systems, universal coverage, and lifestyle programs promoting exercise and balanced diets.

Japan – Low diabetes rates due to traditional diets rich in fish, vegetables, and fermented foods, plus active lifestyles.

South Korea – Similar to Japan, a diet lower in processed foods and an emphasis on public health contribute to lower diabetes prevalence.

Netherlands – High-quality healthcare and cycling culture contribute to lower rates of Type 2 diabetes.

Countries Dealing with Diabetes the Worst

United States – One of the highest diabetes rates among developed countries (~11.3% of adults). High obesity, processed food consumption, and healthcare inequalities contribute.

Mexico – Rising obesity and sugary drink consumption have made diabetes the second leading cause of death.

India – Over 100 million diabetics, with rising numbers due to urbanization, processed foods, and sedentary lifestyles. Healthcare access varies widely.

China – The largest diabetic population globally (140+ million), driven by urbanization, rising fast food consumption, and reduced physical activity.

Best Countries Managing Obesity

Japan – One of the lowest obesity rates (~4.5%) due to traditional diet (fish, rice, vegetables), portion control, and active commuting. The Metabo Law encourages workplace health screenings.

South Korea – Low obesity (~3-4%) due to a diet rich in vegetables and fermented foods, active urban lifestyle, and strong health policies.

Vietnam – Among the lowest global obesity rates (~2%) due to traditional diets and high physical activity levels.

Countries Dealing with Obesity the Worst

Nauru – A little country north east of Australia with a population of ~12,000 The highest obesity rate in the world (61% of adults). Reliance on imported processed foods has replaced traditional diets.

Cook Islands – ~55% obesity rate, with a similar diet shift from fresh local food to processed imports.

United States – Over 42% of adults are obese, driven by fast food consumption, large portion sizes, and sedentary lifestyles.

What are Japan doing right Vs what are America doing wrong?

Japan

• Huge emphasis on home cooked meals using home cooked ingredients

• by law, every Japanese school has to employ a professional nutritionist

• Every child eats food prepared in school, no one brings in a packed lunch

• Children are taught in school to eat until they are 80% full, leading to significantly smaller meals being eaten

USA

• Dietary habits: High calorie, low nutritional foods

• Large portion sizes

• Exercises guidelines not being met

• Advertising and marketing of food products

• Emotional eating and stress foods

• World obesity rankings:  https://data.worldobesity.org/rankings/

•  NY Post article on nutritions in a Japanese school https://nypost.com/2024/12/04/world-news/big-reason-one-nation-outlives-the-rest-of-the-world/?utm_source=chatgpt.com

• Prevalence of Obesity Among Adults and Youth: United States, 2011–2014 https://www.cdc.gov/nchs/products/databriefs/db219.htm

• Harris, J. L., Bargh, J. A., & Brownell, K. D. (2009). Priming effects of television food advertising on eating behavior. Health Psychology, 28(4), 404–413. https://doi.org/10.1037/a0014399

• Dallman MF. Stress-induced obesity and the emotional nervous system. Trends Endocrinol Metab. 2010 Mar;21(3):159-65. doi: 10.1016/j.tem.2009.10.004. Epub 2009 Nov 18. PMID: 19926299; PMCID: PMC2831158.

• Medicines and surgery for Obesity (no date) HSE.ie. Available at: https://www2.hse.ie/conditions/obesity/medicines-and-surgery-for-obesity/ (Accessed: 21 March 2025). 

  
  

• World Health Organization (2024) Obesity and overweight, World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

  
  

• World Health Organization. (2021). Diabetes Fact Sheet. Retrieved from www.who.int

Obesity

Obesity, defined as an accumulation of excess adipose tissue that has a negative impact on physical, psychological, metabolic health or quality of life. It is a major risk factor for diabetes. Its global prevalence has been rising steadily over the past few decades.

Global Overview:

According to the World Health Organization (WHO) more than 1.9 billion adults (aged 18 years and older) were overweight, and over 650 million were obese.

