Is there an "obesity paradox" in diabetes?

NEW YORK Tue Aug 7, 2012 4:34pm EDT

An overweight woman sits on a chair in Times Square in New York, May 8, 2012. REUTERS/Lucas Jackson

An overweight woman sits on a chair in Times Square in New York, May 8, 2012.

Credit: Reuters/Lucas Jackson

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NEW YORK (Reuters Health) - Obesity and diabetes might not be the double whammy you'd expect, according to a fresh look at older studies.

Surprisingly, researchers found that overweight and obese people who get diagnosed with the blood sugar disorder tend to live longer than their leaner peers.

This so-called "obesity paradox" has been observed before in chronic diseases like heart and kidney failure, said Mercedes R. Carnethon of the Feinberg School of Medicine at Northwestern University in Chicago.

But that doesn't mean you should start downing ice cream and other high-calorie foods if you just found out you have diabetes, Carnethon told Reuters Health. Nor does it mean that padding your waist is a good way to improve your prognosis before you get the disease.

In fact, it's probably not that excessive pounds are protective, said Carnethon, but rather that lean people who get diabetes are somehow predisposed to worse health.

"Perhaps those individuals are somehow genetically loaded to develop diabetes and have higher mortality," she said. "A normal-weight person who has diabetes has an extremely high mortality rate."

The new findings are based on data from five earlier studies that tracked people over time to identify risk factors for heart disease. More than 2,600 participants developed type 2 diabetes during the studies, and 12 percent of them had a normal weight when they got the diagnosis.

The death rate was 1.5 percent per year among overweight and obese people, compared to 2.8 percent per year among their trimmer peers.

After accounting for several risk factors for heart disease - including age, blood pressure, high cholesterol and smoking - lean people were more than twice as likely to die at any given point as heavier people. The same held true for deaths caused by heart disease, which is linked to obesity.

"It was a little bit unexpected to see that," said Carnethon.

One potential limitation of the study is that the researchers couldn't always account for how much people smoked, which might explain part of the results.

It's also possible that a few people might have been diagnosed with diabetes outside of the studies and been told to slim down by their own doctor before they were seen by the study researchers. That could also have contributed to the findings, although Carnethon said the effect would be small.

She added that it's not clear how to best treat normal-weight people with type 2 diabetes, although weight training seems preferable over cardio exercise.

Older people and people of Asian descent are more likely to be normal-weight when diagnosed with diabetes, and Carnethon stressed that doctors need to take the disorder extra seriously when it's not accompanied by obesity.

"These findings do apply to a growing segment of the population," she said.

SOURCE: Journal of the American Medical Association, online August 7, 2012.

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Comments (2)
homerobrain wrote:
I only want to share my own experiences.In 1991 I was diagnosed as a diabetic obese person, more precisely I had ( and have!)the so called deathly quartet obesity, blood hypertension,high sugar in blood and high levels of fats like cholesterol and tryglicerides.This is the so called Metabolic X syndrome.Live expectations for people like my is short and most die after a heart attack.That was that time.After statistics I should be now 2012 already death…. but I am not! why??? because of a regular strict live style, with dicipline in food intaking and medicines!!! That was and is my secret.If there is any connection between obesity and diabetics, from physiological point of view it is,
untill now, not clear and if somebody makes and statistical link between both diseases, it is just an not well founded opinion
it is simple wrong and, as I wrote, I am alive

Aug 09, 2012 3:31am EDT  --  Report as abuse
dmendo wrote:
When diabetes is very poorly controlled over months, almost everyone loses weight. Sometimes lots of weight. The cause: they lack insulin which is a hormone that stores nutrients and help maintain muscle and fat stores. This JAMA paper is garbage science. It fails to take into account the fact that the small percentage of non-overweight persons with Type 2 Diabetes at diagnosis (about 10-15% in the studies this paper analyzed; 85-90% are overweight or obese) are not overweight often because they lost lots of weight with their undiagnosed poorly controlled diabetes. These people who did not notice or attend to their symptoms (drinking a lot of fluids and urinating a lot) demonstrate poor self care for various reasons and for all of the above reasons may have fared worse. These epidemiologists just missed these key points as did the person writing the editorial. It is bad to be overweight and bad to have uncontrolled diabetes.

Aug 10, 2012 12:34pm EDT  --  Report as abuse
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