About 34 million adults in the country were living with diabetes in 2024, but there are still insufficient lifestyle interventions
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 cause of type 2 diabetes, remains largely overlooked for the main reason that people in Pakistan see 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 diabetes prevalence rates in the world and the fourth highest number of adults with the disease.
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Dr. Speaking at a World Diabetes Day event, Shahzad Ali Khan, Vice Chancellor of Health Services Academy Islamabad said, “Pakistan has the lowest glycemic [diabetes] control among the countries of the world. 1/4 of people don’t even know about diabetes and even if the rest know about diabetes, they have no knowledge of how to manage it.”
Recent analyzes describe Pakistan as facing a “double burden” of non-communicable diseases (NCDs), with diabetes, cardiovascular disease and obesity all on the rise. A national policy brief led by the 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.
Professor of diabetes and endocrinology at the University of Birmingham, Dr. Waseem Hanif, is reported to have said: “In Pakistan, over 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” where highly processed food, inactivity and urban stress are built into daily life.
Obesity is a disease, not a lifestyle mistake
“Obesity is not a disease, rather a complex culmination of lifestyle failures,” said former health minister Dr. Zafar Mirza. However, global medical thinking has shifted decisively towards recognizing obesity as a chronic, relapsing disease. “We need to define obesity as a chronic metabolic disease with behavioral, environmental and genetic factors,” added Dr. Khan.
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 state, “Understanding these factors is critical because obesity is associated with other diseases, including type 2 diabetes, heart disease and certain types of cancer”.
But with the right care and support from health professionals, people with obesity can make a difference to their health.
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The NCD policy analysis found that “strong policy action to improve the dietary environment and address the growing burden of NCDs … is largely lacking”, with no major “best buy” interventions fully implemented. “We have a double burden of malnutrition in Pakistan, but we only deal with deficiencies. We don’t deal with obesity, hypertension, etc., due to lack of awareness and finances.”
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 pre-diabetes, with many unaware of their condition until complications arise.
Obesity is also rarely treated systematically in primary care. According to research conducted 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 circle: people live for years with untreated obesity, after which they have advanced type 2 diabetes, cardiovascular disease or kidney failure at much higher costs for both families and the state.
Fighting obesity
When asked what needs to be done to fight obesity, Dr. Mirza that “instead of treating obesity, we need to address lifestyle behaviors with lifestyle interventions.” Dr. Shahzad echoed this: “Combating 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 diabetes onset by 58%, outperform early medication… Bariatric surgery has reversed type-2 diabetes in a large percentage of patients… proving how tightly gut hormones and adiposity [fat levels] are connected,” he added.
In addition, GLP-1-based therapies (drugs that mimic the body’s natural hormones that regulate things like hunger and blood sugar levels) have redefined how clinicians manage obesity and diabetes risk. These drugs mimic gut hormones that regulate appetite, insulin, and digestion, helping patients both lower blood sugar and lose significant weight.
In Pakistan, this science is beginning to be put into practice. An Aga Khan University study 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.”
