes, your body still produces insulin, but it cannot respond effectively and tries to compensate for this by producing more insulin. Over time, insulin-producing cells in the pancreas become worn out and unable to produce insulin. Therefore, some people who have had type 2 diabetes for a long period of time need insulin treatment.
If you are diagnosed with prediabetes, you are at risk of developing type 2 diabetes. This is serious. This is serious because persistent hyperglycemia can damage the eyes, nerves and kidneys, increasing the risk of heart attacks, strokes and heart failure.
However, a diagnosis of prediabetics provides an opportunity to make lifestyle changes that can address the damage. Up to half of people with prediabetics can avoid or delay progression to type 2 diabetes.
Who is at risk?
Symptoms such as feeling thirsty, needing LOO more frequently, recurrent thrush infections, and slow wound healing suggest that type 2 diabetes may be possible.
Diabetes does not cause symptoms, so unless you check out you will not know you have symptoms. It is important to take a prediabetic test if you have risk factors including:
Excess weight around your midrif harving type 2 diabetes, especially if you are over 40 years old and have other risk factors
If you are worried, ask your GP to test it. It is diagnosed based on a single non-durable blood test called HBA1c. This shows the average blood glucose level over the past few months.
Get a “know your risk” rating and find out what could put your health at risk.
How to reduce the chances of prediabetics
Look at your hips
If you are overweight or living obese, reducing your weight by just 5% can significantly reduce your risk of developing type 2 diabetes.
It's moving
Sedentary lifestyles are closely linked to diabetes, even without other risk factors. If activities are involved, all small help. You can stop early from the bus, take a walk at lunchtime, use the standing desk, or join a walking group. The best exercises are the kinds you stick to.
Choose unrefined foods
Sophisticated carbohydrates (such as sugar and processed foods, white bread/flour/pasta) can actively increase risk, so choose whole grains and fruits and vegetables instead.
Think about when you eat
For a long time I have practiced the intermittent fasting form known as time-limited diet. I only eat every 24 hours for 6-8 hours. Intermittent fasting has been shown to reduce insulin resistance, and if you take a large scale of unrefined foods and proper protein (I have lots of beans, legumes, vegetables, whole grains), you won't feel really hungry once you get used to it.
Please control
If you have been diagnosed with prediabetes, you are eligible for the health status of the NHS Diabetes Prevention Program, a 9-month lifestyle change course. You have the option of face-to-face groups or digital services, and receive personalized support to choose healthier diets, become more active and manage your weight. Those who completed the program reduced their risk of developing type 2 diabetes by more than a third. Consult GP surgery to find out more.
Why are midlife medium and menopause important?
Carrying extra weight around your center means that fat accumulates around organs such as your pancreas and liver. This can lead to insulin resistance. Insulin resistance causes the body to put glucose into cells to provide energy, as it does not respond properly to insulin signals. And it increases the chances of having hyperglycemia (sugar).
The weight gain around the middle of your body is generally recognized around menopause, a time when estrogen levels, a critical female hormone, decrease. There is also a link between estrogen and type 2 diabetes. Estrogen stimulates cells lined up in blood vessels to deliver insulin to the muscles. This lowers blood sugar levels and reduces the risk of developing type 2 diabetes.
After menopause, male androgen hormone levels in the body increase. Unfortunately, these androgens also promote the tendency to develop fat deep inside the tummy.
Even if you don't put weight around the menopause, you're almost five times more likely to develop abdominal obesity than before menopause. After menopause, your body continues to produce after it is naturally converted to estrogen, which does not seem to provide the same protection against type 2 diabetes.
As a result, it is important to try to ensure that your overall weight and body mass index (BMI) are within a healthy range. However, even so, if your lower back is measured large, you may be at risk for type 2 diabetes.
For healthy measurements, you should aim to have a lower waist below 80cm (31.5 inches) for all women. 94cm (37 inches) for most men. Or 90cm (35 inches) for South Asian men.
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