Obesity is a significant health concern worldwide, beginning in the United States and spreading to other Western countries. While about 75% of Americans fall into either the overweight or obese categories, as many as 93% of Americans have poor metabolic health. As body mass index increases, the risk of type 2 diabetes consistently increases as well. With the rising costs of prescription medications for diabetes and increasing awareness of functional medicine for addressing both diabetes and obesity, focusing on their underlying causes and improving overall holistic health can help support individualized care and root cause resolution.
A functional medicine approach for managing obesity and diabetes includes several key principles:
- Nutrition therapy
- Physical activity
- Weight management
- Inflammation reduction
- Gut health promotion
- Stress management
- Sleep improvement
- Supplement optimization
This article first discusses the underlying link between obesity and diabetes to understand how the conditions interplay. It then presents the functional medicine principles in managing obesity and diabetes. Understanding gut health, nutritional interventions, and dietary modifications is crucial, and the values of sleep, stress management, and emotional well-being all play a part. Coordinating care from a holistic perspective and applying personalized approaches are the cornerstones in utilizing functional medicine for obesity and diabetes.
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Understanding the Link Between Obesity and Diabetes
Obesity and diabetes are directly linked, and understanding their association is a fundamental step towards better health. Adipose tissue, or body fat, is not an inert substance. Instead, it may contribute to a number of cardiometabolic effects, including insulin resistance, pancreatic beta cell dysfunction, hepatic steatosis, atherogenic dyslipidemia, and hormonal dysregulation.
There are several types of adipose tissue. White adipose tissue is pro-inflammatory with high endocrine activity. It plays significant roles in fat storage, metabolism, hormone secretion, and insulin release. Insulin resistance is a key initial factor in poor metabolic health. It may lead to resistance to the effect of insulin in the skeletal muscle and in the liver, plus alterations in beta cell function in the pancreas. When tissues are resistant to insulin, the pancreatic beta cells respond by making more and more insulin, leading to elevated fasting insulin levels. Insulin is a “fed-state” hormone, so it promotes fat storage and inhibits fat breakdown. This can lead to more storage of adipose tissue and obesity.
As the volume of adipose tissue increases, the risks of both obesity and type 2 diabetes mellitus may continue to rise. Adipose tissue may also reduce satiety (fullness) hormones, increase hunger hormones, and promote a pro-estrogen state. It produces free radicals, leading to oxidative stress and mitochondrial dysfunction. Mitochondria are the energy powerhouse of cells. Damage to mitochondria may lead to abnormal cellular metabolism. And as obesity and type 2 diabetes mellitus worsen, chronic inflammation may continue to progress, potentially causing long-term effects on mitochondria, cells, tissues, and other organs.
Principles of Functional Medicine in Managing Obesity and Diabetes
Functional medicine is root-cause-focused health care. Rather than relying on a series of specific protocols uniform across every patient, functional medicine sees the body as a system, and it applies biology to the concepts of form and function as interdependent and interconnected units.
When it comes to obesity and type 2 diabetes mellitus, which are directly linked, functional medicine does not view them as two separate, unrelated processes with different paths of management. Rather, functional medicine acknowledges that the body is a system. And, because they are directly linked, many of the same functional medicine approaches to managing obesity and type 2 diabetes mellitus are unified.
Not everyone with obesity has type 2 diabetes mellitus, and not everyone with diabetes has obesity. However, they are directly associated with the linkage of increased body fat in both conditions. With the increased adiposity comes insulin resistance, which is a core metabolic factor in both obesity and type 2 diabetes mellitus, plus chronic inflammation and its downstream effects.
The functional medicine approach to obesity takes this abnormal function of increased body fat and addresses that root cause. Addressing the root cause of increased adiposity may help improve insulin sensitivity, reduce inflammation, support weight management, improve HbA1C, and help maintain other metabolic components.
However, it is important to understand that the personalized approach of functional medicine is vitally important. Individuals are unique, and physiology varies from person to person, from gene expression to nutritional status to neuroendocrine hormones to other metabolic factors. This is where functional medicine testing can help elucidate the root-cause etiology and can guide personalized approaches for individuals with obesity and diabetes mellitus.