The prevalence of obesity has more than tripled since 1975, with significant disparities between high- and low-income countries (WHO 2024)

Prevalence by Region:

North America:

The United States has one of the highest obesity rates globally. As of 2024, nearly 40.3% of U.S. adults were obese (Samuel D, 2024)

Canada has also seen a rising obesity trend, with approximately 26.4% of adults classified as obese. (Obesity Canada 2025)

Europe:

Obesity is highly prevalent across Europe, with countries like the UK, Turkey, and Hungary reporting obesity rates over 30% and a median of 23% across Europe.(WHO 2022)

Eastern European countries, particularly those with less access to healthcare, have higher obesity rates compared to Western Europe.The highest levels of both overweight and obesity are found in Mediterranean and eastern European countries. Educational inequalities are widespread, with higher obesity prevalence in people with lower educational attainment (WHO 2022)

Latin America and the Caribbean:

Countries like Mexico and Brazil have seen rising obesity rates, especially in urban populations, 19% (100.8 million) are obese (14.6% in men and 24% in women). (Guillermo. G 2015)

Asia:

The prevalence of obesity in Asia has been rising rapidly in recent decades. While traditionally low, countries like China and India have seen significant increases due to urbanization and lifestyle changes. While South-East Asia has some of the lowest prevalence of overweight and obesity globally, they are seeing an alarming trend in the rates of increase in the last 10-15 years.

Africa:

Obesity is less common in many African nations but is increasing in urban centers, especially among women. South Africa has one of the highest obesity rates on the continent.

As more people in Africa move to cities and adopt more Western-style diets, obesity is becoming a growing concern.

According to a multicentric study, the prevalence of obesity in Africa ranges from 4.5% to 32.5% (Azeez. T 2022) However, (Azeez. T 2022, Table 1) shows the prevalence of obesity from various studies in different regions of Africa

Diabetes

Diabetes, particularly Type 2 diabetes, is another condition that has reached epidemic proportions worldwide. Type 1 diabetes is less prevalent but still affects a significant number of individuals.

Global Overview:

The International Diabetes Federation (IDF) estimated that approximately 537 million adults (aged 20–79) were living with diabetes in 2021, and this number is expected to rise to 783 million by 2045.

Type 2 diabetes is the most common form of diabetes, accounting for 90-95% of cases worldwide. It is primarily linked to obesity, physical inactivity, and poor dietary habits. (IDF Diabetes Atlas 2021)

Prevalence by Region:

North America:

The U.S. has a high diabetes prevalence, with over 30 million people diagnosed with diabetes, and an additional 88 million adults having prediabetes.

It is predicted that North America will have a 24% increase in diabetes by 2045 (IDF Diabetes Atlas 2021)

Europe:

Europe has a substantial burden of diabetes, with countries like Germany, Russia, and the UK seeing high rates. The prevalence of diabetes is estimated at around 7-9% of the adult population in most European countries approx 61 million as of 2021. (IDF Diabetes Atlas 2021)

Latin America:

Latin America has seen a rapid rise in diabetes, particularly in Mexico and Brazil. These nations are facing an epidemic of both obesity and diabetes.

Urbanization and changes in diet have contributed significantly to the rising rates of diabetes, with a predicted 50% rise in prevalence by 2045 from 32 million to 49 million (IDF Diabetes Atlas 2021)

Asia:

SE Asian countries have large and rapidly growing populations with diabetes, 90 million as of 2021 and a predicted 68% increase by 2045.

The prevalence of diabetes in the western pacific (China, Australia, NZ) is particularly alarming, with over 8% of the adult population affected 206 million.(IDF Diabetes Atlas 2021)

Southeast Asia and the Middle East are experiencing the 2nd fastest increases in diabetes prevalence with predicted 87% increase by 2045 to 136 million.(IDF Diabetes Atlas 2021)

Africa:

Africa has the fastest growing rate of prevalence of diabetes in the world. While still lower compared to other regions, African countries face a predicted 134% increase in prevalence by 2045 to a total 55 million. (IDF Diabetes Atlas 2021)

