Diabesity: Type 2 Diabetes and Obesity
The word diabesity was created in the 1980s when the US population’s body mass index (BMI) began to increase in order to describe the clinical association between obesity and type 2 diabetes mellitus as clinicians struggle to optimally manage pregnant individuals with increasing girth and therefore increasing rates of diabetes, prediabetes, and gestational diabetes.
Abstract
The word diabesity was created in the 1980s, when the US population’s body mass index (BMI) began to increase in order to describe the clinical association between obesity and type 2 diabetes mellitus. The term did not enter the obstetrical literature until more than a generation later. In 2009, diabesity was used in the title of an article focused on pregnancy outcomes. Since that time, diabesity has become a frequent topic at obstetrical conferences as clinicians struggle to optimally manage pregnant individuals with increasing girth and therefore increasing rates of diabetes, prediabetes, and gestational diabetes. It is now estimated that > 50% of women in the United States have a prepregnancy BMI in excess of 25 kg/m2. State-wide prepregnancy obesity rates (BMI ≥ 30 kg/m2) vary from 20.5% in Utah to 33.5% in Mississippi.1 Increasing maternal BMI is associated with increased risk of morbidity and mortality for both pregnant patients and their offspring.2 Furthermore, prepregnancy BMI directly correlates with the risk of diabetes in pregnancy (gestational diabetes and type 2 diabetes mellitus).3 When obesity is coupled with diabetes in pregnancy, there is a synergistic relationship with regard to pregnancy complications leading to even higher risks than for patients that have either disease in isolation. In addition, the risks of diabesity are not limited to one part of the reproductive cycle but instead are pervasive throughout. Individuals with diabesity have more difficulty conceiving, are more likely to have pregnancy losses, are more likely to have antepartum complications including preeclampsia, more often have children that require neonatal intensive care, and both the individual with diabetsity and their offspring are more likely to develop lifelong metabolic dysfunction. To address the complications, interventions, and best practices for women with both obesity and diabetes in pregnancy, we have compiled articles from content experts across the United States. We begin with a discussion of screening, both genetic and