The Obesity Paradox

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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.

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.

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