Co-occurrence of Diabetes and Obesity

Obesity is the most significant modifiable risk factor for Type 2 diabetes. The global increase in obesity has been mirrored by a rise in diabetes prevalence. Both conditions are increasingly concentrated in low- and middle-income countries as urbanization and lifestyle changes occur in combination with a lack of education and healthcare literacy/accessibility

WHO Obesity and Overweight Facts Sheet, March 2024

https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Samuel D et al 2024 Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023

https://www.cdc.gov/nchs/data/databriefs/db508.pdf

Canadian Adult Obesity Clinical Practice Guideline, January 2025

https://obesitycanada.ca/healthcare-professionals/clinical-practice-guideline/

WHO EUROPEAN REGIONAL OBESITY REPORT 2022

https://iris.who.int/bitstream/handle/10665/353747/9789289057738-eng.pdf

Guillermo. G, Obesity and overweight populations in Latin America, The Lancet Kidney Campaign, Lancet 2015

https://www.thelancet.com/campaigns/kidney/updates/obesity-and-overweight-populations-in-latin-america

Azeez. T, Obesity in Africa: The challenges of a rising epidemic in the midst of dwindling resources, Obesity Medicine Vol 31, May 2022

https://www.sciencedirect.com/science/article/pii/S2451847622000094#bib78

International Diabetes Federation, Atlas Facts and Figures, 2021

https://idf.org/about-diabetes/diabetes-facts-figures/

It is crucial to make positive lifestyle decisions and adjustments to help manage weight, improve quality of life, and reduce the risk of obesity-related health problems. This includes areas such as:

• Healthy Eating: Maintaining a balanced diet with adequate nutrition while reducing caloric intake. This includes increasing lean proteins, whole grains, fruits, and vegetables while ensuring to minimize processed foods, refined sugars, and unhealthy fats.

• Physical Activity: Engaging in regular exercise to build muscle strength, improve flexibility, and enhance endurance.

• Sleep and Mental Well-being: Ensuring adequate sleep and managing stress to support overall health.

• Support groups and Counselling: You can find friendship and understanding in support groups and counselling, where others share similar challenges with obesity.

2. Medical Management:

Body Weight Monitoring

• Regular weight checks help track progress and adjust treatment plans.

• BMI and waist circumference measurements provide insight into health risks. A BMI of 30 or greater and a waist circumference of greater than 35 inches for women and greater than 40 inches for men is considered obese.

Medications

Pharmacological options may be prescribed for individuals struggling with weight loss through lifestyle changes alone. These medications work by:

• Suppressing appetite

• Reducing fat absorption

• Regulating metabolism

Types of Medications

• Brain and Stomach: Medications like Liraglutide (Saxenda), Semaglutide (Ozempic, Wegovy, Rybelsus), and Naltrexone/Bupropion (Contrave) work by regulating hunger signals and slowing digestion.

• Bowel: Orlistat (Xenical, Alli) prevents the absorption of fat in the intestines.

3. Surgery for Obesity 

Bariatric Surgery

Weight loss surgery, or bariatric surgery, may be an option if lifestyle changes and medication are insufficient. 

Bariatric surgery operations may:

1. Reduce hunger.

2. Restrict the amount of food that can be eaten.

3. Reduce the amount of food that can be absorbed.

Types:

1. Biliopancreatic diversion with duodenal switch (BPD/DS)

2. Gastric bypass, also called Roux-en-Y

3. Sleeve gastrectomy

Eligibility for Surgery

A referral to a bariatric surgery center may be considered if patients:

• Have a BMI of 40 or more

• Have a BMI between 35 and 40 with weight-related health conditions

• It is safe to undergo anesthesia and surgery

• Can commit to long-term follow-up care

4. Non-Pharmacological Management

Dietary Modifications

• Caloric Deficit: Reducing calorie intake while maintaining nutritional adequacy.

• Balanced Diet: Prioritising lean proteins, whole grains, fruits, and vegetables while limiting processed foods and unhealthy fats.

• Hydration and Mindful Eating: Ensuring sufficient water intake and adopting mindful eating habits.

 5. Physiotherapy Management

• Lifestyle Advice: Personalised guidance considering individual beliefs, cultural factors, and readiness for change. Interrupt sedentary time and promote exercise for MSK, CV, and metabolic benefits.

