Should you be afraid of your weight or of diabetes?

A study published in the latest issue of the journal Critical Care found that being a little overweight or even a little obese does not increase your risk of dying, that it is diabetes, that does1. Thus, even though many overweight individuals die earlier than the average person does, diabetes accounts for the excess in death rates. We should therefore, start to pay even more attention to the early diagnosis and treatment of diabetes considering this important link between the condition and increased death rates.

This is more so considering that many people do not even know that they have diabetes, in particular type II diabetes, which is why some call it the “silent killer.” This study does not suggest, however, that being overweight and obese do not have associated health problems, which in fact they do. Hence, with the prevalence of obesity and diabetes essentially of epidemic proportions in many countries, developed and developing, it is time we “waged a war” on this ‘twin menace.’ According to one study, the prevalence of obesity (cut-off point for obesity being BMI more than or equal to 30) was 20.9% in the U.S. for example in 2001, compared to 19.8% in 2000, a 5.6% hike, that of diabetes 7.9% and 7.3% in 2001 and 2000, respectively, an increase of 8.2%2. The researchers concluded that increases in obesity and diabetes among US adults persisted regardless of gender, age, race, educational level, and amount of smoking, and noted the strong association of obesity with many major health risk factors.

The current study, based on data obtained from more than 15,000 participants in the Atherosclerosis Risk in Communities (ARIC) study over three years also showed an increase in death rates with increase in weight. However, all the excess deaths seemed closely associated with diabetes. In other words, individuals without diabetes showed no increased risk at all. In fact, those with normal weight and that have diabetes were at greater risk than those that were obese but did not have diabetes. Individuals with diabetes for example at 2.4% risk of developing acute organ failure versus 0.7% for those without it, in-hospital mortality, 46.5% compared to 12.2% and three-year death rates, 51.2% compared to 21.1% also higher in persons with diabetes than in those without it.

The link between obesity and several health risk factors is doubtless, as is its link with the risk of early death, links that this study again supports, with subjects with a BMI over 30, thrice as likely to have diabetes as subjects whose weights were less, 22.4% versus 7.9%. Thus, we should avoid gaining excessive weight, if at all, via adopting healthy lifestyles, including healthy diets and exercise, and diagnose promptly and treat diabetes effectively in overweight/obese persons, and in fact in other high-risk individuals. However, we must have a high index of suspicion also in the normal or under-weight person who nonetheless might have diabetes, diagnosis of the condition in whom we might otherwise fail to spot.

References

1. Slynkova, K, et al "The role of body mass index and diabetes in the development of acute organ failure and subsequent mortality in an observational cohort" Critical Care 2006; 9/25.
2. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001 JAMA. 2003 Jan 1; 289(1):76-9.