Obesity Paradox: Where the Fat Settles—Not Weight—Matters Most in Diabetes

From endocrineweb.com/news

Scientists and doctors call it the obesity paradox—the idea that while obesity may increase the risks of developing heart disease and diabetes for most people, it might actually be protective, offering the possibility of longer survival, in a few lucky individuals.¹
Certainly, if you're among the throngs of people struggling to deal with a higher than recommended body weight, the idea that maybe, just maybe, you are probably hoping to be one of those lucky few who doesn’t need to be concerned.
Alas, the problem is that the obesity paradox is not so much a puzzle as it is more likely a myth for most of us.

Abdominal fat has a more direct impact on risk of diabetes and heart disease, even longevity, than body weight or BMI. Photo: 123rf

Can a High BMI Be Ignored—the Obesity Paradox—Even If You Have Diabetes?

The question of whether the obesity paradox holds true for those with type 2 diabetes (T2D) is especially important, since link between overweight and the development of diabetes and heart disease is well-established. This concern becomes more pressing when your fat settles around the waist, increasing your risk of heart problems.
In a recent intensive review of the research, investigators confirmed that the obesity paradox doesn't hold water for most everyone with type 2 diabetes. In addition, the higher your level of body fat, the greater the likelihood that you will develop diabetes, if you haven’t already, and that other chronic conditions will follow in due course.

Body fat, in simple terms, poses a real danger to your health, and anyone who tries to convince that you are safe from disease isn’t doing you any favours. Take the findings from another recent study—the authors show that when fat settles around the organs (so-called visceral fat)—it is dangerous enough to reduce your longevity even if you're weight is in the healthy range.
This type of abdominal fat, also known as central obesity, has long been known as the riskiest form of overweight. In fact, a bigger waist circumference is likely to shorten your lifespan by about 14 years.

BMI Not a Reliable Measure of Health and Disease

Dr. Bao agrees that the BMI is an imperfect measure, particularly because it cannot reflect where the body fat is located.
In reviewing the waist circumference study, Dr. Boyko points out that this measure, like BMI, can give you an indication of adiposity, but it too is far from perfect. "I've seen people with the same waist circumference," he says "but on further testing, such as with ultrasound imaging, I have found some patients with more hidden or internal visceral fat, while others present with mostly subcutaneous fat, which collects right under the skin instead of surrounding the organs."
Given the limits in body weight measures, Dr. Bao suggests that those who fall in the healthy weight range also know what your waist circumference is, so you have more information about your possible disease risks.

Dr. Boyko indicates that the number of women in the WHI study at normal weight and central obesity was relatively small, only 1,390, suggesting that it is fairly rare to be at a healthy weight but have an enlarged waist circumference.
Still, he would still advise anyone even in the healthy weight range to exercise daily and eat a mostly plant-based diet, such as the Mediterranean approach to eating to avoid any risk of diabetes, heart disease, and many forms of cancer.

Lastly, the newest data indicates that simply by cutting out 300 calories a day for at least two years, you are most likely to achieve healthier aging and greater longevity. While you don’t need to fast to live longer, just cutting out the soda or skipping dessert offers promise of a better quality of life.

https://www.endocrineweb.com/news/diabetes/62220-obesity-paradox-where-fat-settles-not-weight-matters-most-diabetes