• Supervised Physical Activity: Tailored exercise programs to build strength, improve flexibility, and sustain weight loss under safe conditions. This may include aerobic training, flexibility and balance, and resistance training. Recommended 150-300 minutes of moderate physical activity, or for individuals who are trying to lose weight, 200-300 minutes of moderate to vigorous physical activity a week is recommended. Combined aerobic and resistance exercises are most effective.

• Managing Health Conditions: Addressing related issues like arthritis, back pain, and chronic conditions such as heart disease.

• Collaborative Care Planning: Coordinating long-term management plans with healthcare professionals and community services.

• Gait and balance training: Helps to improve posture, mobility, and functional movements.

  
  

  References:

  1. CSP (2015). Physiotherapy works for obesity. [online] The Chartered Society of Physiotherapy. Available at: https://www.csp.org.uk/publications/physiotherapy-works-obesity.

  2. Mayo Clinic (2021). Obesity - Diagnosis and treatment - Mayo Clinic. [online] Mayoclinic. Available at: https://www.mayoclinic.org/diseases-conditions/obesity/diagnosis-treatment/drc-20375749.

  3. NHS (2023). Treatment - Obesity. [online] NHS. Available at: https://www.nhs.uk/conditions/obesity/treatment/.

  4. NICE (2025). Overview | Overweight and Obesity Management | Guidance | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng246.

  5. Cleveland Clinic (2022). Bariatric (weight loss) surgery: Types & requirements. [online] Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/treatments/bariatric-surgery.

     
     

Insulin injections

Blood sugar monitoring

Pancreas transplant/islet cell transplant

Type 2 diabetes

Lifestyle changes

Insulin injections

Blood sugar monitoring

Medical management

- Blood sugar monitoring

Recording of blood sugars as much as 4 times daily can be required if the patient is on insulin. This is the only way of knowing sugar levels are within the target range. This can be done with a continuous glucose monitor or a glucose meter. A1C testing can be done also to measure average blood sugar levels over the past 2 to 3 months

- Insulin injections

Type 1 and type 2 diabetes can be managed with insulin injections to manage blood sugar levels. Insulin can be short acting, rapid acting and long acting and patients can be prescribed a mixture depending on their needs. It is injected with a fine needle or an insulin pen. Insulin pumps are also available which are worn outside the body and a tube connects the reservoir to a catheder under the skin. The insulin pump can work with the glucose monitor in a closed loop system to monitor blood sugars and deliver insulin as needed.

- Medication

Oral medications are used to help the pancreas release more insulin, to prevent the release of glucose from the liver or to break down carbohydrates. Some inhibitor medications are used to prevent the kidneys from reabsorbing filtered sugar.

- Transplantation

Some type 1 diabetes patients can have a pancreas transplant to eliminate insulin therapy. There are complications regarding immuno-suppression in transplant patients so these are not commonly done.

Non – pharmalogical management

- Diet changes

Cutting back on refined sugars, alcohol and processed meats are important changed need to be made in diabetes patients as they impact glycaemic control.

Physiotherapy management

- Exercise prescription

Aerobic and resistance training has been found to produce positive effects on blood glucose levels.

Resistance training importance

- It is found that diabetes patients have less muscular strength than patients without diabetes.

- It is also found that strength deficits and functional impairments are linked

Aerobic training importance

- Exercise can play important roles in controlling blood glucose

- As intensity and duration increase there is an increase in glucose uptake by muscles and balanced by hepatic glucose

- Aerobic activity can also reduce risk of post exercise hypoglycaemia

Gait and balance importance

- Maintaining independence for elderly patients and reducing falls risks.

- Balance exercise is important in patients with peripheral neuropathy.

- Gait can be impaired by a muscular weakness

- Found that diabetic patients had slower walking speed and gait deviations.

Diabetes Exercise Guidelines

As outlined above resistance, aerobic and balance and gait training are all important in the management of diabetes:

- 150 minutes of aerobic exercise per week

- Resistance training at least two times per week

- Balance and gait exercises weekly

References

• Mayo clinic staff. (2024). Diabetes. [Online]. Mayo clinic. Last Updated: 27 March. Available at: https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451 [Accessed 18 March 2025].

• Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet. 2014 Jun 7;383(9933):1999-2007.

• Kaur, J., Singh, S.K. and Singhvij, J., 2015. Physiotherapy and rehabilitation in the management of diabetes mellitus: a review. Indian Journal of Scientific Research, 6(2), pp.171-181.

• Bird SR, Hawley JA. Exercise and type 2 diabetes: new prescription for an old problem. Maturitas. 2012 Aug;72(4):311-6.

• American Diabetes Association Weekly Exercise Targets. Retrevied from https://diabetes.org/health-wellness/fitness/weekly-exercise-targets. [Accessed 18 March 2025].

• Diabetes is a chronic disease that affects how the body regulates glucose levels and can be extremely serious if not managed properly. 

• There are 2 types: Type I Diabetes occurs when the immune system mistakenly attacks insulin-producing cells, leading to an insulin deficiency. Type II Diabetes is one of the most common metabolic disorders. It is caused by a combination of 2 factors-defective insulin secretion from pancreas and inability of insulin sensitive tissues to respond appropriately to insulin. 

• Type 1 diabetes typically develops in childhood or adolescence, while Type 2 is more common in adults and is often linked to lifestyle factors such as obesity and physical inactivity. 

• Both types can result in health issues such as heart disease, kidney failure and vision loss. 

• Managing diabetes is vital and requires ongoing monitoring, medication, dietary adjustments and physical activity. It usually varies on the type of diabetes and the lifestyle of the person. 

References:

Medicines and surgery for Obesity (no date) HSE.ie. Available at: https://www2.hse.ie/conditions/obesity/medicines-and-surgery-for-obesity/ (Accessed: 21 March 2025). 

World Health Organization (2024) Obesity and overweight, World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

World Health Organization. (2021). Diabetes Fact Sheet. Retrieved from www.who.int

American Diabetes Association - Standards of Care in Diabetes 2025 (American Diabetes Association , 2025)

The standards of care in Diabetes guidelines are updated annually and provide up-to-date recommendations for health practitioners and individuals managing their condition. Information regarding the standards of care recommendations discussed in the journal are as follows;

- Improving care and promoting health in populations

- Diagnosis and classification of Diabetes

- Prevention or delay of Diabetes and associated comorbidities

- Comprehensive medical evaluation and assessment of comorbidities

- Facilitating positive health behaviours and well-being to improve health outcomes

- Glycemic goals and Hypoglycemia

- Diabetes technology

- Obesity and weight management for the prevention and treatment of Type 2 Diabetes

- Pharmacologic approaches to Glycemic treatment

- Cardiovascular disease and risk management

- Chronic kidney disease and risk management

- Retinopathy, Neuropathy, and foot care

- Older adults

- Children and adolescents

- Management of Diabetes in pregnancy

- Diabetes care in the hospital

- Diabetes advocacy

• Obesity

NICE Guidelines - Obesity and Weight Management (NICE, 2025)

NICE provides Guidelines, Recommendations and Resources for healthcare professionals and the general public to access. The recommendations provided encompass the following areas regarding information pertaining to obesity and weight management;

- General principles of care

- Prevention in schools and nurseries

- Identification, assessment and referral

- Specific advice for people from ethnic minority backgrounds

- Behavioural overweight and obesity management interventions

- Dietary advice

- Raising awareness of interventions

- Planning and funding services and interventions

- Multidisciplinary teams for children

References;

• American Diabetes Association (2025). Standards of Care in Diabetes - 2025. [online] diabetesjournals.org. Available at: https://diabetesjournals.org/care/issue/48/Supplement_1 [Accessed 20 Mar. 2025].

• NICE (2025). Overview | Overweight and Obesity Management | Guidance | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng246 [Accessed 20 Mar. 2025].

