People who’ve lived for years with both type 2 diabetes and obesity may feel trapped in a vicious cycle: Weight gain makes your blood sugar harder to control, and high blood sugar makes it more difficult to lose weight. The situation is so common it has its own name: diabesity.
Here’s why these two health conditions are so closely linked — and what can help manage both conditions more effectively.
Why Obesity Makes Diabetes Worse
The link between excess body fat and type 2 diabetes isn’t just about weight. It's also about how your fat cells behave. When you have obesity, your fat tissue stops acting as an energy tank and starts interfering with your body chemistry, says Bahram Mirza, MD, an endocrinologist with Kaiser Permanente Riverside Medical Center in California.
Fat tissue releases free fatty acids and inflammatory chemicals that interfere with how insulin works in the muscles and liver.
“These processes increase insulin demand,” which exhausts the cells in the pancreas that make insulin, says Dr. Mirza. These changes accelerate the progression of type 2 diabetes. “Previously effective lifestyle and medication strategies may no longer be sufficient as the disease progresses,” he says.
Excess weight is tightly linked with development and worsening of insulin resistance, adds Joshua J. Neumiller, CDCES, PharmD, a professor of pharmacotherapy at Washington State University and an immediate past president of healthcare and education at the American Diabetes Association. “When the body becomes increasingly resistant to insulin, type 2 diabetes can become more difficult to manage.”
Here’s a closer look at why obesity makes diabetes worse.
Visceral fat triggers inflammation. The type of fat found deep in the belly releases chemicals that keep the body in a state of high alert, making it much harder to stabilize blood sugar levels.
Spillover fat impacts your organs. When fat cells get too full, extra fat can seep into organs like the liver and pancreas, where it doesn’t belong. Fat in these organs makes it harder for insulin to do its job — moving sugar out of the blood and into cells for energy. Over time, the pancreas gets worn out from working too hard, blood sugar stays high, and diabetes gets worse.
Hormone resistance makes you hungry. Fat cells produce a hormone called leptin to tell your brain you are full. With obesity, the signal fails to register, making you feel constantly hungry even when your body has plenty of stored energy.
Why Diabetes Makes Obesity Worse
While obesity often leads to diabetes, the same is true of the reverse. Type 2 diabetes creates several hurdles that make losing weight and keeping it off challenging, including:
High blood sugar and hunger: When your blood sugar is high, you may feel hungrier than usual or have stronger cravings. When insulin doesn’t work the way it should, sugar can’t move into your cells to be used for energy. Because your brain needs a steady fuel supply, it may send hunger signals that push you to eat more, even when your blood sugar is already elevated.
Barriers to movement: Physical and mental hurdles often make staying active with type 2 diabetes a significant challenge. Fatigue, a common symptom of diabetes, can make it difficult to find the energy to exercise, while nerve pain, which affects nearly half of those with the condition, can make movement uncomfortable. Many also avoid activity due to a fear of low blood sugar (hypoglycemia).
Medication side effects: Diabetes medications like insulin, sulfonylureas, thiazolidinediones, and meglitinides effectively lower sugar but often cause weight gain.
How to Break the Vicious Cycle
Breaking the cycle between these two health conditions requires addressing underlying hormonal and metabolic changes, often through a combination of lifestyle changes, medications, and, for some people, weight loss surgery.
Lifestyle Changes: Beyond Cutting Calories
Dietary restrictions can only take weight loss so far. According to Dr. Neumiller, people with diabetes should take a multipronged approach to weight loss.
Pair your carbs. Pairing carbs like fruit, bread, or pasta with protein or healthy fats — think an apple with peanut butter or pasta with chicken — slows down how quickly sugar enters your bloodstream. This helps prevent the sharp spikes and crashes that leave you feeling hungry and tired.
Get enough sleep. For better blood sugar control, aim for six to eight hours of sleep every night. Too little or even too much shut-eye can trigger cortisol, a stress hormone that causes insulin resistance.
Focus on resistance training. “Resistance training increases lean muscle mass, improving insulin sensitivity and glucose uptake,” says Mirza.
Walk more often. Make it a habit to add more steps throughout your day. A simple 10- to 15-minute walk right after a meal, for example, can meaningfully reduce post-meal hyperglycemia, says Mirza. It signals your muscles to burn off the sugar you just ate before it can be stored as fat.
Medications That Address the Root Causes
Diabetes practitioners often prescribe newer medications, like GLP-1s, to address the root causes of diabesity. Drugs like semaglutide and tirzepatide do more than just lower blood sugar, they help correct the hormonal imbalances that can make weight loss so difficult, help your body recognize when it’s full, and manage insulin more naturally.
Because they target weight and blood sugar at the same time, Neumiller says these medications are an excellent option for people who need to improve both their A1C test results and their weight to stay healthy.
Beyond the scale, they also offer long-term protection for the heart and kidneys, adds Mirza.
Another family of diabetes drugs, SGLT2 inhibitors, also help protect heart and kidney health while reducing weight. These daily pills help the kidneys remove sugar from the bloodstream, which has the secondary effect of flushing calories out of your system through urine. Though they do not provoke the dramatic weight loss that GLP-1 drugs do, they’re associated with a loss of about 2 kilograms, which is roughly 4.5 pounds.
One older diabetes drug also deserves special mention: Metformin, though available as an inexpensive generic, is still considered fundamental to the diabetes treatment in most adults, and can be used in combination with the newer generation of diabetes drugs. Metformin helps control high blood sugar by improving insulin resistance and also contributes to weight loss.
Weight Loss Surgery
Metabolic surgery can be a powerful option for some people, since it can help reset the body’s internal chemistry — not just weight on the scale. According to Mirza, these procedures lead to rapid, positive changes in gut hormones like GLP-1 and peptide YY, reduce fat in the liver, and help the body respond to insulin more effectively.
“For patients with obesity and difficult-to-control diabetes, metabolic surgery is a disease-modifying therapeutic intervention rather than a cosmetic procedure,” says Mirza.
Many people see major improvements in blood sugar, and some are able to reach diabetes remission, meaning their levels stay in a healthy range without glucose-lowering medications. This is more likely when surgery happens earlier in the course of the disease.
The American Diabetes Association notes that surgery may be considered for people with type 2 diabetes and a body mass index (BMI) of 30.0 or higher, says Neumiller. But surgery isn’t a cure for anything if you don’t permanently adopt healthier habits.
“These benefits can reverse if people regain weight lost, so long-term support and lifestyle changes remain important to maintain benefits,” says Neumiller.
The Takeaway
Obesity and type 2 diabetes have a two-way relationship. Excess body fat can lead to inflammation, insulin resistance, and hormonal disruptions that make blood sugar harder to control, while high blood sugar can increase hunger, fatigue, and weight gain.
Diabetes can make weight loss harder, too. High blood sugar can also trigger nerve pain and fatigue that can limit physical activity. Some common diabetes medications lower glucose but promote weight gain, deepening the cycle.
Both conditions should be treated together. A combination of targeted lifestyle changes, weight-friendly diabetes medications, and metabolic surgery (in some cases) can improve insulin sensitivity, support weight loss, and protect long-term health.
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Resources
Michaelidou M et al. Management of Diabesity: Current Concepts. World Journal of Diabetes. April 15, 2023.
Rohm TV et al. Inflammation in Obesity, Diabetes and Related Disorders. Immunity. January 11, 2022.
Ko J et al. Metabolic Traits Affecting the Relationship Between Liver Fat and Intrapancreatic Fat: A Mediation Analysis. Diabetologia. October 4, 2022.
Diabesity: How Obesity Is Related to Diabetes. Cleveland Clinic. November 8, 2021.
Tan B et al. A Cellular and Molecular Basis of Leptin Resistance. Cell Metabolism. March 4, 2025.
Pavlidou E et al. Diabesity and Dietary Interventions: Evaluating the Impact of Mediterranean Diet and Other Types of Diets on Obesity and Type 2 Diabetes Management. Nutrients. December 21, 2023.
Henson J et al. Waking Up to the Importance of Sleep in Type 2 Diabetes Management: A Narrative Review. Diabetes Care. February 23, 2024.
Danpanichkul P et al. Predictors of Weight Reduction Effectiveness Of SGLT2 Inhibitors In Diabetes Mellitus Type 2 Patients. Frontiers Endocrinology. January 23, 2024.
Shetye B et al. Bariatric Surgery, Gastrointestinal Hormones, and the Microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. Obesity Pillars. June 2022.
Sadeghi S et al. Remission and Relapse of Diabetes After Sleeve Gastrectomy and One-Anastomosis Gastric Bypass: The Tehran Obesity Treatment Study. Diabetes, Obesity and Metabolism. September 30, 2024.
Elise M Brett, MD, is a board-certified adult endocrinologist. She received a bachelor's degree from the University of Michigan and her MD degree from the Icahn School of Medicine at Mount Sinai. She completed her residency training in internal medicine and fellowship in endocrinology and metabolism at The Mount Sinai Hospital. She has been in private practice in Manhattan since 1999.
Dr. Brett practices general endocrinology and diabetes and has additional certification in neck ultrasound and fine-needle aspiration biopsy, which she performs regularly in the office. She is voluntary faculty and associate clinical professor at the Icahn School of Medicine at Mount Sinai. She is a former member of the board of directors of the American Association of Clinical Endocrinology. She has lectured nationally and published book chapters and peer reviewed articles on various topics, including thyroid cancer, neck ultrasound, parathyroid disease, obesity, diabetes, and nutrition support.
Susan Jara is a health communications strategist and writer with more than 15 years of experience transforming complex medical information into clear, accurate, and engaging content for diverse audiences of patients and caregivers. She specializes in patient education, health literacy, and SEO-driven content strategy, with expertise across chronic disease, mental health, addiction, arthritis, autoimmune conditions, and wellness.
Susan holds a bachelor’s degree in journalism and media studies from New York University’s Gallatin School of Individualized Study. Her career includes leadership roles at the Global Healthy Living Foundation and Health Monitor Network, where she developed multichannel health content across web, email, podcasts, video, social media, and print. Susan's work reaches millions of readers each year, and she collaborates with leading healthcare providers, researchers, advocacy groups, and industry partners to create resources that reach millions of readers each year.
