How obesity is driving Pakistan’s diabetes epidemic | The Express Tribune

Pakistan’s diabetes crisis is now among the worst in the world, but health experts warn that only half the battle is being fought. Obesity, a critical driver of Type 2 diabetes, remains largely overlooked for the main reason that people in Pakistan see it as a lifestyle failure, not a disease.

The International Diabetes Federation (IDF) estimates that more than 34 million adults in the country live with diabetes as of 2024, giving Pakistan one of the highest diabetes prevalences in the world and the fourth highest number of adults with the disease.

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Speaking at an event for World Diabetes Day, Vice Chancellor of Health Services Academy Islamabad, Dr Shahzad Ali Khan, said, “Pakistan has the lowest glycemic [diabetes] control among the countries of the world. 1/4 people don’t even know about diabetes, and even though the rest know of diabetes, they have no knowledge of how to manage it.”

Recent analyses describe Pakistan as facing a “double burden” of non-communicable diseases (NCDs), with diabetes, cardiovascular disease and obesity all rising. A national policy brief led by Aga Khan University and partners warns that NCDs now account for 58% of annual deaths, and that mortality from diabetes and related conditions is climbing.

Professor of Diabetes and Endocrinology at the University of Birmingham, Dr Waseem Hanif, is reported to have said, “In Pakistan, over 100 million people are obese… Obesity is a disease, and its main symptom is hunger.”

He framed obesity not as a moral failing but as “a normal response to an abnormal environment,” one in which highly processed food, inactivity and urban stress are built into daily life.

Obesity is a disease, not a lifestyle failure

“Obesity is not a disease, rather a complex culmination of lifestyle failures,” said former health minister Dr Zafar Mirza. However, global medical thinking has shifted decisively toward recognising obesity as a chronic, relapsing disease. “We need to define obesity as a chronic metabolic disease with behavioural, environmental and genetic drivers,” added Dr Khan.

Novo Nordisk Pakistan, a multinational pharmaceutical company working in the diabetes and obesity space in Pakistan, states that “obesity is a complex chronic disease, and losing weight is not just a question of eating less and moving more”. They add it is driven by genetics, physiology, environment and brain biology.

They further say, “Understanding these factors is critical, 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 of healthcare professionals, people with obesity can make a difference to their health.

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The NCD policy analysis found that “strong political action to improve the dietary environment and address the growing burden of NCDs… is largely lacking”, with no major “best buy” interventions fully implemented. “We have a double burden of malnutrition in Pakistan, but we are dealing with deficiencies only. We are not dealing with obesity, hypertension, etc., because of a lack of attention and finances.”

Underdiagnosed diabetes, undertreated obesity

IDF figures and analyses done by independents such as Health Policy Watch — a platform reporting on global health —suggest tens of millions of Pakistanis have diabetes or pre-diabetes, with many unaware of their condition until complications emerge.

Obesity is also rarely treated systematically in primary care. According to research done by Aga Khan University, risk factors show high levels of overweight and obesity in both urban and rural populations, yet routine screening and structured weight management remain sparse.

The result is a vicious circle: people live for years with untreated obesity, then present with advanced type 2 diabetes, cardiovascular disease or kidney failure at far higher cost to both families and the state.

Combating obesity

When asked about what to do to combat obesity, Dr Mirza said that “instead of treating obesity, we have to deal with lifestyle behaviours with lifestyle interventions.” Dr Shahzad echoed this, “Combating obesity reduces type 2 diabetes. Even modest weight loss (up to 10%) can dramatically improve insulin sensitivity.”

“Lifestyle interventions like the Diabetes Prevention Program reduce diabetes onset by 58%, outperforming early medications…Bariatric surgery has reversed type-2 diabetes in a large percentage of patients… proving how tightly gut hormones and adiposity [fat levels] are intertwined,” 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 obesity and diabetes risk. These drugs mimic gut hormones that regulate appetite, insulin and digestion, helping patients both lower blood sugar and lose significant weight.

In Pakistan, this science is beginning to translate into practice. A study from Aga Khan University reported that semaglutide, a drug used to treat obesity and type 2 diabetes, was effective in reducing body weight in Pakistani patients with Type 2 diabetes, with “measurable tolerability and patient satisfaction.”