Transient insulin-induced hypoglycaemia increases energy intake. Participants consumed more fat after insulin compared to that after saline. High-fat foods can lead to passive overconsumption and have a low glycaemic index, which may prolong hypoglycaemia. Both factors could ultimately promote weight gain in individuals with recurrent hypoglycaemia.

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Type-2 diabetes is common in the elderly and when compounded by obesity presents a major challenge for the physician. Obesity plays a central role in the aetiology and pathogenesis of type-2 diabetes. Body weight is determined by an interaction between genetic, environmental and psychosocial factors acting through the physiological mediators of energy intake and expenditure. Obesity is thought to predispose to type-2 diabetes primarily by causing insulin resistance. Education and changes in lifestyle remain the key issues in obesity management. Anti-obesity drugs may delay the onset of diabetes but there is limited experience of their use in elderly patients. Obesity should not be viewed as a cosmetic problem that affects a few individuals, but a major health hazard that is both preventable and amenable to treatment.

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