Type 2 diabetes and obesity: a biological, behavioral, and environmental context

According to the Centers for Disease Control and Prevention (CDC), type 2 diabetes accounts for 90-95% of diabetes (29.1 million) cases and manifests in 15-30% of prediabetes (86 million) cases, where 9 out of 10 individuals do not know they have prediabetes. Obesity, observed in 56.9% of diabetes cases, arises from the interactions among genetic, biological, environmental, and behavioral factors that are not well understood. Assessing the strength of these links in conjunction with the identification and evaluation of intervention strategies in vulnerable populations is central to the study of chronic diseases. This research addresses three issues that loosely connect three levels of organization utilizing a combination of quantitative and qualitative methods. First, the nonlinear dynamics between insulin, glucose, and free fatty acids is studied via a hypothesis-based model and validated with bariatric surgery data, demonstrating key metabolic factors for maintaining glucose homeostasis. Second, the challenges associated with the treatment or management, and prevention of diabetes is explored in the context of an individualized-based intervention study, highlighting the importance of diet and environment. Third, the importance of tailored school lunch programs and policies is studied through contagion models developed within a social ecological framework. The Ratatouille Effect, motivated by a pilot study among PreK-8th grade Arizona students, is studied and exposes the importance of institutionalizing practical methods that factor in the culture, norms, and values of the community. The outcomes of this research illustrate an integrative framework that bridges physiological, individual, and population level approaches to study type 2 diabetes and obesity from a holistic perspective. This work reveals the significance of utilizing quantitative and qualitative methods to better elucidate underlying causes of chronic diseases and for developing solutions that lead to sustainable healthy behaviors, and more importantly, the need for translatable multilevel methodologies for the study of the progression, treatment, and prevention of chronic diseases from a multidisciplinary perspective.