About 34 million adults nationwide were living with diabetes in 2024, but lifestyle interventions remain insufficient.
Pakistan’s diabetes crisis is now one of the worst in the world, but health experts warn only half the battle is fought. Obesity, a key factor in type 2 diabetes, remains largely neglected, mainly because Pakistanis view it as a failure of their lifestyle and not a disease.
The International Diabetes Federation (IDF) estimates that more than 34 million adults in the country will be living with diabetes in 2024, giving Pakistan one of the highest prevalences of diabetes in the world and the fourth highest number of adults with the disease.
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Speaking at an event organized on the occasion of World Diabetes Day, Islamabad Academy of Health Services Vice Chancellor Dr Shahzad Ali Khan said, “Pakistan has the lowest blood sugar level [diabetes] control between the countries of the world. A quarter of people don’t even know about diabetes, and even if the rest know about diabetes, they don’t know how to manage it. »
Recent analyzes describe Pakistan as facing a “double burden” of non-communicable diseases (NCDs), with increases in diabetes, cardiovascular disease and obesity. A national policy brief led by the Aga Khan University and partners warns that NCDs now account for 58% of annual deaths and that mortality from diabetes and related diseases is increasing.
Professor of diabetes and endocrinology at the University of Birmingham, Dr Waseem Hanif, was quoted as saying: “In Pakistan, more than 100 million people are obese… Obesity is a disease and its main symptom is hunger. »
He presented obesity not as a moral failing but as “a normal response to an abnormal environment,” one in which highly processed foods, inactivity, and urban stress are part of daily life.
Obesity is a disease, not a lifestyle failure
“Obesity is not a disease, but rather the culmination of a complex lifestyle,” said former Health Minister Dr Zafar Mirza. However, global medical thinking has shifted decisively toward recognizing obesity as a chronic, relapsing disease. “We need to define obesity as a chronic metabolic disease with behavioral, environmental and genetic factors,” added Dr Khan.
Novo Nordisk Pakistan, a multinational pharmaceutical company working in the field of diabetes and obesity in Pakistan, states that “obesity is a complex chronic disease, and losing weight is not just a matter of eating less and moving more.” They add that it depends on genetics, physiology, environment and brain biology.
They add: “Understanding these factors is essential, because obesity is associated with other diseases, including type 2 diabetes, heart disease and certain types of cancer.”
But with the right care and support from medical professionals, obese people can make a difference to their health.
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The NCD policy analysis found that “strong policy action to improve the food environment and address the growing burden of NCDs… is largely lacking,” and no major “cost-effective” interventions are fully implemented. “In Pakistan, we face a double burden of malnutrition, but we only deal with deficiencies. We do not deal with obesity, hypertension, etc., due to lack of attention and financial means.”
Underdiagnosed diabetes, undertreated obesity
FDI figures and analyzes by independent organizations such as Health Policy Watch – a platform that reports on global health – suggest that tens of millions of Pakistanis have diabetes or prediabetes, and many are unaware of their condition until complications develop.
Obesity is also rarely treated systematically in primary care. Risk factors reveal high levels of overweight and obesity in urban and rural populations, but routine screening and structured weight management remain rare, according to a study by the Aga Khan University.
The result is a vicious cycle: People live for years with untreated obesity, then develop advanced type 2 diabetes, cardiovascular disease or kidney failure, costing families and the state far more.
Fight obesity
When asked what needs to be done to combat obesity, Dr. Mirza replied that “instead of treating obesity, we need to address lifestyle behaviors through lifestyle interventions.” Dr. Shahzad echoed this: “Tackling obesity reduces type 2 diabetes. Even modest weight loss (up to 10%) can significantly improve insulin sensitivity.
“Lifestyle interventions such as the Diabetes Prevention Program reduce the onset of diabetes by 58%, surpassing early medications…Bariatric surgery has reversed type 2 diabetes in a large percentage of patients…proving how tight gut hormones and adiposity are. [fat levels] are closely linked,” he added.
Additionally, GLP-1-based therapies (drugs that mimic the body’s natural hormones, which regulate things like hunger and blood sugar levels) have redefined how clinicians manage the risk of obesity and diabetes. These medications mimic gut hormones that regulate appetite, insulin, and digestion, helping patients lower their blood sugar and lose significant amounts of weight.
In Pakistan, this science is beginning to be put into practice. A study from the Aga Khan University reported that semaglutide, a drug used to treat obesity and type 2 diabetes, was effective in reducing the body weight of Pakistani patients with type 2 diabetes, with “measurable tolerability and patient satisfaction.”
