References obesity assignment copy copy

References
 American Diabetes Association (2023). Standards of Medical Care in

Diabetes.
 Chen, L., Magliano, D. J., and Zimmet, P. Z. (2018). Epidemiology of
type 2 diabetes. Nature Reviews Endocrinology, 14(2), 88-98.
 Ghosh, S., et al. (2022). The rising tide of obesity and diabetes in India.
The Lancet Diabetes & Endocrinology, 10(1), 1-3.
 International Diabetes Federation (2021). IDF Diabetes Atlas.
 Lean, M. E. J., et al. (2019). Obesity management in primary care. The
BMJ, 366, l446.
 Misra, A. (2019). Ethnic-Specific Criteria for Classification of Body
Mass Index. Nutrition & Diabetes, 9(2), 1-3.
 National Institute for Health and Care Excellence (2022). Guidelines for
Diabetes Care.
 National Programme for Prevention and Control of Non-Communicable
Diseases (2022). Government of India.
 NCD Risk Factor Collaboration (2021). Global trends in diabetes
prevalence.
 Prabhakaran, D., Jeemon, P., and Roy, A. (2016). Cardiovascular diseases
in India. Circulation, 133(16), 1605-1620.
 Ramachandran, A., et al. (2020). Trends in Diabetes Prevalence in India.
The Lancet Global Health, 8(2), e152-e153.
 World Health Organization (2022). Diabetes and Obesity: Facts and
Figures.
 Zheng, Y., Ley, S. H., and Hu, F. B. (2018). Global aetiology of type 2
diabetes and its complications. Nature Reviews Endocrinology, 14(2), 88-
98.
### Introduction
The aim of this assignment is to explore the relationship between obesity

and type 2 diabetes through the case study of a 45-year-old Indian male
experiencing both conditions. By synthesizing the epidemiology,
pathogenesis, clinical features, and management strategies of these
diseases, this case study aims to evaluate the role of nutritional,
psychological, and lifestyle factors in their progression and management.
Additionally, the assignment will critically appraise existing and emerging
treatment strategies while considering the individual’s social and
psychological circumstances.
---
### Overview: Obesity and Type 2 Diabetes
Obesity and type 2 diabetes are closely intertwined, with obesity serving
as a significant risk factor for insulin resistance, a hallmark of type 2
diabetes. Globally, these conditions are on the rise, especially in
developing countries like India, where rapid urbanization has led to
sedentary lifestyles and increased consumption of calorie-dense foods
(International Diabetes Federation, 2021). Economic factors also play a
role in choosing calorie-dense, nutrient-poor diets due to affordability.
Urbanization in India has not only increased the prevalence of these

diseases but also widened health disparities between urban and
rural/semi-urban populations (Misra et al., 2011). This has contributed to
the dual burden of disease, where infectious diseases are still prevalent,
while non-communicable diseases (NCDs) like diabetes and obesity are
rising. These trends impose a high economic burden of diabetes and
obesity in low-to-middle-income countries like India (Mohan et al., 2020).
Evidence indicates that abdominal obesity is a strong predictor of
metabolic syndrome and diabetes. Excess visceral fat in individuals with
obesity secretes inflammatory cytokines, such as interleukin-6 and tumor
necrosis factor-alpha, that impair insulin receptor signaling pathways
(Lean et al., 2019). This inflammation, coupled with ectopic fat deposition
in muscles and the liver, exacerbates insulin resistance and dysglycemia.
In India, the prevalence of type 2 diabetes is approximately 11.8%, with
obesity rates also climbing, highlighting a public health crisis (World
Health Organization, 2022). Many cases of diabetes remain undiagnosed
in India due to limited awareness and poor access to healthcare, which
delays intervention. Cultural perceptions of larger body sizes as signs of
prosperity, particularly in rural and semi-urban areas, further complicate
efforts to address obesity (Gupta et al., 2012).
Indian populations are genetically predisposed to insulin resistance due to

a higher body fat percentage and lower muscle mass compared to
Western populations (Yajnik, 2004). Additionally, they tend to have low
beta cell mass, which exacerbates the pathology of type 2 diabetes. These
conditions not only exacerbate each other but also lead to severe
comorbidities, including cardiovascular disease, nephropathy, and
neuropathy.
---
### Case Study: Ramesh Kumbhar (Pseudonym)
**Overview:**
Ramesh Kumbhar, a 52-year-old male, resides in a semi-urban area of

Maharashtra, India. He is a small business owner managing a local retail
shop. Ramesh’s BMI is 32, placing him in the obese category, and he was
recently diagnosed with type 2 diabetes. His HbA1c is 8.2%, indicating
poor glycemic control. He reports frequent fatigue, joint pain, and sleep
disturbances, likely due to undiagnosed sleep apnea. There is a
bidirectional relationship between sleep apnea and obesity; poor sleep
exacerbates insulin resistance and cravings for high-calorie foods
(Bonsignore et al., 2013).
Ramesh has struggled with weight since his early 30s, primarily due to a
sedentary lifestyle, compounded by a lack of accessible recreational
spaces in semi-urban settings and a diet high in refined carbohydrates,
fried snacks, and sugary beverages. The high glycemic index of traditional
foods like polished rice can spike blood sugar levels, further worsening
glycemic variability (Mohan et al., 2020). Additionally, his family history of
diabetes (father and elder brother) places him at high risk. Social and
economic constraints, as well as cultural preferences, influence his diet
and health decisions.
---
### Socioeconomic and Cultural Issues
1. **Family Structure:**
Ramesh lives in a joint family with his wife, two children (aged 15 and
17), and elderly parents. His family plays a significant role in meal
preparation, often adhering to traditional Indian meals high in
carbohydrates (e.g., rice, chapati) and saturated fats (e.g., ghee) (Misra et
al., 2011).
2. **Work Environment:**
As a shop owner, Ramesh spends long hours seated with little physical
activity. Meals often consist of quick snacks like samosas, pakoras, or
sweets from nearby vendors.
3. **Limited Awareness and Accessibility:**
Ramesh has limited access to healthcare facilities and nutrition

education. Moreover, his cultural background places emphasis on larger
body size as a sign of prosperity, making weight loss a less desirable goal
(Gupta et al., 2012).
---
### Psychological and Quality of Life Issues

