The Obesity Paradox

Normal-weight adults who are newly diagnosed with Type 2 diabetes have a significantly higher risk of death than those who are overweight or obese, according to a new analysis recently published in The Journal of the American Medical Association. An “obesity paradox,” or phenomenon in which overweight and obese people appear to have better outcomes than thinner individuals, has been linked with several conditions, such as heart failure, high blood pressure, and kidney disease.

To evaluate the link between body weight and mortality risk in people with newly diagnosed Type 2, researchers looked at data from five observational studies conducted at different times between 1979 and 2011. They identified 2,625 people ages 40 and older who had developed Type 2 diabetes over a follow-up of 27,125 person-years (a measurement taking into account both the number of people included in the study and the amount of time they were followed). Half of the participants were women and 36% were nonwhite.

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During the follow-up period, 449 participants died, 178 from cardiovascular causes, 253 from noncardiovascular causes, and 18 from unidentified causes. The researchers found that rates of total mortality and mortality from both cardiovascular and noncardiovascular causes were higher in normal-weight people than in their obese or overweight counterparts. After adjusting for several factors, it was discovered that normal-weight people with diabetes had more than twice as high a rate of both total and noncardiovascular mortality.

The study authors note that the findings do not mean people should intentionally start gaining weight as a safety measure. It’s likely not that the extra weight is protective, but rather that people who develop diabetes at a normal weight are predisposed to poorer health. “Perhaps those [normal-weight] individuals are somehow genetically loaded to develop diabetes and have higher mortality. A normal-weight person who has diabetes has an extremely high mortality rate,” notes study author Mercedes R. Carnethon, PhD.

Limitations of the study included inconsistent data on smoking habits, a lack of analysis regarding how the use of medicines might have contributed to newly diagnosed diabetes, and an inability to determine how preexisting medical conditions might have led to diabetes development in normal-weight adults.

To learn more about the research, read the articles “Extra Pounds are Lifesavers for New Diabetics” or “Normal-Weight Diabetes Patients Face Higher Risks” or see the study’s abstract in The Journal of the American Medical Association.

  • Deb

    Very interesting. Makes all the pressure to lose weight a little suspect.

  • David Spero RN

    When the data doesn’t support scientists’ theories, they call it a “paradox.” They rarely question whether the theory was right in the first place. The idea that fat causes type 2 diabetes is highly suspect.

  • Benedict

    “Limitations of the study included inconsistent data on smoking habits, a lack of analysis regarding how the use of medicines might have contributed to newly diagnosed diabetes, and an inability to determine how preexisting medical conditions might have led to diabetes development in normal-weight adults.”
    I feel the above could be the key statement here.

  • Clay Readnour

    I am type 2 diabetic, and I am overweight. I don’t think for one second that my diabetes was caused by fat. Mine was caused by an insulin tolerance, built up over time. Fat is usually a symptom, not a cause. In science, it’s almost always a mistake to confuse correlation and causation. Just because type 2 diabetics tend to be overweight doesn’t mean that fat causes diabetes. That being said, it doesn’t really surprise me that a type 2 diabetic that developed diabetes at a normal weight would have a higher mortality rate than an overweight one. An overweight type 2 may not have any other health problems, and the extra weight would be just a symptom of excess consumption that led to an insulin tolerance, while a normal weight type 2 would have other issues.

  • Joe

    Some people are genetically programmed to be fat, and are fat their whole life. These are the ones who develop diabetes and survive fairly well with it, because it’s in their genes to do so.

    We are bombarded with research and treatments based on diet, exercise, and medication, but it seems clear to me that metabolic syndrome is a genetic disorder. Type 2 diabetics, particularly those with metabolic syndrome, should be outraged that virtually no research is being done on genetics as a cause for obesity and T2D, or genetic modification as a treatment and potential cure. Instead we struggle with diets that don’t work, exercise regimens that don’t help and medications that have more side-effects than benefits.

    I have to go take my walk now. When I return my body will be screaming “EAT” because I’m programed in such a way that my body assumes that any expenditure of calories must be offset by a larger intake of calories, lest we starve. My genes assume that food is scarce, and therefore my body must hold on to as many calories as it can. That’s why my body temp is always more than a full degree below normal, and the more I diet the smaller percentage of calories I burn per unit of exercise. It’s an endless, vicious cycle, and it starts and ends with my genes.

  • stephanie c

    I take mental meds that more than likely could have caused my type 2 diabetes. I gained a consideral amount of weight. I believe that body fat does play a part. I am angry that the meds we take can cause more problems than the diease you have. When will this cycle end?

  • im diabetic

    i have found out exorcize and lots of hot green tea makes me feel better when i am active my blood sugar stays where it should the green tea seems to help my hunger you have to make your self drank the tea after a while you get hooked and you like it

  • RFM

    “researchers looked at data from five observational studies conducted at different times between 1979 and 2011″

    Well, that says it all as to the studies utility. In 1997 you needed a fasting blood sugar of 143 to be a diabetic, after 1997 the number became 126. This is the dirty little secret in the “epidemic” of type 2; the diabetic association lowers the numbers to include a larger percentage of the population. Yes, it is good for early detection and to head off problems that might be more advanced with a higher number for diagnosis, but it still makes it ridiculous to compare population percentage rates from decade to decade. Does anyone know what the fasting blood sugar number to be diagnosed as diabetic was in 1979?

  • Sharon Moore

    I was (and still) obese (5’7 and 330 lbs when diagnosed with Type 2 12 years ago at the age of 42). I began a high protein low carb regimen (on my own) and lost weight (48 pounds) over the years and had better control of diabetes (with 50 units of lantus). As you know, high protein tends to be higher in fat. However, my cholesterol level is normal as my body has the natural ability to ward off high levels according to my doctor.

    My doctor passed away, so a new doctor (NOT an endocrinologist) who focused on fat, started me on a vegetarian soy diet regimen for a month to see how I would do. My glucose and A1C levels skyrocketed, not to mention that I gained 10 pounds — and didn’t really enjoy the diet as I did with high protein. So I’m back to high protein (meat, cheese, eggs etc), multi-vitamins, and better control of diabetes.