Aging Men and Obesity, Diabetes and Heart Disease

with Sonya Addison, MD with Boone Health Diabetes & Endocrinology

Obesity and diabetes have become the two most pressing health crises in the United States. While genetics plays a role, obesity remains one of the strongest drivers of type 2 diabetes. Over the past four decades, unhealthy eating habits high in saturated fats and refined carbohydrates, sedentary lifestyles, and the lack of physical activity have fueled the weight gain that leads to diabetes and potentially, heart disease.

As men age, sedentary behavior increases. Joint pain and arthritis can make it difficult to be active, and once children are raised and retirement approaches, it can be a lot easier to adopt a sedentary lifestyle.

Additionally, while testosterone naturally declines with age, obesity and chronic disease can drive testosterone levels even lower. Low testosterone makes weight loss harder, worsens blood sugar control, and increases the risk of sleep apnea, heart disease, and type 2 diabetes.

Prediabetes

Type 2 diabetes doesn’t manifest out of nowhere. It begins as prediabetes. Prediabetes happens when blood sugar levels are higher than normal. Normal fasting blood sugar levels for adults are between 70 – 99 mg/dL (milligrams of blood sugar, or glucose, per deciliter of blood). Prediabetes occurs when blood sugar levels are between 100-125 mg/dL, while diabetes is diagnosed when blood sugar levels are 126mg/dL or higher. Prediabetes often has no clear symptoms, which is why regular screenings can be so important.

“Regular screenings are one of the most powerful tools we have,” said Sonya Addison, MD with Boone Health Diabetes and Endocrinology. Age and weight appropriate A1C testing, fasting glucose panels, and routine screenings allow clinicians to identify prediabetes before it progresses.

“If we can identify prediabetes, we can start with education, lifestyle changes, and simple medications before it develops into diabetes,” Dr. Addison shares.

“The longer someone lives with obesity, metabolic syndrome, or prediabetes, the higher their risk of developing diabetes and cardiovascular disease as they get older.”

“Screening guidelines once focused on adults in their 40s and 50s, but today many patients in their 20s and 30s have been obese since childhood, and their lifetime risk of getting diabetes is significantly higher.”

Lifestyle Changes

Once diabetes is diagnosed, Dr. Addison uses aggressive diabetes management to get blood glucose levels and A1C closer to normal ranges. Effective care goes far beyond prescribing medication. It requires education; supportive lifestyle planning; identifying realistic, enjoyable physical activities; and addressing mobility limitations and chronic pain.

“We have to treat people, not the disease,” she said. Diabetes and heart disease are also known as an inseparable link. Diabetes is considered a cardiac risk equivalent, meaning anyone with diabetes is automatically at a higher risk for heart disease and stroke.

“Once someone has diabetes,” Dr. Addison explains, “we are automatically trying to prevent cardiac disease. We do that with statin medications, stricter control of cholesterol and lipid numbers, weight loss, and cardiac screenings.”

Nutrition plays a central role in this battle. Our culture has become quick to grab highly processed foods for snacks and meals. These types of foods lead to rapid hunger cycles and blood sugar crashes. They also tend to lack fiber and protein. Instead, patients are taught that whole, nutrient-dense foods help people feel full longer. When patients understand how food affects blood sugar and feeling full, they’re better equipped to make sustainable changes in their everyday lives.

Dr. Addison also discusses physical activity options with patients. Many patients with obesity struggle with back pain, knee and hip arthritis, or limited mobility. They aren’t able to simply start running or lifting weights. Instead, Dr. Addison works with patients to find accessible options that work with their abilities, including water aerobics or chair yoga. Community resources like SilverSneakers programs and YMCA group classes have been known to help patients stay accountable and engaged.

Drug Options

In addition to lifestyle changes, the emergence of GLP1 medications has reshaped obesity and diabetes treatment. Patients are now able to take medication that treats both diabetes and obesity. Drugs like Ozempic and its weight loss counterpart Wegovy, as well as Mounjaro and Zepbound, have helped patients lose significant weight, improve blood sugar control, and reduce long-term complications.

SGLT2 inhibitors like Jardiance and Farxiga help manage diabetes, protect the kidneys, and reduce heart failure risk. Ozempic has been shown to reduce the risk of recurrent heart attack or stroke, and Mounjaro is showing similar promise as ongoing studies continue.

“These medication classes have truly changed how I practice medicine,” Dr. Addison said. “I have patients who have lost 50, 100, 150 pounds, and many who have been able to discontinue insulin entirely.”

Despite their effectiveness, insurance coverage remains inconsistent. Many insurers refuse to cover weight loss medications, leaving patients to pay high prices that can still reach around $400 per month. For most families, that cost is too steep.

While compounding pharmacies have stepped in to meet demand, often marketed through online platforms, patients should be cautious when using them. These products are not FDA approved, and some can be purchased online without a doctor. Dr. Addison said that some of the medications from compounded pharmacies are not purified correctly, might not be sterile, and don’t have a point of contact to report to if there are any problems.

Because of those concerns, getting these medications from a provider is the safest route.

“Prediabetes often has no clear symptoms,” Dr. Addison said. “Knowing the risk factors, getting regular screens, and making important lifestyle changes can help prevent prediabetes from creeping up on you.”

By Erin Wegner

For more information on Diabetes & Endocrinology services, visit boone.health/diabetes-and-endocrinology or call 573-815-7146.