Biobehavioral factors related to the development and course of type 2 diabetes and cardiometabolic impairment in adults: The critical role of weight, diet, physical activity, and other lifestyle behaviors

Abstract

The purpose of this chapter is to review several individual-level, and potentially modifiable, behavioral factors known to be involved in the etiology of cardiometabolic impairments and type 2 diabetes in the context of aging. There is widespread acknowledgement that the dual epidemics of obesity and type 2 diabetes are interrelated and that lifestyle behaviors associated with excess weight play an integral role in the development, course, and outcomes of the physiological disease process. The study of diet, eating habits, and physical activity within a social-ecological framework has been central to advancing the scientific understanding of obesity and type 2 diabetes for over 50 years. The role of other behavioral lifestyle factors such as sleep, smoking, alcohol use, and psychosocial stress is less well understood but highly relevant because of their biological associations with obesity and the regulation of glucose and insulin. Furthermore, examining the individual-level lifestyle behaviors and associated pathophysiology (i.e., “biobehavioral factors”) most frequently implicated in the development and course of obesity and type 2 diabetes is essential for improved chronic disease prevention and control. Therefore, this chapter has three primary aims. We will (1) review and discuss the biological impact of several key lifestyle behaviors that have been shown to be significant in weight self-regulation and discuss their biological relationship to type 2 diabetes in adults; (2) critically evaluate research findings of the last 10 years that highlight the importance and significance of the biobehavioral relationships associated with type 2 diabetes; and (3) summarize promising research directions that are likely to yield important insights regarding behavioral lifestyle factors for type 2 diabetes prevention and management.