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Summaries for Patients |5 May 2015

The Obesity Paradox in Type 2 Diabetes Mellitus Free

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Author, Article, and Disclosure Information
  • 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.


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    • What is the problem and what is known about it so far?
    • Why did the researchers do this particular study?
    • Who was studied?
    • How was the study done?
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What is the problem and what is known about it so far?

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.

Why did the researchers do this particular study?

To compare cardiovascular disease risks and survival rates for underweight, normal-weight, overweight, and obese patients with type 2 diabetes.

Who was studied?

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.

How was the study done?

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.

What did the researchers find?

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.

What were the limitations of the study?

The investigators did not have information on causes of death, patients' fitness levels, or whether patients took medications to decrease their cholesterol levels.

What are the implications of the study?

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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1 Comment

Gauranga Dhar

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.

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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.

DOI: 10.7326/P15-9015

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