Many of us find that with age, it can get harder to fit into our jeans – take it from me, I know! As a doctor, I’m also acutely conscious that weight gained around the midriff (so-called abdominal obesity) carries certain health risks, including developing type 2 diabetes.
The number of people with this condition has skyrocketed along with our waistlines – up from 1.4m people in the UK in 1996 to more than 4.3m as of 2024. A further 13.6m people are currently identified as being on the cusp of developing type 2 diabetes, which includes everyone with prediabetes. But what exactly does this mean for your health?
What is prediabetes?
Prediabetes can be a precursor to type 2 diabetes. Type 1 and type 2 diabetes have completely different causes.
TYPE 1 DIABETES is usually diagnosed in childhood or early adulthood and you’ll need insulin treatment for the rest of your life. It’s an autoimmune disease, where your immune system attacks the cells in your pancreas that produce insulin. It has nothing to do with lifestyle.
TYPE 2 DIABETES is largely about insulin resistance – as is prediabetes. If you have prediabetes, your blood glucose (sugar) will be higher than normal, but not yet high enough for a diagnosis of type 2 diabetes.
Insulin is the most important hormone for controlling blood glucose. If you have type 2 diabetes, your body still produces insulin but can’t respond to it effectively, and tries to make up for this by producing more insulin. Over time, insulin-producing cells in your pancreas become worn out and less able to make insulin. That’s why some people who’ve had type 2 diabetes for a long time need insulin treatment.
If you’re diagnosed with prediabetes, you’re at significant risk of developing type 2 diabetes. This is serious because persistently high blood glucose can damage eyes, nerves and kidneys, and increase your risk of heart attack, stroke and heart failure (cardiovascular disease).
However, a diagnosis of prediabetes offers a chance to make lifestyle changes that can address the damage. Up to half of people with prediabetes can avoid or delay progressing to type 2 diabetes.
Who’s at risk?
Symptoms such as feeling thirsty, needing the loo more often, recurrent thrush infections and slow wound healing suggest you may have type 2 diabetes.
Prediabetes doesn’t cause symptoms, so you won’t know you have it unless you get checked out. It’s important to get tested for prediabetes if you have risk factors including:
- Excess weight around your midriff
- Having type 2 diabetes in your family
- Being of Afro-Caribbean or South Asian descent
- Getting older (especially if you’re over 40 and have other risk factors)
If you’re worried, ask your GP for a test. You’ll be diagnosed on the basis of a single non-fasting blood test called an HbA1c, which indicates your average blood glucose over the last few months.
Take the ‘Know Your Risk’ assessment to find out what could be jeopardising your health.
How to reduce your chances of prediabetes
Watch your waist
If you’re overweight or living with obesity, cutting your weight by just 5% can significantly reduce your risk of developing type 2 diabetes.
Get moving
A sedentary lifestyle, even without other risk factors, is closely linked to prediabetes. Where activity is concerned, every little helps – get off the bus a stop earlier, take a walk at lunchtime, use a standing desk or join a walking group. The best exercise is the kind you’ll stick with.
Choose unrefined foods
Refined carbs (sugary and processed foods, white bread/ flour/pasta etc) can actively increase your risk, so choose wholegrains and fruits and vegetables instead.
Consider when you eat
For a long time, I have practised a form of intermittent fasting called time-restricted eating – I only eat during a six-to-eight-hour period each 24 hours. Intermittent fasting has been shown to reduce insulin resistance and, if you major on unrefined foods and adequate protein (I have lots of beans, pulses, veg and wholegrains), you really don’t feel hungry once you’re used to it.
Take control
If you are diagnosed with prediabetes, you’re eligible for the Healthier You NHS Diabetes Prevention Programme, a nine-month lifestyle change course. There’s a choice of face-to-face groups or a digital service, and you’ll receive personalised support to make healthier diet choices, get more active and manage your weight. People who complete the programme cut their risk of developing type 2 diabetes by more than a third. Speak to your GP surgery to find out more.
Why do midlife midriff and menopause matter?
Carrying extra weight around your middle means fat can build up around your organs, such as your pancreas and liver. This can cause insulin resistance, where your body doesn’t respond properly to insulin’s signals to let glucose into your cells to provide energy. And that increases your chance of having high blood glucose (sugar).
An increase in weight around the middle of your body is commonly noticed around the menopause, a time when levels of the important female hormone oestrogen drop. There’s a link between oestrogen and type 2 diabetes, too. Oestrogen stimulates cells that line the blood vessels to deliver insulin to your muscles – and this lowers your blood sugar and reduces your risk of developing type 2 diabetes.
After the menopause, the level of male androgen hormones in your body increases. Unfortunately, these androgens also promote the tendency to develop fat deep inside your tummy.
Even if you don’t put on weight around the menopause, you’re almost five times more likely to develop ‘abdominal obesity’ than before the menopause. Some of the androgens your body continues to produce after menopause are naturally converted into oestrogen, but this doesn’t seem to offer the same protection against type 2 diabetes.
As a result, it’s important that you try to ensure your overall weight and body mass index (BMI) are within the healthy range. But even if they are, you may still be at risk of type 2 diabetes if you have a large waist measurement.
For a healthy measurement, you need to aim for your waist to be less than: 80cm (31.5in) for all women; 94cm (37in) for most men; or 90cm (35in) for South Asian men.