• Course covers healthy eating, physical activity, sleeping well, behaviour change

• Free 12 month course ran by dietitians

• Both online and face to face around the country

• Runs weekly for first few months, followed by support sessions over the rest of the year

NICE Guidelines

• Cover prevention and management of overweight, obesity and central adiopsity in children,young people and adults

• 45 to 60 minutes of moderate intensity physical activity a day

• Dietary approaches

• The guidelines for diabetes highlight recommendations for care and management for adults with type 2 diabetes.These include :  patient education, dietary advice, managing blood glucose including HbA1c measurement and targets, drug treatments and managing complications.

ASOI Association for the Study of Obesity on the Island of Ireland

• Public resources

• Clinical practice guidelines

Diabetes ireland 

Diabetes Ireland offer a range of resources and support services that can be recommended to patient’s diagnosed with diabetes. These include : 

• Educational programmes  such as CODE (community oriented diabetes education). CODE is a group self-management course facilitated by a nurse or dietitian. It covers management of the condition, allowing individuals to learn from each other. It is free to participate and is being delivered virtually.

• A series of downloadable patient booklets are available. They cover various aspects of diabetes management. 

European Association for the Study of Diabetes

• EASD offer free online courses designed for healthcare professionals looking to update current knowledge. The aim of these courses are to educate and engage healthcare professionals around the world by addressing themes in practical diabetology and complex themes in modem diabetology that overlap with other medical disciplines. 

• They host an annual meeting presenting the latest advancements in diabetes research and treatment.

Obesity Management Course NIPC 

The National Institute for Prevention and Cardiovascular Health offer a free online training and education programme designed to equip healthcare professionals in Ireland with core knowledge, skills and competencies to deliver evidence-based obesity management. The course covers modules in  the ASOI Obesity Clinical Practice Guidelines, Obesity stigma and patient perspectives, obesity assessment and treatment in primary care.

Rethink Obesity 

This global platform provides healthcare professions with latest resources on obseity management, emphasizing person-centred and empathetic dialogue with patients. It offers articles on obesity-related complications, medical weight management strategies, and access to continuing medical education (CME) credits.

• ‌NICE (2025). Overview | Overweight and Obesity Management | Guidance | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng246.

• NIPC - National Institute for Prevention and Cardiovascular Health. (2025). Obesity Management Course - NIPC - National Institute for Prevention and Cardiovascular Health. [online] Available at: https://nipc.ie/obesity-management-course/ [Accessed 27 Mar. 2025].

• ‌Diabetes Ireland. (n.d.). Home. [online] Available at: https://www.diabetes.ie.

• www.rethinkobesity.global. (n.d.). Discover the science to obesity for HCPs. [online] Available at: https://www.rethinkobesity.global.

‌

Obesity

Health Behaviours

Health behaviours are influenced by the conditions that an individual lives, works and eats in. Policies in locations also affect the health choices about diet and activity that an individual can make. This may lead to an individual gaining weight or developing obesity.

1. Physical Inactivity

2. Consuming highly processed food high in added sugar. This may be due to the food availability in an area.

3. Consuming insufficient amounts of fibre and not including fruit and vegetables into a daily diet.

4. Consuming more calories than calories expended.

5. Lack of good quality sleep, which can affect hormones that control hunger urges.

Systems and Environment

Obesogenic environments refer to the influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations (Swinburn et al, 1999). Risk factors surrounding this include:

1. Increase in availability, advertisement and accessibility of energy dense, unhealthy food (lower in cost but lower in nutritional value).

2. Lack of access to healthy, affordable foods.

3. Lack of access to healthcare services and education.

4. Lack of safe spaces for physical activity. Poor community design can result in lack of green spaces, bikes lanes, paths etc.

5. Low socioeconomic status. This is associated with less leisure time for physical activity and consumption of energy-dense foods that are poor in nutrients.

Stress

1. Long term stress may lead to overproduction of hormones such as cortisol. These hormones help to regulate energy balances and appetite. High levels can promote cravings of foods high in fats and with added sugar.

Health Conditions

1. Some conditions may cause insulin resistance, lead to weight gain or obesity. Examples of these include Cushing's syndrome, Polycystic Ovarian Syndrome and an under active thyroid.

