Obesity is commonly associated with insulin resistance and hyperinsulinemia and is a major risk factor for the development of type-2 diabetes. Obesity and diabetes tend to occur together because carbohydrate metabolism and body weight gain regulation rely on common hormonal (insulin and leptin) and CNS signaling system. It is clear that obesity is associated with a state of chronic low-level inflammation (in white adipose tissue) and inflammation contributes to insulin resistance. Although adipose tissue is known to express and secrete a variety of metabolites, hormones and cytokines that have been implicated in the development of insulin resistance, the molecular basis for the link between obesity and diabetes is still not very clear. While free fatty acids released from adipose tissue have long been implicated in the development of obesity linked diabetes, it is now apparent that there is an overlap among the hormones, neuropeptides, signaling molecules and inflammation in these two disorders. This sharing might play an important role in the pathophysiology of these two syndromes. The article mainly focuses on the role of insulin, leptin, brain, and inflammation and stress as major elements which participate in the pathophysiology of obesity linked diabetes.

The epidemic of obesity associated diabetes is a major crisis in modern societies in which food is plentiful and exercise is optional. Obesity and type-2 diabetes have reached epidemic proportions in many developing and developed countries. This comorbidity is now described as the "twin epidemics" with the recent adoption of the term "diabesity" (Shafrir,1996). Children and adolescents are becoming more and more obese due to sedentary life style and unhealthy eating pattern and are developing type-2 diabetes. Evidence suggests that the relative risk of developing diabetes was 2.9 times higher for obese person (age 20-75 years) than persons with normal weight.

About 80% of those with type-2 diabetes are overweight and the risk of developing the disease increases progressively as the Body Mass Index (BMI), waist to hip ratio, waist circumference or more specifically the amount of deep abdominal body fat increases. Studies indicate that compared to the risk of type-2 diabetes among the normal-weight individuals, the risk is about twofold in the mildly obese (BMI 30+), rising strongly in the case of morbid obesity (BMI 40+) or malignant obesity (BMI 50+). The length of time, a patient has suffered from obesity is an additional factor in diabetes risk.

Although the BMI has been the most commonly cited risk factor for developing diabetes, recently it has been shown that waist circumference may be a more accurate indicator than BMI. Guidelines now identify a waist circumference of more than 88 cm in women and 102 cm in men as indicating those with the highest risk of developing type-2 diabetes.

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