Obesity and Diabetes: Why There Is No Obesity Paradox

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Recent studies suggesting that heavier people with diabetes have lower death rates than normal weight patients may be a myth.

A strong body of research shows that being overweight or obese puts people at risk for chronic conditions like heart disease, diabetes, cancer and even early death. But several small studies connecting obesity to a protective effect against type 2 diabetes-related death have raised questions about a possible ‘obesity paradox,’ and whether weight can be a benefit in preventing progression of the disease. A 2012 study published in the journal JAMA, for example, studied 2,625 people recently diagnosed with type 2 diabetes, of which only 12% were normal weight. But the larger people with diabetes lived longer than their thinner peers.

Why the heavier people lived longer wasn’t clear; the researchers speculated that genetics, or the type of fat that certain obese people accumulated compared to normal weight individuals could be responsible.

But in a new study published in the New England Journal of Medicine, scientists say that’s unlikely. “We didn’t see this protective effect at all,” the study’s leader, Diedre Tobias of the Harvard School of Public Health, told the Associated Press. “The lowest risk was seen in the normal-weight category.”

(MORE: ‘Obesity Paradox’: Why Being Thin with Diabetes Is a Dangerous Combo)

Tobias and her colleagues looked at 11,427 female nurses and male health professionals who were diagnosed with diabetes. They were divided into groups based on their body mass index (BMI), with those with a BMI over 25 considered overweight and people with a BMI over 30 considered obese. After 15 years, the scientists recorded the participants’ death rates and found that those with BMI in the 22.5 to 25 range, considered normal weight, had the lowest risk of diabetes-related death.

(MORE: You Can’t Be Fit and Fat)

The researchers also looked at subgroups within the study population and found that for people younger than 65, their risk of dying from diabetes rose with weight, and the same trend was seen among non-smokers (smokers have higher death rates overall).

The findings should dispel the idea that staying heavy will lower the risk of complications related to diabetes; the size of the study and the consistent trend of rising mortality linked to climbing weight confirm that extra pounds are a major risk factor for dying from the disease. While being slightly overweight did not significantly raise the risk of diabetes-related death, doctors note that once patients start to put on pounds, it’s hard to keep them off. So the advice they have been giving patients for years still holds — to avoid complications from chronic illnesses like diabetes and heart disease, it’s best to keep BMI down.


The problem with the idea of the 'diabetes paradox' posited here is that it suggests that excess weight is in fact a good thing if one is suffering from diabetes. The only problem with this is that excess weight also makes people more vulnerable to a host of other medical problems, and therefore is not a desirable thing for individual well being. Genetic predisposition no doubt plays a role in the progression of disease in different individuals, and it remains entirely possible that the genetic factors influencing the progression of diabetes in individuals of different body weight has nothing to do with the weight as such.


Ha!  As so called "obesity" rates have risen in the US, along with diabetes, so has life expectancy.
Type 2 diabetes is associated with aging.  If you don't younger from some infectious disease or malnutrition, you are more susceptible to degenerative diseases as you age.

The level of what's defined as fasting blood sugar has dropped from 200 in my grandfather's time to 140 not so long ago and now 125.
My brother died middle-aged in a nursing home because he never would take care of his own diabetes. That's a different case. Many of the older people were thin and frail. Were the fatter ones more likely to be living on their own?  It's hard to get the real statistics.

I've lost weight intentionally twice in my life, and each time, ended up horribly ill with repeated bouts of sinusitis and ear infections. Weight loss does weaken most people, whether or not doctors want to admit it.

All weight loss programs fail 97% of the time.

Now I am ambivalent about discussing weight and diabetes. I was dx'd with diabetes type 2 some time ago and ended up on insulin fairly quickly.  My newest endocrinologist put me on Victoza over a year ago. I had started losing some weight before that due to dropping my insulin dose slowly.  With Victoza, I got totally off insulin. 

I have lost 75 lbs without starving myself, but both he and I agree my experience has nothing to do with anyone else. I was on very high doses of insulin. The Victoza treats my own diabetes better.  It has decreased my appetite, but I still eat the same foods, but don't crave carbohydrate as much.

I'm still fat, but function much better. 
I have to admit what I am, but I still defend other people for being fat and diabetic.

My experience is only relevant to others in the sense that medical research is progressing in diabetes and weight.


The small minority of studies saying otherwise are mostly promoted by branches of the political left. Look up "Fat Acceptance", and it's ties with feminist organizations. They've gladly embraced a few dissenters so they can quote them when anyone points out that their fatness is unhealthy (and thereby, "bodyshaming" them). The faulty logic is as follows: 

>Some fat people are healthy


>Being fat is not unhealthy

In other words, these people are ready to deny mainstream scientific opinion simply because it hurts their feelings.