Medications

1. Some medications can interrupt brain signals for hunger which may cause weight gain.

2. These include steroids, psychiatric drugs, forms of hormonal birth control, anti-seizure medication and forms of blood pressure medication.

   
   

Diabetes:

Type 1 Diabetes: 

1. Family history of type 1 diabetes (parent/sibling).

2. Age: Typically develops in children, teens or young adults.

3. Race and ethnicity. According to CDC, white people are more likely to develop type 1 compared to African American/Hispanic or Latino people. 

Type 2 Diabetes: 

1. Primary risk factor is being overweight or having obesity. This can increases insulin sensitivity and lead to diabetes. Overweight is classified as having a BMI over 25. (Diabetes Ireland)

2. Aged 45 or older.

3. Having a parent or sibling with type 2. 

4. Are physically active less than 3 times per week. 

5. Have non-alcoholic fatty liver disease. 

6. Have previously had gestational diabetes.

7. Have, or had, high BP, high cholesterol, or heart disease. (Diabetes Ireland)

8. Have pre-diabetes. This is when blood sugar level is higher than normal. (Diabetes Ireland)

9. Have PCOS (Poly-cystic ovarian syndrome - may develop insulin resistance (Diabetes Ireland)

10. High-risk race and ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) (American Diabetes Association)

Gestational diabetes: 

1. Had gestational diabetes during a previous pregnancy.

2. Have given birth to a baby weighing over 9 pounds. 

3. Are overweight or obese.

4. Are over 25.

5. Have family history of type 2 diabetes. 

6. Have hormone disorder polycystic ovarian syndrome.

   
   

   References

   Risk factors for Obesity:

   1. National Centre for Chronic Disease Prevention and Health Promotion - Risk Factors for Obesity. Available at: 

   https://www.cdc.gov/obesity/risk-factors/risk-factors.html

   2. Scott, K.A., Melhorn, S.J. and Sakai, R.R. (2012) ‘Effects of chronic social stress on Obesity’, Current Obesity Reports, 1(1), pp. 16–25. doi:10.1007/s13679-011-0006-3. 

   3. National Heart, Lung and Blood Institute, Overweight and Obesity, Causes and Risk Factors. Available at: 

    https://www.nhlbi.nih.gov/health/overweight-and-obesity/causes

   4. Swinburn, B., Egger, G. and Raza, F. (1999) ‘Dissecting obesogenic environments: The development and application of a framework for identifying and prioritizing environmental interventions for Obesity’, Preventive Medicine, 29(6), pp. 563–570. doi:10.1006/pmed.1999.0585.

   5. Lee, A., Cardel, M., & Donahoo, W. T. (2019). Social and Environmental Factors Influencing Obesity. In K. R. Feingold (Eds.) et. al., Endotext. MDText.com, Inc

Risk Factors for Diabetes:

1. Diabetes Risk Factors, CDC. Available at:
   https://www.cdc.gov/diabetes/risk-factors/index.html

2. Diabetes Ireland, Risk Factors. Available at: 

   https://www.diabetes.ie/risk-factors/

3. ElSayed, N.A. et al. (2023) Diagnosis and Classification of Diabetes:Standards of care in diabetes—2024’, Diabetes Care, 47(Supplement_1). doi:10.2337/dc24-s002.

Environmental and societal factors have a significant impact in the cause of obesity 

The availability of safe spaces for physical activity, such as parks, gyms, and walking paths, can influence how active people are. 

Additionally, larger portion sizes in restaurants and takeaways contribute to overeating, making portion control more challenging. Unhealthy eating habits can also be learned by children during their childhood based on those around them.

Access to nutritious food is another key factor, particularly in low and middle income countries, where foods high in fat, sugar, and salt, as well high in calories and low in nutrients are often more affordable. 

Food advertising also promotes the consumption of processed food, further increasing the risk of obesity.

Genetics: Genetic makeup can affect how and where the body stores fat, appetite regulation, and responses to food intake. Certain genetic traits inherited from parents, such as having a large appetite, may make losing weight more difficult. Additionally there are some rare genetic conditions that can cause obesity such as Prader-Willi Syndrome.

