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vast majority of cultures. Today, humans are largely sedentary with
easy access to an abundance of energy-rich, processed foods.

The physiological links between obesity and diabetes are poorly under-
stood, but what is important is that obesity leads to insulin resistance in
the majority of cases. It is generally thought that defects in lipid metab-
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olism in obese patients are the root cause of T2DM in these patients.
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In the obese patient, lipid molecules may leak from the adipocytes
into the bloodstream where they are eventually taken up by liver and
muscle cells. Once inside these cells, the lipids interfere with signal-
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ling processes crucial to the correct functioning of insulin. In addition,
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insulin resistance is associated with subclinical inflammatory responses
throughout the body. Furthermore, it is also becoming increasingly
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clear that adipose tissue is far more than just a storage tissue, acting
in many ways like an endocrine organ. In obesity, the para-endocrine
functions of this tissue may be impaired. 20

Figure 5. Age-adjusted prevalence of diabetes by ethnicity and BMI category, clearly
showing the increasing prevalence of the disease with increasing BMI (upper – men;
lower – women). 39

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