Addressing “diabesity” – it’s not all about Ozempic 

According to the CDC, one in five people living with diabetes don’t even know they have it. More than 40% of people in the US are living with obesity, which increases the risk of Type 2 diabetes – which in turn can contribute to weight gain. Managing “diabesity” is a balancing act that requires careful attention to both dietary choices and overall lifestyle.

Diagnosis for diabetes can be done via a hemoglobin A1C test, random blood sugar test, fasting blood sugar test and/or glucose tolerance test. Diagnosis for obesity primarily uses the Body Mass Index (BMI). Research has found that as BMI increases, so do the risks for chronic conditions. BMI, an equation using a person’s height and weight, has recently come under fire; it was developed 200 years ago based on white males and has little validity for other ethnic groups, and fails to distinguish between fat versus muscle and how fat is distributed. That said, BMI is deeply integrated into our healthcare systems for categorizing weight.

As we look at supporting patients living with diabetes and/or obesity, there are a number of tools a clinician can use to support patients, primarily access to Registered Dietitian Nutritionist (RDN) for medical nutrition therapy, pharmaceuticals (GLP-1s and other therapies), and bariatric surgery.

The role of nutrition and RDNs

While pharmaceutical therapies have been grabbing the headlines lately, nutrition is the cornerstone of managing both diabetes and obesity. A well-balanced diet can help regulate blood sugar levels, control weight and mitigate the complications associated with these conditions. Personalization is key when it comes to dietary recommendations for individuals with diabetes and obesity. Medical Nutrition Therapy (MNT) is an evidence-based and individualized nutrition process to help treat certain medical conditions and can only be provided by RDNs. MNT is imperative for those who have been prescribed a GLP-1 to ensure optimal nutritional choices when hunger and food consumption is decreased. 

MNT is based on decades of medical research on the connection between diet, nutrition and health outcomes and is very different from general nutrition education. Basic nutrition education can be provided by anyone. Worth noting here, a “nutritionist” can have a broad range of training, from a weekend course to qualifications. Uncredentialed nutritionists typically lack education and experience, which could lead to patient harm. A RDN is a board-certified food and nutrition expert. Dietitians, not health coaches or nutritionists, are found in hospitals working with patients. Dietitians support individuals who might be living with acute and chronic illnesses including diabetes and obesity. Dietitians are a key part of the care team supporting patients who are being prescribed anti-obesity medications and bariatric surgery. They help manage side effects and ensure patients are not at risk of becoming deficient in vitamins, minerals, or macro- and micro-nutrients.

Supporting employees living with “diabesity”

In addition to ensuring your health plan covers access to RDNs for Medical Nutrition Therapy, you might also consider exploring a cardiometabolic solution – a holistic program provided by a specialty vendor for obese individuals with an elevated risk of developing cardiovascular disease. It is important to remember that cardiometabolic conditions are not isolated, independent conditions. For example, having excess weight increases the likelihood that a person will develop high cholesterol, high triglycerides and fatty liver disease. A program that addresses an individual’s risk factors while providing dietary recommendations and support for lifestyle change and behavioral health can prevent the progression of this disease. As the market continues to evolve, it’s important to explore new solutions and consider how they could enhance your overall strategy for managing diabesity in your population.

If you currently don’t cover anti-obesity medications and are (rightfully) concerned about cost, it might be worthwhile to analyze your population to see how anti-obesity medications could potentially impact down-stream clinical comorbidities. Finally, it’s important to cover bariatric surgery and ensure patients are utilizing high-quality providers with a track record of good outcomes.

Beyond the health plan, organizations can promote a culture in which the social norm is to make healthier choices – with the communal goal of achieving the best level of well-being for each person.