Energy Imbalance : Obesity can develop when there is an energy imbalance, meaning the body consumes more calories than it uses. Excess energy from food is stored as fat, primarily in the form of triglycerides in fatty tissue. An energy imbalance causes the body to store more fat than be used for immediate energy or in the future.

Dietary Habits: Eating large amounts of processed food, eating larger portions than you need, comfort eating, drinking too many sugary drinks or drinking too much alcohol contribute to the development of obesity.

Physical Inactivity: Sedentary lifestyles result in unused energy being stored as fat. Factors such as desk-bound jobs and use of cars rather than walking or cycling, reduce opportunities for exercise.

Stress: Stress can increase cortisol levels. Cortisol is a stress hormone that has been linked to obesity. High levels of cortisol can make you feel hungrier and can cause you to eat foods high in fat and sugar. Stress can also disrupt sleep. Insufficient sleep can disrupt metabolism, increase hunger, and lower energy levels, making weight management more challenging.

Medications and Medical Conditions: Certain medications can contribute to weight gain. Additionally health issues like an underactive thyroid (hypothyroidism) or Cushing's syndrome can contribute to weight gain. However if conditions such as these are  properly diagnosed and treated they are not as likely to be a cause of obesity. 

Additional Potential Causes of Weight Gain : 

• Pregnancy - due to growth of baby 

• After giving birth - caring for a newborn can affect sleep, eating habits and stress levels

• Stopping smoking - can have effects on appetite 

• Injury - due to being less active than before the injury 

• Menopause - due to changes in hormones

Causes of Diabetes : 

What Causes Type 1 Diabetes: 

Type 1 diabetes is caused by the immune system destroying the insulin-producing beta cells in the pancreas. This prevents the body from making enough insulin, a hormone needed to help blood glucose enter cells for energy. Without insulin, glucose in the blood cannot get into the cells, leading to diabetes. Genetic factors and environmental triggers may play a role in this immune response.

What Causes Type 2 Diabetes: 

Type 2 diabetes develops when the pancreas doesn’t produce enough insulin and the body becomes resistant to insulin, meaning cells in the muscles, fat, and liver don’t respond properly to it. This leads to rising blood glucose levels. 

What Causes Gestational Diabetes : 

Changes to hormones in pregnancy also make it harder for blood glucose to enter the cells in the body, causing insulin resistance. If the pancreas cannot produce the additional insulin required to overcome these changes, this leads to the development of gestational diabetes.

References - Causes of Obesity :

HSE. (2022). Causes of Obesity. [Online]. HSE.ie. Last Updated: 09 August 2022. Available at: https://www2.hse.ie/conditions/obesity/causes/ [Accessed 3 April 2025].

NHS. (2023). Causes of Obesity. [Online]. NHS.ie. Last Updated: 15 February 2023. Available at: https://www.nhs.uk/conditions/obesity/causes/ [Accessed 3 April 2025].

World Health Organisation. (2024). Obesity and overweight. [Online]. who.int. Last Updated: 1 March 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Accessed 3 April 2025].

National Lung Heart and Blood Institute. (2022). Overweight and Obesity Causes and Risk Factors. [Online].nhlbi.nih.gov. Last Updated: 24 March 2022. Available at: https://www.nhlbi.nih.gov/health/overweight-and-obesity/causes [Accessed 3 April 2025].

References - Causes of Diabetes :
National Institute of Diabetes and Digestive and Kidney Disease. (2024). Symptoms & Causes of Diabetes. [Online].niddk.nih.gov. Last Updated: October 2024. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes#:~:text=Type%201%20di [Accessed 3 April 2025].

British Heart Foundation. (2025). Diabetes Causes, Symptoms and Treatment. [Online]. bhf.org.uk. Last Updated: January 2025. Available at: https://www.bhf.org.uk/informationsupport/risk-factors/diabetes#Heading3 [Accessed 3 April 2025].

World Health Organisation. (2024). Diabetes. [Online]. who.int. Last Updated: 14 November 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes [Accessed 3 April 2025].