Socio-Behavioral Determinants of Obesity and Type 2 Diabetes in Middle-Aged Adults: Insights from a Population-Based Study in Sialkot

Abstract

Background: The parallel rise of obesity and Type 2 Diabetes Mellitus (T2DM) has emerged as a major public health challenge in developing nations, driven by behavioral and lifestyle transitions associated with urbanization and socioeconomic change. Understanding how modifiable behaviors influence metabolic outcomes is essential for designing context-specific interventions. Objective: To identify the lifestyle and behavioral determinants—dietary habits, physical activity, and medication adherence—associated with obesity-linked T2DM among adults aged over 40 years in Sialkot, Pakistan. Methods: A cross-sectional population-based study was conducted among 200 adults (≥40 years) from both urban and rural sectors. Data were collected using a structured questionnaire assessing diet, physical activity, and medication adherence. Anthropometric measurements and HbA1c levels were obtained following standard procedures. Statistical analysis using Chi-square tests and multivariable logistic regression determined associations between behavioral factors and diabetes, adjusting for sociodemographic variables. Results: Unhealthy dietary intake (aOR 2.46, 95% CI 1.42–4.26), low physical activity (aOR 2.18, 95% CI 1.25–3.82), and poor medication adherence (aOR 3.05, 95% CI 1.61–5.78) were significantly associated with diabetes (p<0.05). Combined lifestyle risk increased diabetes prevalence from 15% to 82%. Conclusion: Behavioral determinants—particularly diet, activity, and adherence—play a decisive role in the development of obesity-related diabetes. Integrating lifestyle interventions into community and primary care programs is essential to curb the growing metabolic burden in Pakistan. Keywords: Obesity, Type 2 Diabetes, Lifestyle, Physical Activity, Medication Adherence, Public Health, Pakistan.