‘Obesity Paradox': Why Being Thin with Diabetes Is a Dangerous Combo

Overweight people who are diagnosed with the blood sugar disorder outlive their thinner counterparts, a study shows

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Being overweight or obese is a risk factor for developing Type 2 diabetes, but it turns out that these heavier patients may have an advantage: people who are overweight when they are diagnosed with diabetes live longer than their thinner peers.

The so-called obesity paradox, in which being overweight appears to be protective against early death, has been seen before in heart failure and chronic kidney disease.

But, says study author Mercedes Carnethon, associate professor of preventive medicine at Northwestern University, that doesn’t necessarily mean that gaining excess weight is a healthy strategy; rather, it may be that people who are thin when they develop diabetes are already be vulnerable to worse health. “We hypothesized that their diabetes may be different,” she says. “They may have developed diabetes for reasons unrelated to obesity.

Overall, about 85% of people with diabetes are heavy. Gaining too much weight is a major contributor to Type 2 diabetes, since excess fat cells can affect the way the body breaks down glucose and produces insulin, but some normal weight individuals can develop the disease as well. The elderly and people of Asian descent are more likely to be at normal weight when diagnosed, for example.

(MORE: Doctors Should Screen All Adults for Obesity, U.S. Panel Says)

For the new study, published in the Journal of the American Medical Association (JAMA), Carnethon and her team reviewed data on five previous studies that were tracking people for heart disease risk factors. The studies, which were conducted between 1990 and 2011, included 2,625 people who were recently diagnosed with diabetes, about 12% of whom were at normal weight.

The lean patients looked metabolically similar to those who were obese, with the exception of their weight, the researchers found. But they were twice as likely to die at any point than their heavier counterparts. Even after adjusting for other risk factors known to contribute to diabetes, such as high blood pressure, high cholesterol levels and smoking, the higher mortality rates remained. Further, to account for the possibility that the normal weight patients could have been losing weight due to other underlying illnesses, the researchers excluded people who died within two years of their diabetes diagnosis. The doubling of early death risk persisted.

Overall, the death rate in overweight and obese people with diabetes was 1.5% per year, compared with 2.8% in thin patients.

(MORE: Type 2 Diabetes Is Tougher to Treat in Kids and Teens)

So, what sets the disease apart in normal weight people? More studies are needed to figure that out, but the authors have a few guesses. Genetic predisposition to improper insulin production may be part of the problem, says Carnethon. “We need to explore the genetic variations related to insulin secretion,” says Carnethon. “It’s possible that genetic factors could be promoting insulin resistance, and influencing something else related to mortality. We really don’t know.”

It’s also possible that body fat may still play a role. The studies measured the participants’ body mass index (BMI), a ratio of their height and weight, but it wasn’t able to take into account their body fat composition, or how much of their overall body weight was made up of fat versus muscle. Many seemingly thin people carry more fat than muscle, making them trim on the outside, but fat on the inside. Even with a healthy BMI, for example, such people may harbor a lot of visceral fat, deep in their abdomen, a type of fat that is particularly dangerous to health, since it secretes hormones and substances that can hamper insulin’s ability to break down sugar. Because many of the thin diabetes patients included in the new study were elderly, they likely had less muscle mass and more fat.

The findings raise the alarm that diabetes isn’t just a disease of the overweight or obese, says Carnethon, and that physicians should be looking for signs even among their leaner patients, particularly those who are elderly. “Doctors’ concern about normal weight people with diabetes should potentially be even higher than that for their counterparts who develop diabetes at a heavier weight,” she says.

MORE: Pumping Iron Can Cut Your Diabetes Risk

14 comments
GuoLiang
GuoLiang

But how much of that diabetes was caused by their obesity in the first place?

irpsit
irpsit

Hey everyone, please check this: there are two little known types of diabetes: LADA (latent autoimmune diabetes) and MODY (maturity onset diabetes of the young), which most patients and doctors often do not know it exists.

In MODY, people like me, were diagnosed at young age (I was at 12, but my father at age 40) and are thin (BMI 17 or 18), and the slightly elevated sugar/glucose levels remain like that for years, without any complications. MODY is genetically inherited and runs in families, but often relatives do not know about it. Often diabetics type 1 or 2 are misdiagnosed and mistreated and instead they have MODY !!!

