Obesity and diabetes: The twin pandemics

Obesity and diabetes have been called the twin pandemics of the new millennium. Obesity promotes insulin resistance that in turn leads to atherogenic dyslipidemia, hypertension, impaired fibrinolysis and impaired glucose metabolism. Concomitantly, enhanced inflammation and oxidative stress, induced by visceral adipose tissue, contribute to accelerated atherosclerosis and cardiovascular disease. Treatment begins with prevention of obesity through lifestyle modification such as dietary change and exercise. Unfortunately, adherence to such lifestyle changes is poor. Pharmacologic treatment and bariatric surgery provide additional options, however, with varying outcomes. Glycemic control is an additional related issue, which also requires medical intervention such as oral hypoglycemics, anti-hyperglycemics and/or insulin, singly or in combination. Various treatment regimens for obesity and diabetes meet, at best, with partial success, therefore the staving of the "twin pandemics" and the resultant excessive cardiovascular morbidity and mortality, is only possible by effective prevention strategies that need to be implemented globally, nationally and locally.