Last week, the East Africa Diabetes Group (EADSG) in collaboration with Rwanda’s Ministry of Health held a congress in Kigali, aimed at discussing the latest development in treatment of diabetes, measures of addressing challenges posed by an increasing burden of diabetes and other non-communicable diseases in the region and beyond.

During the congress, a presentation on the statistics from International Federation of Diabetes Africa indicated that the number of diabetic people is growing, with data showing that four out of five people with diabetes live in low and middle income countries.

Figures further showed that the percentage of people living with diabetes before being diagnosed is very high – with three out of four being undiagnosed in Africa.

The mortality associated with diabetes is also high. In African settings, diabetes is an acute and chronic killer disease with a rate of death up to 80 per cent in some countries.

Among the causes of diabetes, experts highlighted waist circumference, saying it is a high risk factor to one developing diabetes and other conditions that come along with bad lifestyles.

According to Dr Charlotte Bavuma, an endocrinologist at University Teaching Hospital, Kigali (CHUK), previously body mass index, the ratio of one’s weight to their height, was used as a key risk factor to diabetes.

She, however, says it has been since established that some people who may not be obese but have a lot of fat around their abdomen area are at a higher risk of diabetes and other conditions as well.

Understanding abdomen fat

Bavuma explains that fat tissues, which are most located in the abdomen, cause accumulation of the fat around the waist area.

"Another cause is when one eats unhealthy diets most of the time and they don’t do physical activities. The first area for such fats to accumulate is the abdomen,” she says.

Bavuma points out that, along with being overweight and obese, people with high blood pressure (hypertension), high blood glucose, a family history of such problems, those who are not physically active and those who smokes are at a high risk of having large waist circumference, which can put them at risk of developing many diseases.

"It is important for one to find out why they are gaining weight around the waist. This can help them take the necessary steps towards achieving a healthy size. A commitment to a healthy and active lifestyle is crucial to helping such people maintain a healthy waistline,” she says.

The medic further explains that, for one to develop a large waist, it could be as a result of a poor diet and unhealthy eating habits. For instance, if one is consuming more calories than they burn, they will gain weight. So, it’s not the amount of food but rather the kind one takes that affects waist size, Bavuma says.

"A diet rich in processed foods, artificial ingredients, unhealthy fats and sugars promotes weight gain, including accumulation of fats around your abdomen,” she says.

Bavuma says the way to find out any other cause of a large waist circumference is carrying out tests which can help identify the condition at hand and how it should be managed.

How to know when at risk

Dr Alexander Kayiranga, a general practitioner in Kigali, says obese people, with a body mass Index (BMI) of 30 or more and non-obese individuals with large waists are considered at higher risk of developing diabetes. Body Mass Index is a simple calculation using a person’s height and weight. The formula is BMI = kg/m2 where kg is a person’s weight in kilogrammes and m2 is their height in metres squared. A BMI of 25.0 or more is overweight, while the healthy range is 18.5 to 24.9.

"Both men and women with large waists stand the same risk of catching diabetes as obese people. Measuring waist circumference can help identify overweight individuals,” he says.

For instance, he explains that people with a BMI of 25-29.9 with a large waist, are at high risk of developing diabetes, especially if they are obese. In women, however, he says those with a waist of 88 centimetres (35 inches) or more are the ones who are at risk, while 102 centimetres (40 inches) and more in men is considered a large waist that is unhealthy.

Kayiranga further explains that if one has waist which is larger than the normal size, they are not only associated with type 2 diabetes, but also high cholesterol levels, high blood pressure and cardiovascular diseases. This is so because of the excess abdominal fat.

Dr Chrispn Gishoma, the director of Rwanda Diabetes Association, says having a normal waist helps one stay away from many diseases.

To find out if one has a normal waist, he says, they can use a tape measure around their waist and then visit a health facility to find out if they are on a safe side or not.

Gishoma says the tape measure should be placed around the top of the hipbone, which is usually at the level of the belly.

He, however, says that there is possibility of having adverse health effects even among people with a BMI less than 30.

"Regardless of the weight, people should do their best to make sure they don’t get involved in habits that will lead to accumulation of fats around their abdomen. Maintaining a normal waist size is an indicator of good health,” he says.

Gishoma adds that measuring waist circumference also helps screen for other possible health risks that come with overweight and obesity.

Insulin resistance

Erick Musengimana, a nutritionist working with Rwanda Diabetes Association, notes that one’s weight may fit their height, but having a large abdomen can cause them diabetes because the fat on the abdomen can cause resistance to insulin.

"Insulin is a hormone which helps the glucose from the food into the cells to provide energy; so if there is resistance to insulin, the blood glucose becomes high,” he says.

Musengimana adds that the cells in the body are powered by the sugar molecules known as glucose.

"To keep this on track, the body uses insulin to regulate glucose uptake. The insulin opens the cells gas caps to allow the glucose to flow. However, sometimes the cells stop responding to insulin. This is what is referred to insulin resistance,” he explains.

Musengimana notes that insulin resistance is a harmful process in the body, which gets worse with time. When a person with insulin resistance consumes excessive amounts of sugar and carbohydrates, there is huge load of sugar in the blood stream.

The body handles it by producing large amounts of insulin, which can keep blood sugar normal but causes a lot of harm to the rest of the body.

"When one has insulin resistance, their blood floods with glucose, which increases the risk for diabetes. It also fills it with other molecules that promote heart clogging blood clots,” he says.

On this note, Musengimana says when one has insulin resistance they should adopt a lifestyle that will help overcome it.

One of the measures, he says, is to exercise.

"The exercise shouldn’t be vigorous but at least 30 minutes per day, including brisk walking. Also, they should visit health facilities to find out their weight. This will help them to ensure they maintain a normal weight or to reach their weight goal,” he says.

Eating a healthy diet can also help one keep away from insulin resistance. Here, one should consume plenty of vegetables, whole grains, nutsbeans, legumes and others on daily basis, says Musengimana.

Bavuma also notes that people should adopt a lifestyle that will help reduce the fat in the abdomen so that they stay away from the risks of developing diseases.

She also says one of the complications associated with a large waist circumference is diabetes, while fatty liver diseases may lead to cirrhosis and hypertension, among others.