About 34 million adults in the country were living with diabetes in 2024, but insufficient lifestyle interventions persist.
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 factor in type 2 diabetes, remains largely ignored for the main reason that people in Pakistan view it as a lifestyle failure, not a disease.
The International Diabetes Federation (IDF) estimates that more than 34 million adults in the country will be living with diabetes by 2024, giving Pakistan one of the highest prevalences of diabetes in the world and the fourth largest number of adults with the disease.
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Addressing World Diabetes Day, Islamabad Academy of Health Services Vice-Chancellor Dr Shahzad Ali Khan said: “Pakistan has the lowest glycemic index [diabetes] control between the countries of the world. “A quarter of people don’t even know about diabetes, and while the rest do know about it, they don’t know how to control it.”
Recent analyzes describe Pakistan facing a “double burden” of non-communicable diseases (NCDs), with an increase in diabetes, cardiovascular diseases and obesity. A national policy report 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 increasing.
Dr Waseem Hanif, Professor of Diabetes and Endocrinology at the University of Birmingham, is reported to have said: “In Pakistan, more than 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 foods, inactivity, and urban stress are incorporated into daily life.
Obesity is a disease, not a lifestyle failure.
“Obesity is not a disease, but rather a complex culmination of lifestyle failures,” said former Health Minister Dr. Zafar Mirza. However, global medical thinking has turned decisively towards the recognition of obesity as a chronic and relapsing disease. “We need to define obesity as a chronic metabolic disease with behavioral, environmental and genetic factors,” Dr. Khan added.
Novo Nordisk Pakistan, a multinational pharmaceutical company working in the field of diabetes and obesity in Pakistan, states that “obesity is a complex chronic disease and losing weight is not just a matter of eating less and moving more.” They add that it is driven by genetics, physiology, environment and brain biology.
They further add: “Understanding these factors is essential, because obesity is associated with other diseases, such as type 2 diabetes, heart disease and certain types of cancer.”
But with the right care and support from healthcare professionals, people with obesity can make a difference in their health.
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The NCD policy analysis found that “strong policy action to improve the food environment and address the growing burden of NCDs…” is largely lacking, with no major “better buy” interventions being fully implemented. “We have a double burden of malnutrition in Pakistan, but we are only dealing with the deficiencies. We are not dealing with obesity, hypertension, etc., due to lack of attention and funding.”
Underdiagnosed diabetes, undertreated obesity
IDF figures and analysis by independents such as Health Policy Watch, a platform that reports on global health, suggest that tens of millions of Pakistanis have diabetes or prediabetes, and many are unaware of their condition until complications arise.
Obesity is rarely treated systematically in primary care. According to research by the Aga Khan University, risk factors show high levels of overweight and obesity in both urban and rural populations, but routine screening and structured weight management remain scarce.
The result is a vicious cycle: people live for years with untreated obesity and then develop advanced type 2 diabetes, cardiovascular disease or kidney failure, at a much greater cost to both families and the State.
Fight obesity
When asked what to do to combat obesity, Dr Mirza said, “Instead of treating obesity, we have to address lifestyle habits through lifestyle interventions.” Dr. Shahzad echoed this: “Combatting obesity reduces type 2 diabetes. Even modest weight loss (up to 10%) can dramatically improve insulin sensitivity.”
“Lifestyle interventions, such as the Diabetes Prevention Program, reduce the onset of diabetes by 58%, outperforming early medications… Bariatric surgery has reversed type 2 diabetes in a large percentage of patients… demonstrating how closely gut hormones and adiposity influence each other. [fat levels] They 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 the way doctors manage the risk of obesity and diabetes. These medications mimic gut hormones that regulate appetite, insulin, and digestion, helping patients lower blood sugar and lose weight significantly.
In Pakistan, this science is beginning to be translated 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.”
