Skip to content

    Diabetes Health Center

    Font Size
    A
    A
    A

    Obesity Paradox: Thin Not in for Type 2 Diabetes?

    Normal Weight in People Diagnosed With Type 2 Diabetes Tied to Higher Risk of Early Death

    Body Size and Death Risk

    For the study, researchers pooled data from five different studies of heart disease. During the course of those studies, 2,600 adults over age 40 were diagnosed with diabetes. A total of 293 people (11.2%) had normal weight based on body mass indexes (BMIs) at the time of their diagnosis.

    Even after accounting for health risks, like smoking, high bad cholesterol, waist size, and high blood pressure, people who had normal BMIs were about twice as likely to die during the studies compared to people who were overweight or obese.

    The study wasn't able to tease out what it was about normal-weight people with diabetes that might have made them less healthy than those who were overweight or obese, but researchers have some theories.

    Body Composition, Fat Distribution May Trump Body Size in Diabetes

    One is body composition -- the ratio of fat to muscle. Muscle is critical to controlling blood sugar because it is metabolically active, uses insulin, and burns sugars and calories.

    "The muscle-versus-fat ratio is extremely important for diabetes development as well as health outcomes related to diabetes," Carnethon says.

    Studies show that it's becoming more common for normal-weight people to carry less muscle and more body fat.

    Doctors have even coined a term for this: TOFI, or thin outside, fat inside. It's especially common in older adults who naturally lose muscle and bone with age.

    "It could well be that these people do have an adverse body fat distribution. They haven't measured it in this study, so you can't be 100% sure, but it would fit into the general idea that these people have an adverse fat distribution. There could be more on the inside," says E. Louise Thomas, PhD, a research scientist at University College London. Thomas studies body fat and metabolism, but she was not involved in the research.

    "What may be very significant is not just the actual weight, but what's in that weight. What's the ratio between muscle and fat and where is that fat stored?" says Rifka C. Schulman, MD, an endocrinologist at Long Island Jewish Medical Center in New Hyde Park, N.Y.

    Today on WebMD

    Diabetic tools
    Symptoms, diagnosis, treatment, and more.
    woman flexing muscles
    10 strength training exercises.
     
    Blood sugar test
    12 practical tips.
    Tom Hanks
    Stars living with type 1 or type 2.
     
    kenneth fujioka, md
    Video
    Can Vinegar Treat Diabetes
    Article
     
    Middle aged person
    Tool
    jennie brand miller
    Video
     

    Prediabetes How to Prevent Type 2 Diabetes
    Article
    type 2 diabetes
    Slideshow
     
    food fitness planner
    Tool
    feet
    Slideshow