And to complicate things there are more than 11 types of MODY, which are diagnosed after genetic screening.

redyoga
redyoga

The reality is that few if any “thin Type 2s” exist.  If antibody testing and genetic testing are performed on those 15% of people with “Type 2” diabetes who are thin, they are found to be either autoantibody positive and in fact have Type 1 autoimmune diabetes or they have monogenic diabetes (the more up-to-date term for MODY diabetes).  These “thin Type 2s” have been misdiagnosed, which results in undertreatment (a person with Type 1 diabetes needs exogenous insulin to survive) and the hastening of diabetic complications including death.  So of course they have shorter lives:  live-saving insulin is withheld from them because they are misdiagnosed, and their lives are shortened as a result of improper care and malpractice.  Dr. Carnethon admits in the JAMA article that autoantibody testing was not performed as part of her study; the researchers simply assumed that adults with diabetes had Type 2 diabetes. 

andyprior130
andyprior130

Obesity and diabetic both the terms are simultaneously related to each other, people suffer from obesity is also have the chances to suffer from diabetics the term obesity is also increases the risk of heart failure. So to avoid the risk of diabetics and we may reduce the possibilities of obesity that can cause due to various reasons.

http://medifasthealthblog.wordpress.com

cjer
cjer

I am 72 yrs old...just diagnosed with Type II diabetes....5 ft 6 in...130 pds.   Lost 3 pds since being on this low carbohydrate diet for a month.  Cannot afford to lose weight!  I am like my mother who was diagnosed with diabetes in her mid 80's, we never cared for sweets but love potatoes and corn.   Our ancestry is American Indian, German, Scotish and English.   I understand a lot of American Indians have diabetes.  So it is inherited.   I have one daughter and one grandson that do not care for sweets.  That must be an anherited tendency also.   I am thinking it is not only the pancreas that is out of whack but the liver must be sluggish. 

ohdee
ohdee

For centuries, many asians consume a forest fruit called "sky fruit" or mahogany swietenia to control diabetes and high blood pressure. Unfortunately the efficacy of the product depends on the process and formulation.

Kimsbenn
Kimsbenn

I have noticed a growing trend to make being obese more "acceptable". Clothing sizes have shrunk without losing material, charts have been adjusted to make higher weights within normal range, and a growing "Big is Beautiful" campaign urging acceptance. while I don't doubt the validity of a possible pattern, with more than 60% of Americans overweight, is this just another way to make being overweight the norm?

lightandlove50
lightandlove50

When you go behind politics we see that type 2 diabetes has already been reversed. Dr Liu in Denmark revealed how to reverse diabetes without any medications.

No one needs a drug to reverse type 2 diabetes. All of this information was taken from the Spirit Happy Diet people in Denmark.

Diabetes has been reversed in over 10,000 people by using a specialized diabetes diet. The diet also reversed body fat in people trying to lose weight. Scientists showed food chemicals is the cause of almost all diabetes. They also showed how to reverse your own diabetes without medications.  It is not about weight but it is about food chemicals

Just google      SPIRIT HAPPY DIET

Carol Zhu
Carol Zhu

I think that they should look into the "other" causes of death and also see what type of treatment they used. All drugs have side  effects, but some are a lot worse than others. Actos, for instance, is a type of 2 diabetes medication that can increase the risk of bladder cancer after only a year (according to the FDA).

http://www.publichealthwatchdo...

Instead of drawing direct conclusions about this study, we should consider all the factors that might have given them these results.

J_Buddah
J_Buddah

There was a study done that showed that many, not some, thin people in there twenties have the beginning stages of heart disease because of their visceral fat. Visceral fat is fat in and around your organs. If your pancreas and liver are filled with fat then your pancreas cannot secrete insulin properly and you liver cannot shut off internal glucose production when glucose levels are high. If you do not secrete enough insulin you cannot convert sugar into fat because your liver needs insulin for it to signal to convert sugar into fat. It may be that these thin people are not eating a lot of fat with their carbohydrates and/or their pancreas is weak which cannot store fat from the diet and convert sugar into fat for storage.  Subcutaneous fat is not harmless but it is relatively benign compared to visceral fat. Also some people do not have the capacity to create a lot of subcutaneous fat because of genetics or because you fat tissue is insulin resistant; however, these same people have the capacity to store visceral fat. If your fat becomes insulin resistant early in your disease then your blood sugar will have no where to go and stay in your blood.  It all comes down to where your fat is stored. If you eat a bad diet you may be thin on the outside but store your fat in and around your organs. Whatever you do keep your blood sugar low. There is a huge debate on how to keep blood sugar low but if you use logic you know not to eat too much sugar  and things that turn into sugar if you want your sugar levels low. A good amount of carbohydrates is 20-30 grams from vegetables. If you eat more than 20 grams of protein within four hours the excess protein is converted into sugar.  Fat does not turn into sugar unless your body absolutely needs it so let your body make just enough of the sugar it needs by limiting carbohydrates and protein. Now get on with your life this food issue is done.

thanku4playing
thanku4playing

This story is misleading and dangerous.  A major cause of type 2 diabetes is being over weight.  Losing weight will always reduce the severity of diabetes.  If you are thin when you are diagnosed, and then gain weight, you will be even worse off. 

Codybiv
Codybiv

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