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from 'food noise' to blood sugar: how targeting obesity is revolutionizing type 2 diabetes care
the real question is, dr. sean wharton points out: “what is keeping the blood sugar down? is it the medication or is it the fact that the person lost the weight? it is both”
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recent international diabetes conference highlighted the link between obesity and type 2 diabetes, along with research on glp-1 medication impact.
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leading experts explored the latest diabetes research at the recent european association for the study of diabetes (easd) annual conference. one thing that came through loud and clear for attendees like dr. sean wharton, canadian obesity physician and diabetes expert, was the focus on obesity.
the two chronic diseases, diabetes and obesity, are closely linked.
“what came out of the meeting for me was that it was clear that the major risk factor for type 2 diabetes is obesity,” wharton says. “we know that 90 per cent of people with type 2 diabetes are living with overweight or obesity. and in every study and every way we’ve looked at it, if that person with type 2 diabetes is living with overweight or obesity, when we correct their overweight or obesity, their type 2 diabetes significantly improves.”
obesity a major risk factor for type 2 diabetes
for some people, their diabetes even goes into remission, where they no longer have elevated blood sugar levels. wharton talks about a significant lifestyle trial, the diabetes remission clinical trial published in the lancet, where people living with type 2 diabetes followed dietary and activity interventions. he notes that about 23 per cent of patients in the first year no longer needed their type 2 diabetes medication and were able to have a blood sugar level lower than the diabetes cutoff. but by year five, under six per cent of people continued to achieve this result. the majority of people still live with diabetes even with lifestyle modification.
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“so it was short-lived. it was never in remission, because the challenge is maintaining that dietary level was impossible,” he says. “so that’s not the way that i view things. i view things as we’re living with type 2 diabetes, taking an intervention that treats the obesity, and at times it can treat the type 2 diabetes also because many of these drugs are type 2 diabetes and obesity medication at the same time.”
medication and lifestyle improve disease management in obesity and type 2 diabetes
the real question is, wharton points out, “what is keeping the blood sugar down? is it the medication or is it the fact that the person lost the weight? it is both.”
and the shift in thinking is that treatment and prevention for type 2 diabetes in people with overweight and obesity is the weight management drug. “we do know that the person can exist just on the weight management drug and no other diabetes medications. so if they were on insulin before, if they were on oral medications, they don’t need those anymore. they only need the obesity management drug to keep the weight down and also keep their blood sugars down. so that’s the big thing.”
as it turned out, the conference on diabetes had a lot of content around obesity medication.
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for example, semaglutide is a glp-1 receptor agonist originally developed for diabetes management and now widely used for weight management. research continues to reveal its efficacy, like the inform survey presented at easd. this real-world survey explores how semaglutide for weight management helped suppress “food noise,” which is unwanted and intrusive thoughts about food. survey respondents also reported improvements in their mental well-being and lifestyle.
wharton has conducted research on a related theme, published in obesity, that looked at semaglutide’s impact on food cravings and emotional eating, with study participants using a questionnaire. “i do know about cravings and emotional eating, as per the control of eating questionnaires. this is related to food noise.”
in people with obesity, losing at least five per cent body weight is recommended to prevent or improve weight-related health complications. the problem is, this is difficult to achieve through diet and exercise alone because of compensatory changes in appetite-regulating hormones. these hormones work to maintain normal weight homeostasis, keeping people at their heavier weight.
wharton’s research has shown that semaglutide is an effective longer-term treatment for overweight or obesity through improving the control of eating and food cravings, so that people can achieve and maintain substantial weight loss. participants reported fewer cravings, reduced hunger and increased feelings of fullness.
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medical community ‘slow to the science’
while public recognition and demand for obesity medication is growing, wharton also says the medical community in canada is much the same as the other g7 countries, with poor and slow recognition of obesity being a major factor for the majority of inflammatory diseases (like type 2 diabetes) that we’re currently living with, and slow to ensure that those interventions are available for patients. “we’re slow to the science, slow to the diagnosis, slow to the intervention and slow to the accessibility.”
the most important learning coming out of the conference was the promise of a “new era” where oral glp-1 medications will be coming to market, breaking down the access barriers of injections that are costly and require refrigeration. pill formulations could be easy to make, easy to administer, and easy to transport.
“so now we’re in a position where we may be able to see interventions that allow for access to care for millions and millions of people that really need it,” he says, adding he hopes to see the oral medications available in canada in late 2026.
as weight management and glp-1 therapies appear in every facet of the world’s discussions, wharton notes that science is revealing significant benefits of glp-1 analogs for things like alzheimer’s risk and alcohol abuse because they help to repair the brain tissue. the joint pain of conditions like osteoarthritis and rheumatoid arthritis also improves with the medication through decreased inflammation.
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in fact, he says the easd conference may look very different 10 years from now as advanced glp-1 therapies help to prevent the complications of type 2 diabetes and the onset of the disease itself. “what if we don’t have type 2 diabetes? how many crutches do you need for polio or significant interventions for the complications of polio? we don’t need things for the complications of polio because we don’t have polio anymore, so that is where i believe some of this is heading.”
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