The Role of Gut Health in Obesity and Diabetes
The gut microbiome contains a complex community of trillions of bacteria, viruses, and fungi (called the microbiota). The microbiome plays an integral role in supporting health. Your gut has significant impacts on immunity, cardiovascular health, metabolic health, overall nutritional status, and may help reduce the risk of autoimmune disease, cancer, gastrointestinal dysfunction, inflammatory conditions, and more.
The balance of your microbiome can be tipped out of equilibrium by many factors, like a poor diet, stress, inflammation, medications, and other factors. This unfavorable shift in the microbiome allows harmful bacteria to take over and beneficial bacteria to decrease, a condition called dysbiosis. Dysbiosis may promote a cascade of inflammation, neurohormone dysregulation, insulin resistance, and other metabolic changes, illustrating the potential links between dysbiosis and obesity and type 2 diabetes.
A diet high in fat, sugar, and heavily processed foods may support harmful bacteria within the microbiome. As the populations of harmful bacteria grow, they may release substances that trigger inflammation in the gut lining and increase intestinal permeability (often called leaky gut), potentially leading to inflammatory effects throughout the body. Dysbiosis has also been linked to many of the complications of type 2 diabetes as well, such as kidney disease, vascular disease, and neuropathy.
Because the foods you eat have a direct impact on your gut, learning to eat to support your gut health can have significant implications on your overall health. Just like an overgrowth of harmful bacteria can lead to gut inflammation, supporting beneficial bacteria may help manage inflammation and protect the intestinal mucosa layer.
Prebiotics and probiotics are important for gut health. Think of prebiotics as the food or nourishment for the microbiota. All living organisms require nutrition. Prebiotics are found in certain foods. They travel through the gastrointestinal tract to the large intestine, where they are fermented and broken down by the microbiota, a process that releases compounds like short-chain fatty acids. The most common prebiotic is dietary fiber, but certain foods like oats, apples, leafy greens, garlic, and flaxseed function as prebiotics as well. While prebiotics are the nourishment, probiotics are the living organisms themselves. When dysbiosis is present, it can take months of a dedicated probiotic regimen to support a healthy microbiome. In order for oral probiotics to be effective, they must survive the conditions of the gastrointestinal tract to make their way to the large intestine. Many foods act as favorable probiotics, like yogurts, kimchi, kombucha, and sauerkraut.
Nutritional Interventions and Dietary Modifications
Optimal nutrition is important for dietary modifications in diabetic care. Both obesity and diabetes are pro-inflammatory states. Proper nutritional strategies for obesity and diabetes may include anti-inflammatory diets. Processed foods, refined carbohydrates, added sugars, artificial sweeteners, chemical additives and preservatives, and genetically modified organisms are all pro-inflammatory food ingredients. When these foods are consumed and their breakdown begins, they may trigger a cascade of inflammation, which could increase the risk of (or worsen) heart disease, insulin resistance and diabetes, weight gain, and other inflammatory conditions.
In contrast, many foods in their more natural states may help manage inflammation, called anti-inflammatory foods. These may support blood sugar regulation, weight management, and overall metabolic health. The best nutritional strategies for obesity and diabetes may include a diet full of anti-inflammatory foods, which not only may help reduce inflammation but also support overall metabolic health by managing insulin, blood glucose, and neuroendocrine hormones.
Minimizing pro-inflammatory processed foods and maximizing anti-inflammatory whole foods is suggested for everyone, especially those with obesity and/or type 2 diabetes mellitus. Evidence also suggests that a higher protein and lower glycemic impact diet may help manage insulin resistance. Still, the ideal breakdown of macronutrients for managing obesity and type 2 diabetes mellitus must be individualized. A functional medicine mindset includes a personalized nutrition approach based on the whole person.
Physical Activity and Exercise Programs
Physical exercise, defined as intentional physical activity, is a cornerstone of managing type 2 diabetes mellitus and obesity. Not only may physical exercise help with weight management, but it also may aid in the management and support of many associated factors of diabetes and obesity. Cardiovascular exercise offers more calorie burn and, thus, may help manage adipose tissue, which can support metabolic health. Strength (resistance) training may help improve muscle mass while also supporting insulin sensitivity, and it also may help reduce stress on major joints like hips and knees.
