Diabetes and Obesity: Understanding the Metabolic Connection
Dr. Phulrenu ChauhanNov 14, 2026
Visceral fat, insulin resistance and the thin-fat body type explain why diabetes risk can persist even at a normal BMI, highlighting the importance of early detection and metabolic health
Walk into a diabetes clinic in India and one thing stands out: not every patient looks overweight. Some are slim, some are overweight. Yet underneath, the story often remains the same. Obesity and type 2 diabetes are closely linked, but their relationship goes beyond body weight and blood sugar. The common cause lies in where the body tends to store the fat. Recent estimates state that 101 million Indians are already living with diabetes. A recent ICMR–INDIAB study showed the weighted prevalence of abdominal obesity 39.5 per cent in the Indian population.
The Fat You Cannot SeeNot every fat is equal. The subcutaneous fat is relatively harmless. The troublesome kind is visceral fat, which surrounds itself around the liver, intestines, pancreas, heart and other organs deep inside the belly. Visceral fat behaves like an active organ. It releases fatty acids and inflammatory chemicals that interfere with insulin, which is the hormone that absorbs glucose from the blood.
When insulin becomes less effective, the liver continues producing glucose and muscles then take up less of it. Initially, the pancreas also catch up by producing extra insulin, and blood sugar stays normal, sometimes maybe for years together. Eventually the overworked insulin-making beta cells tire, sugar levels rise, and Type 2 diabetes sets in
This is also why the weighing scale can mislead. Many Indians carry more fat around the abdomen and less muscle than other populations especially the Western population, at the same body weight, the so-called “thin-fat” body type. A person with a normal body mass index(BMI) can still be at risk. A waist above 90 cm in men or 80 cm in women is a warning sign for metabloic syndrome. Genetic susceptibility, family history, physical inactivity and pancreatic dysfunction also increase risk of metabolic syndrome and diabetes mellitus.
Small Losses, Big GainsThe visceral fat is usually the first to go when we lose weight. You do not need to reach an “ideal” body weight. Losing 5 to 10 percent of your weight improves insulin sensitivity and brings down blood sugar, blood pressure, triglycerides and liver fat
In people with prediabetes, modest weight loss combined with regular physical activity has been shown to cut the risk of developing diabetes by more than half. In some people with recently diagnosed diabetes, larger and sustained weight loss can even cause remission
What Actually HelpsDiet: Indian meals usually consist of rice, rotis and refined flour. Fill half the plate with vegetables, a quarter with protein such as dal, eggs, paneer, fish or chicken, and a quarter with whole grains. Avoid sugary drinks, packaged snacks and fried food
Physical activity: Muscles are the body’s biggest utilisers of sugar. Aim for 150 minutes of brisk walking a week, plus strength training two to three times a week. Even a 10-minute walk after meals reduces sugar spikes
Sleep: Regularly sleeping less than six hours impairs glucose tolerance, alters cortisol secretion, even in healthy adults and eventually worsens insulin resistance. Loud snoring with daytime sleepiness may point to sleep apnoea, which is worth getting checked
Medicines: Newer drugs such as GLP-1 RA(Glucagon-like peptide-1 receptor agonists) Semaglutide and Tirzepatide mimic natural gut hormones that curb appetite, slow digestion and help the pancreas release insulin when it is required. Many patients lose 10 to 20 per cent of their body weight on them. SGLT2 inhibitors help the kidneys flush out excess sugar and also protect the heart and kidneys. These medicines support lifestyle change; they do not replace it, and should only be taken under medical supervision.
Recognising risk early and combining sustainable lifestyle changes with appropriate medical treatment can improve long-term outcomes. The goal is not simply to lose weight, but to improve insulin sensitivity, protect organ function and support lasting metabolic health
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