Diabetes Metab J.  2018 Jun;42(3):179-187. 10.4093/dmj.2018.0055.

The Evidence for an Obesity Paradox in Type 2 Diabetes Mellitus

• Han SJ
• Boyko EJ

• KMID: 2413979
• DOI: http://doi.org/10.4093/dmj.2018.0055

Abstract

Although overweight/obesity is a major risk factor for the development of type 2 diabetes mellitus, there is increasing evidence that overweight or obese patients with type 2 diabetes mellitus experience lower mortality compared with patients of normal weight. This paradoxical finding, known as the "obesity paradox," occurs in other chronic diseases, and in type 2 diabetes mellitus is particularly perplexing given that lifestyle intervention with one goal being weight reduction is an important feature of the management of this condition. We summarize in this review the findings from clinical and epidemiologic studies that have investigated the association between overweight and obesity (usually assessed using body mass index [BMI]) and mortality in type 2 diabetes mellitus and discuss potential causes of the obesity paradox. We conclude that most studies show evidence of an obesity paradox, but important conflicting findings still exist. We also evaluate if potential bias might explain the obesity paradox in diabetes, including, for example, the presence of confounding factors, measurement error due to use of BMI as an index of obesity, and reverse causation.

Keyword

Bias; Body mass index; Diabetes mellitus, type 2; Epidemiology; Mortality; Obesity; Survival

MeSH Terms

Bias (Epidemiology)
Body Mass Index
Chronic Disease
Diabetes Mellitus, Type 2*
Epidemiologic Studies
Epidemiology
Humans
Life Style
Mortality
Obesity*
Overweight
Risk Factors
Weight Loss

Figure

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  Fig. 1 The limitations of epidemiological studies and body mass index (BMI).

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