This article is part of South First's year-long series to Beat Obesity, Lower Diabetes (BOLD), an attempt to keep the lens steady, week-after-week analysis on what is changing, what is not, and what must.
Published Jan 23, 2026 | 7:00 AM ⚊ Updated Jan 23, 2026 | 7:00 AM
Obesity is not just about food intake and physical activity
Synopsis: Obesity-related diabetes is not inevitable. Recognising it as a condition shaped by both biology and behaviour—and intervening early on both fronts—offers the best chance to prevent a lifelong disease.
Obesity-related diabetes is often framed as a consequence of overeating and poor lifestyle choices. However, doctors say this explanation oversimplifies a far more complex condition.
“Obesity is not just about food intake and physical activity,” said Dr Srinath Aswathiah, Senior Consultant, Diabetologist and Endocrinologist at Kauvery Hospital in Chennai.
Long before blood sugar levels cross diagnostic thresholds, changes in hormonal signals, brain responses and stress-related behaviours begin altering the body’s metabolism, setting the stage for type 2 diabetes, he told South First.
Medical experts have noted obesity-related diabetes developing quietly over the years, shaped by both biological vulnerability and everyday behavioural patterns such as sleep loss, stress-driven eating and reduced physical activity.
“There is a constant interaction between the gut, the brain and fat tissue,” Dr Aswathiah explained. Emotional stress and poor sleep can disrupt hunger and satiety signals, increase food cravings and reduce insulin sensitivity, often overpowering conscious efforts to eat less or exercise more.
Understanding this interplay is crucial as diabetes increasingly affects younger adults and even adolescents.
At the core of obesity-related diabetes lies insulin resistance, a condition in which muscle and liver cells stop responding effectively to insulin. As a result, glucose remains in the bloodstream instead of being absorbed by cells. To compensate, the pancreas releases more insulin to maintain normal blood sugar levels.
“This compensatory phase can last for years,” Dr Aswathiah noted, “but eventually the system fails, leading to rising glucose levels.” Excess body fat, particularly visceral fat around the abdomen, speeds up this failure by worsening insulin resistance.
Hormones play a decisive role in regulating hunger and fullness. Ghrelin, often called the ‘hunger hormone’, stimulates appetite, while hormones such as GLP-1 and leptin signal satiety.
“These hormonal signals are processed in different brain centres—some linked to pleasure, others to balance,” Dr Aswathiah explained. When pleasure-driven centres override satiety signals, people may continue eating even after the body’s energy needs are met.
Obesity also triggers chronic low-grade inflammation and leads to excess fat being deposited in organs such as the liver and pancreas rather than stored safely under the skin. These changes worsen insulin resistance and impair insulin secretion.
Early warning signs—fatty liver, darkened skin patches around the neck, persistent fatigue or post-meal drowsiness—often appear before diabetes is formally diagnosed.
Psychological stress does not directly cause obesity, but it alters hormones and behaviour in ways that increase metabolic risk over time. Chronic stress raises cortisol levels, which encourage fat to accumulate around the abdomen and make muscle and liver cells less responsive to insulin.
“Stress also disrupts sleep and increases cravings,” Shashikant Iyengar, Founder of Metabolic Health India, said.
Poor sleep further worsens this imbalance by increasing hunger hormones and reducing feelings of fullness, quietly worsening metabolic health over time, he told South First.
Emotional eating and binge eating further complicate the picture by changing how and why people eat. Dr Aswathiah said repeated binge episodes activate reward pathways in the brain.
“The gut–brain axis becomes overactive, driving eating for pleasure rather than hunger,” he said. As a result, people may consume large amounts of food even when they are not physically hungry, reinforcing weight gain and making blood sugar control increasingly difficult.
Modern food environments intensify these behaviours. “Ultra-processed foods are engineered to be addictive,” Iyengar noted. “They push people toward hedonic eating, eating for comfort, stress relief or reward.”
Regular consumption of such foods encourages repeated overeating and frequent insulin spikes, patterns strongly linked to obesity and poorer metabolic outcomes, particularly among those already insulin resistant.
Experts cautioned that generic advice to “eat less and move more” often fails because it does not account for hormonal resistance and psychological factors that influence appetite, motivation and behaviour.
As weight increases, appetite hormones shift, and the body actively resists weight loss by increasing hunger and reducing energy expenditure. “This is why people feel they are doing everything right but still struggle,” Dr Aswathiah said.
Effective prevention, therefore, requires a combined strategy. On the medical side, structured lifestyle programmes focused on sustainable weight loss, food quality and regular physical activity show the strongest evidence.
In selected cases, insulin-sensitising drugs or newer anti-obesity medications may be used cautiously. “These are not shortcuts but tools for high-risk individuals,” Iyengar explained.
Equally important are psychological interventions, which help address the behaviours that undermine lifestyle change. Cognitive behavioural therapy, stress management, and treatment of depression and sleep disorders reduce emotional eating, improve adherence and support long-term weight control.
“Addressing the mind is as important as treating the metabolism,” Iyengar said.
Obesity-related diabetes is not inevitable. Recognising it as a condition shaped by both biology and behaviour—and intervening early on both fronts—offers the best chance to prevent a lifelong disease.
(Edited by Majnu Babu).
