THE RELATIONSHIP BETWEEN OBESITY AND TYPE 2 DIABETES MELLITUS IN PAKISTAN: A SYSTEMATIC REVIEW

Abstract

Type 2 diabetes mellitus (T2DM) is a growing public health crisis, with Pakistan among the top 10 countries globally in prevalence. Obesity, particularly central adiposity, is the most consistent and modifiable risk factor, yet country-specific evidence remains fragmented. This systematic review with meta-analysis synthesized data on the association between obesity and T2DM in Pakistani adults, incorporating both general (BMI) and central (waist circumference, waist-to-hip ratio) measures. A comprehensive search of PubMed, ScienceDirect, Google Scholar, and regional journals identified 230 studies, of which 54 met inclusion criteria, spanning cross-sectional, cohort, case-control, and clinical intervention designs (2010–2026). Obesity significantly increased T2DM risk, with odds ratios ranging 3.1–4.2, and central obesity consistently outperformed BMI as a predictor, particularly in urban and South Asian populations. Cohort studies demonstrated temporal causality, and intervention studies confirmed that weight reduction improves glycemic outcomes. Lifestyle factors—sedentary behavior, high-calorie diets, and urbanization—amplify the risk, while genetic predisposition further modulates susceptibility. Evidence gaps remain in longitudinal assessments, cost-effectiveness evaluations, and culturally tailored interventions. These findings underscore that addressing obesity, particularly central adiposity, is critical to curbing T2DM in Pakistan. Public health policies must prioritize early screening, structured lifestyle modification, and targeted prevention programs. Integrating clinical, behavioral, and socio-economic perspectives in future research will be essential to guide effective interventions and reduce the escalating burden of T2DM in high-risk populations.