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The full report is titled “The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis. A Cohort Study.” It is in the 5 May 2015 issue of Annals of Internal Medicine (volume 162, pages 610-618). The authors are P. Costanzo, J.G.F. Cleland, P. Pellicori, A.L. Clark, D. Hepburn, E.S. Kilpatrick, P. Perrone-Filardi, J. Zhang, and S.L. Atkin.
The Obesity Paradox in Type 2 Diabetes Mellitus. Ann Intern Med. 2015;162:I-26. doi: 10.7326/P15-9015
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Published: Ann Intern Med. 2015;162(9):I-26.
Obesity is a well-established risk factor for cardiovascular disease and type 2 diabetes. However, studies show that overweight patients with cardiovascular disease live longer than normal-weight patients with cardiovascular disease. This could be because sicker people lose weight. It is unclear whether patients with type 2 diabetes also live longer if they are overweight.
To compare cardiovascular disease risks and survival rates for underweight, normal-weight, overweight, and obese patients with type 2 diabetes.
The patients had type 2 diabetes, were seen in a single diabetes center in the United Kingdom, and were part of a long-term study. They did not have cardiovascular disease at their first visit.
Information on how long the patients had diabetes, whether they smoked cigarettes or had other chronic diseases, and physical measurements (such as weight and height) were collected at their first visit. Investigators collected information on hospitalizations for cardiovascular problems and deaths during the long-term follow-up.
Patients who were overweight or obese had an increased risk for hospitalization for cardiovascular disease. Compared with normal-weight patients, underweight patients had the worst survival and overweight patients had the best survival. The survival of obese patients was not different from that of normal-weight patients.
The investigators did not have information on causes of death, patients' fitness levels, or whether patients took medications to decrease their cholesterol levels.
Patients who have type 2 diabetes and are overweight or obese have an increased risk for cardiovascular disease. However, patients who were overweight but not obese lived longer than those who were underweight or normal weight. The explanation for these results is unknown and does not mean that patients with diabetes should try to become overweight. Patients should continue to follow a healthy lifestyle.
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Bangladesh Institute of Family Medicine and Research
July 31, 2015
Do not gain weight but stay healthy
We, the physicians should not advise patients to become overweight from normal BMI on the basis of “obesity paradox”. Overweight individuals, if the high weight due to visceral fat will obviously lead to metabolic abnormalities, higher insulin resistance and subsequent cardiovascular adverse outcomes. I think if higher weight is due to lean mass or subcutaneous fat or in special cases due to high brown fat content, these persons are physically more fit than normal weight persons. I think we should differentiate healthy overweight from unhealthy lean. We should advise patients not to gain weight but stay healthy.
Cardiology, Endocrine and Metabolism, Diabetes, Obesity, Coronary Risk Factors.
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