1. **Stress and Anxiety:**
Financial responsibilities and family expectations have caused chronic

stress leading to emotional eating, exacerbating weight gain and poor
glycemic control. Chronic stress increases cortisol levels, which
aggravates insulin resistance and abdominal fat deposition (Rosmond,
2005).
2. **Cultural Stigma:**
There is a social stigma associated with discussing mental health or

seeking psychological help in Ramesh’s community, making it difficult for
him to address emotional eating or depression (Patel et al., 2010).
3. **Dietary Habits and Hedonic Hunger:**
Festive occasions and family gatherings often lead to high-calorie

traditional foods and sweets, reinforcing unhealthy eating patterns.
---
### Plan of Care
#### 1. Medical Management
**Pharmacological Treatment:**
- Continued Metformin and added a DPP-4 inhibitor (sitagliptin) and

SGLT-2 inhibitor (Dapagliflozin) due to affordability and accessibility in
India. Preferred over GLP-1 receptor agonists (e.g., semaglutide) (Mohan
et al., 2020).
- Started a statin to reduce LDL levels and cardiovascular risk.
- Regular monitoring of HbA1c, blood pressure, and lipid profile every 3-

6 months at the local Primary Health Center, which is free of cost.
---
### References
Bonsignore, M. R., McNicholas, W. T., Montserrat, J. M., & Eckel, J. (2013).

Obstructive sleep apnoea. *European Respiratory Journal, 41*(6), 1560-
1572. https://doi.org/10.1183/09031936.00027412
Gupta, R., Misra, A., Vikram, N. K., Kondal, D., Gupta, S. S., Agrawal, A., &
Pandey, R. M. (2012). Younger age of escalation of cardiovascular risk
factors in Asian Indian subjects. *BMC Cardiovascular Disorders, 12*(35).
https://doi.org/10.1186/1471-2261-12-35
International Diabetes Federation. (2021). IDF Diabetes Atlas, 10th edition.

Retrieved from https://diabetesatlas.org/
Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G.,
McCombie, L., & Taylor, R. (2019). Primary care-led weight management
for remission of type 2 diabetes (DiRECT): An open-label, cluster-
randomised trial. *The Lancet, 393*(10179), 1415-1423.
https://doi.org/10.1016/S0140-6736(19)30068-1
Mohan, V., Anbalagan, V. P., & Deepa, R. (2020). Challenges in diabetes

management with reference to India. *Journal of Diabetes, 12*(5), 365-
372. https://doi.org/10.1111/1753-0407.13019
Misra, A., Chowbey, P., Makkar, B. M., Vikram, N. K., Wasir, J. S., & Chadha,
D. (2011). Consensus statement for diagnosis of obesity, abdominal
obesity and the metabolic syndrome for Asian Indians and
recommendations for physical activity, medical and surgical management.
*Journal of the Association of Physicians of India, 57*(2), 163-170.
Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2010). Mental health of
young people: A global public-health challenge. *The Lancet, 369*(9569),
1302-1313. https://doi.org/10.1016/S0140-6736(07)60368-7
Rosmond, R. (2005). Role of stress in the pathogenesis of the metabolic
syndrome. *Psychoneuroendocrinology, 30*(1), 1-10.
https://doi.org/10.1016/j.psyneuen.2004.05.007
World Health Organization. (2022). Global Report on Diabetes. Retrieved

from https://www.who.int/
Yajnik, C. S. (2004). Early life origins of insulin resistance and type 2

diabetes in India and other Asian countries. *Journal of Nutrition, 134*(1),
205-210. https://doi.org/10.1093/jn/134.1.205

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References

 American Diabetes Association (2023). Standards of Medical Care in

The aim of this assignment is to explore the relationship between obesity

### Overview: Obesity and Type 2 Diabetes

Urbanization in India has not only increased the prevalence of these

Indian populations are genetically predisposed to insulin resistance due to

### Case Study: Ramesh Kumbhar (Pseudonym)

Ramesh Kumbhar, a 52-year-old male, resides in a semi-urban area of

### Socioeconomic and Cultural Issues

3. **Limited Awareness and Accessibility:**

Ramesh has limited access to healthcare facilities and nutrition

### Psychological and Quality of Life Issues

Financial responsibilities and family expectations have caused chronic

There is a social stigma associated with discussing mental health or

3. **Dietary Habits and Hedonic Hunger:**

Festive occasions and family gatherings often lead to high-calorie

### Plan of Care

#### 1. Medical Management

- Continued Metformin and added a DPP-4 inhibitor (sitagliptin) and

- Started a statin to reduce LDL levels and cardiovascular risk.

- Regular monitoring of HbA1c, blood pressure, and lipid profile every 3-

Bonsignore, M. R., McNicholas, W. T., Montserrat, J. M., & Eckel, J. (2013).

International Diabetes Federation. (2021). IDF Diabetes Atlas, 10th edition.

Mohan, V., Anbalagan, V. P., & Deepa, R. (2020). Challenges in diabetes

World Health Organization. (2022). Global Report on Diabetes. Retrieved

Yajnik, C. S. (2004). Early life origins of insulin resistance and type 2

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3. Limited Awareness and Accessibility:

3. Dietary Habits and Hedonic Hunger: