Shagun Bindlish, MD, FACP, FOMA, DABOM, DACLM, is an internist and diabetologist with advanced expertise in obesity and lifestyle medicine. She serves as medical and scientific chair for the ADA Northern California and is the founder of the Golden State Obesity Society. An educator at Touro University California and University at Sea CME, she has trained providers worldwide in metabolic health. 

Recognized with the Obesity Medicine Association’s Outstanding Contribution Award in 2024, she is also nominated by her peers for the Compassionate Physician of the Year Award by the California Medical Association. Her work focuses on advancing diabetes and obesity care through innovation, education, and advocacy.

Shagun Bindlish, MD, FACP, FOMA, DABOM, DACLM

Each November, as blue lights illuminate buildings and ribbons mark Diabetes Awareness Month, we’re reminded of the millions living with diabetes and of the millions more standing quietly at the edge of diagnosis. For clinicians, it’s time to look beyond the numbers on a glucose meter and confront a more profound truth: 

 is not just a disease of high blood sugar; it reflects a deeper metabolic imbalance.

Behind every elevated HbA1c lies a story of metabolic overload, a body struggling to manage excess energy, inflamed adipose tissue sending distress signals, and β-cells fighting to maintain equilibrium. Obesity and diabetes are not parallel epidemics; they are interwoven threads of the same metabolic fabric. This month

awareness must mean integration, uniting how we think, talk, and care for these interconnected conditions.

The Metabolic Bridge Between Obesity and Type 2 Diabetes

Obesity reshapes metabolism long before a single glucose reading turns abnormal. Adipose tissue, once thought to be inert, is a dynamic endocrine organ. As fat cells expand, they release free fatty acids and pro-inflammatory cytokines such as TNF-α and IL-6, while adiponectin, the guardian of insulin sensitivity, declines. This inflammatory cascade disrupts insulin signaling in the liver and muscle, forcing pancreatic β-cells to secrete more insulin just to maintain normalcy.

Over time, the relentless demand leads to β-cell exhaustion. The pancreas cannot keep up; glucose rises. What we call “type 2 diabetes” is often the final act of years of unseen metabolic struggle.

The lesson is clear: Obesity and Diabetes are not separate diseases but biological partners along a shared continuum.

Why Some with Obesity Develop Diabetes, and Others Don’t

Not everyone with obesity develops diabetes, and understanding why is key to prevention. Two individuals with identical BMIs may walk entirely different metabolic paths. The difference lies in where fat is stored and how it behaves.

Visceral and ectopic fat nestled in the liver, pancreas, and muscle acts as a metabolic saboteur, promoting insulin resistance. In contrast, subcutaneous fat can serve as a safer storage reservoir. Those able to expand subcutaneous depots without spilling fat into vital organs remain metabolically healthier, even at higher weights.

The second determinant is β-cell resilience. Genetics, early nutrition, ethnicity, and even prenatal exposures influence β-cell endurance. For instance, South Asian and Hispanic individuals develop diabetes at lower BMI thresholds because their β-cell reserve is smaller. Add to those modern stressors, poor sleep, inactivity, processed diets, and the balance tips faster.

Identifying risk early allows us to intervene before β-cells exhaustion.

 BMI and waist circumference remain simple yet powerful markers of visceral adiposity.

 Fasting glucose, HbA1c, fasting insulin, and, when needed, an oral glucose tolerance test reveal early dysglycemia.

 Family history, gestational diabetes, PCOS, sleep apnea, ethnicity, and medication history refine assessment.

 Regular HbA1c, waist measurement, and even continuous glucose monitoring in high-risk individuals can expose subtle metabolic shifts.

A 5 – 10% weight loss can reduce diabetes risk by half. Mediterranean-style nutrition, daily movement combining aerobic and strength training, and adequate sleep can also reduce diabetes risk. Yet sustaining it requires behavioral scaffolding: goal setting, self-monitoring, and community support.

2. Pharmacotherapy: The Metabolic Revolution

A new generation of therapies is redefining possibilities. GLP-1 receptor agonists, such as semaglutide and dual GIP/GLP-1 agents like tirzepatide deliver unprecedented improvements in both weight and glycemia. When viewed not as shortcuts but as metabolic restoratives, these medications empower patients and clinicians alike. For many, they are the bridge from chronic struggle to sustainable success.

3. Metabolic Surgery: Durable Transformation

For patients with severe obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities), bariatric or metabolic surgery offers a durable impact, often achieving diabetes remission through hormonal and metabolic reset. The key lies in lifelong follow-up: nutritional, psychological, and medical.

Together, these pillars form a continuum of lifestyle first, pharmacotherapy next, and surgery when indicated.

Integrating Care: Healing the Whole Metabolism

Too often, diabetes clinics focus on glucose while obesity programs focus on weight. This division misses the point. Both conditions spring from the same root cause: disordered energy balance and impaired insulin action. An integrated metabolic care uniting endocrinology, obesity medicine, nutrition, psychology, and exercise physiology delivers the best outcomes.

Technology now enhances this integration: continuous glucose monitors, smart scales, and AI-based coaching can personalize interventions in real time. But integration is not just logistical, it’s philosophical. By treating obesity and diabetes together, we move from symptom control to root-cause medicine.

 promise greater synergy across glucose and weight regulation.

 will soon allow personalized interventions based on insulin resistance or β-cell profile.

 are transforming lifestyle monitoring and early prevention.

 recognizes that metabolic disease begins decades before diagnosis.

Obesity Medicine Association (OMA) Clinical Practice Guidelines

: Comprehensive frameworks for evidence-based care.

: An interactive roadmap integrating pharmacotherapy, behavior, and surgery.

: Education on communication, bias reduction, and metabolic comorbidities.

This Diabetes Awareness Month, let’s redefine awareness itself. It’s no longer enough to chase glucose targets. We must confront the metabolic roots that feed the epidemic. Every conversation about diabetes must include obesity; every discussion about weight must include metabolic health.

Articles

Diabetes Awareness Month highlights the interconnectedness of obesity and type 2 diabetes, emphasizing the need for integrated care. Obesity and diabetes are not separate diseases but part of a shared metabolic continuum. The distribution and behavior of fat, along with β-cell resilience, determine diabetes risk. Early risk assessment and intervention are crucial. Management involves lifestyle changes, pharmacotherapy, and metabolic surgery. Integrated care, combining endocrinology, obesity medicine, and technology, addresses the root causes of metabolic disorders, moving beyond symptom control to holistic treatment.

Shagun Bindlish, MD, emphasizes the urgent need to integrate diabetes and obesity care, addressing their shared metabolic roots for better health outcomes.