When type 2 diabetes mellitus and obesity occur together, physical exercise for diabetic obesity may show significant improvements in glycosylated hemoglobin (HbA1C) levels, insulin sensitivity, cardiovascular health, and weight management. Losing weight is often very challenging in individuals with diabetes because of the alterations in hormones and metabolism. Physical activity is important in both weight management success and maintaining weight loss.
The general suggestion for physical exercise in obesity and type 2 diabetes includes moderate-intensity cardiovascular exercise for at least 150 minutes per week. Adding strength (resistance) training at least 2-3 days per week may show significant improvement in metabolic markers. Strength training can be easily combined with cardiovascular exercise by adding light weights into aerobic activity, or it can be performed separately in addition to the cardiovascular components.
Staying with a physical exercise program is not easy and requires commitment. For the best chance of success, exercise for diabetic obesity should be individualized. Some people may prefer to exercise in four 40-minute sessions per week instead of five 30-minute sessions. Others may find that three 50-minute increments are most reasonable. Individualization is important, even down to specific activities based on individual abilities or preferences.
Stress Management and Emotional Well-Being
Chronic psychosocial stress can be detrimental to overall health and well-being. Psychological, social, and physiological stresses can all increase the risk of and accelerate the progression of various conditions.
Chronically elevated stress levels have been linked to worse long-term glycemic control in individuals with type 2 diabetes mellitus. Chronic physical and mental stress may contribute to abnormal stress hormone levels, chronic inflammation, intestinal dysbiosis, and even higher risks of developing autoimmune conditions. Chronic inflammation and intestinal dysbiosis are directly implicated in obesity, as they may lead to both weight gain and more difficult weight management.
Both type 2 diabetes mellitus and obesity cause significant negative psychological stress. Obesity is heavily stigmatized, making it difficult even to seek care. The spectrum of changes in diabetes can require notable lifestyle adjustments. And both obesity and type 2 diabetes can make people feel helpless, with things out of their control.
At the same time, positive emotional well-being in obesity and in type 2 diabetes bears a significant impact on management success and adherence. Addressing this paradox is vital to improving overall health; it is a driving principle within functional medicine.
Addressing the physiological components of health may help improve chronic physiological stress. Addressing emotional stress includes strategies like mindfulness, meditation, prayer, breathing techniques, yoga, hobbies, time with family and friends, and adequate rest and sleep. Adopting an individualized approach to stress management and emotional well-being is important in achieving long-term success.
Monitoring and Personalized Adjustments in Management
People are living entities, constantly changing and adapting to their environments. Functional medicine acknowledges the body as a system, and it understands the concepts of biological form and function don’t exist in a vacuum. Metabolic processes are constantly affected by variable factors. Take nutrition, for example. Each food interacts with body systems–hormones, microbiome, metabolism, and gene expression. Not to mention the quality of the macronutrients and the other vitamins and minerals the food contains, all of which dictate how foods are broken down by the body. The effects of obesity and type 2 diabetes management are not uniform across every individual.
Continuous glucose monitoring, HbA1C trends, weight tracking, serial fasting insulin levels, regular lab testing, dietary recalls, and physical activity logs are just a few assessment tools available to monitor individual responses to management. Using these results to monitor responses to diabetes and obesity management offers the opportunity for personalized adjustments. The data gathered from these assessment tools is beneficial not only if it drives meaningful change but also if it occurs at regular intervals, focusing on the ever-evolving form and function of body systems. Personalized adjustments must move in the direction of better health, addressing the root cause of obesity and type 2 diabetes mellitus interplay.
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Interventions for Obesity in Diabetic Patients: Key Takeaways
Poor metabolic health is a significant concern in our current world, and it is the underlying link between diabetes and obesity. From nutrition to physical exercise to stress management and much more, functional medicine is uniquely poised to support health outcomes in individuals with obesity and diabetes, improving quality of life through personalized and holistic care. As the field of functional medicine continues to grow, it offers promise in not only supporting health but also in promoting wellness. Viewing the body as a whole and looking at interrelated forms and functions allows for the best possible holistic support.
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