{By Dr Saptarshi Bhattacharya}
Type 2 diabetes has long been framed as a lifestyle disease a condition born from poor eating habits, weight gain, sedentary routines, and stress. While these factors play a powerful role, reducing diabetes to lifestyle alone oversimplifies a complex, multi-layered condition. The truth is far more nuanced: Type 2 diabetes develops at the intersection of genetics, environment, metabolism, socioeconomic conditions, and modern living. Understanding this interplay is essential for any meaningful public health strategy.
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Why Type 2 Diabetes Is Far More Than A Lifestyle Disorder
India today is home to over 100 million people with diabetes and another 136 million with prediabetes. Yet many of these individuals do not fit the stereotypical profile. Thin, young professionals are showing signs of insulin resistance; children are being diagnosed with fatty liver; women with PCOS or thyroid issues face early metabolic disruption; and individuals who appear outwardly fit are developing the condition due to hidden visceral fat. The narrative that diabetes is purely the outcome of “personal choices” is no longer scientifically accurate and, more importantly, it is harmful.
Genetics forms the quiet but potent backbone of vulnerability. South Asians have a unique genetic makeup that makes them more prone to insulin resistance, even at lower body weights. The “thrifty gene” hypothesis suggests that populations historically exposed to food scarcity evolved to store energy efficiently. In today’s calorie-rich environment, this genetic advantage turns into a metabolic liability. But genes alone do not determine destiny; they interact with lifestyle triggers that shape the final outcome.
Urban lifestyles create the perfect storm. Highly refined diets packed with white rice, wheat, oils, sugar, and ultra-processed snacks lead to rapid glucose spikes. Long commuting hours, desk-bound jobs, irregular sleep, and chronic stress worsen insulin resistance. Even air pollution, increasingly recognised as an endocrine disruptor, contributes to metabolic inflammation. The cumulative effect is an overwhelmed system where normal insulin action begins to wane. Yet, there is an overlooked dimension in this conversation social determinants of health.
The Hidden Links: Genetics, Urban Living, And Social Inequity
Access to nutritious food is deeply unequal. Many urban families rely heavily on packaged and restaurant foods due to time constraints or lack of affordable alternatives. Physical activity is a privilege in cities that offer little safe public space. High stress workplaces, erratic work hours, and lack of mental health support further elevate risk. For women, caregiving burdens, hormonal fluctuations, and limited prioritisation of their health predispose to metabolic disorders even earlier. These structural realities are as critical as individual behaviour, yet seldom acknowledged.
Early Warning Signs And The Silent Progression Of Diabetes
Another blind spot is the delayed diagnosis pattern. Diabetes does not begin when fasting plasma glucose rises above 126 mg/dL or when HbA1c crosses 6.5%. The body often fights insulin resistance for 8–10 years before these numbers turn abnormal. During this “silent phase”, fasting insulin rises, fat deposits around abdominal organs, fatty liver develops, and chronic inflammation simmers. Many people in their twenties and thirties walk around with normal glucose levels but significant metabolic dysfunction brewing beneath. Expanding our screening parameters to include lipid profile, liver function tests, CRP, waist circumference, and waist-to-height ratio can help identify high-risk individuals earlier.
The solution, therefore, must be equally multi-dimensional. Public health communication should evolve from guilt-driven messaging to empowerment-driven guidance. Improving food environments from clear labelling to limiting trans-fats and regulating ultra-processed foods will have broader impact than advising individuals to “eat healthy”. Cities must prioritise walkability, safe cycling lanes, and accessible parks. Workplaces should recognise the metabolic cost of chronic stress and adopt wellness policies that are more than just token initiatives.
At the individual level, small but consistent changes create powerful shifts: prioritising protein and fibre, reducing refined carbohydrates, lifting weights to build muscle (the body’s main glucose sink), walking after meals, managing stress, and improving sleep quality. These interventions not only regulate glucose but also strengthen the body’s insulin response.
Ultimately, the conversation about type 2 diabetes must move beyond blame and narrow thinking. It is not a disease of poor discipline; it is a mirror reflecting our biological inheritance, our changing lifestyles, our urban ecosystems, and our social inequities. By acknowledging this complexity, we can design a future where prevention is realistic, diagnosis is earlier, and living with diabetes is not a lifelong struggle but a manageable condition.
If India is to bend the curve of its diabetes epidemic, we must decode the condition in its full depth – lifestyle, genetics, environment, and everything in between and act on all fronts, not just one.
The author, Dr Saptarshi Bhattacharya, is a Senior Consultant, Endocrinology, at Indraprastha Apollo Hospitals.
[Disclaimer: The information provided in the article is shared by experts and is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]
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