The Obesity-Mortality Paradox Re-visited

Obesity does not reduce mortality in young patients with diabetes, suggested a research, which was published in the Journal of Diabetes Investigation. The link between obesity and disease conditions is well known. Obesity increases the risk for conditions like heart attack, heart failure, high blood pressure, diabetes, stroke and sleep apnea. The excess weight puts a lot of stress on the knees resulting in osteoarthritis. The increasing incidence of obesity in children is of particular concern and calls for remedial measures to improve the daily diet and physical activity of kids.

Obesity increases insulin resistance, that is, it reduces the effectiveness of insulin, and therefore predisposes to type 2 diabetes. In fact, regular exercise and weight reduction can bring the glucose levels back to normal in individuals with borderline diabetes.

Obesity is defined in terms of the body mass index (BMI), which is the ratio of weight to height. A BMI of more than 30 is considered as obese, while a BMI of between 18.5 and 25 is considered as normal. A BMI of between 25 and 30 is included in the overweight group. It is important to note here, that the BMI does not differentiate between the weights due to bone and muscle mass, and that due to fat. Going purely by BMI, a bodybuilder could fall in the “obese” group!

The obesity paradox has been a point of discussion in the medical world in the recent years. The once dreaded obesity has been suggested to actually reduce the death rates as compared to individuals with normal weight.

Researchers studied if obesity could reduce death rates in patients with diabetes. They compiled information from twenty studies which covered around two hundred thousand patients. They found that:

• The risk for mortality from all causes was lesser in obese patients as compared to normal weight patients, though the result was not statistically significant.
• The reduced mortality in obese patients was applicable only for elderly patients and in studies with a follow-up period of less than 10 years
• The positive effect of obesity on mortality reduced on long-term follow-up

Before you decide that it is best for you to put on weight, please note that the researchers themselves feel there could be a problem with the results due to various factors which may include:

• Elderly people often suffer from conditions like high cholesterol levels and hypertension irrespective of whether they are obese or not. These disorders may not be so common in younger individuals with normal weight. Therefore, the adverse effect of obesity in younger individuals may be more obvious.
• In younger patients, factors like genetic factors and latent autoimmune diabetes in adults, may be present, which could worsen the outcomes in this population.
• The data is based on BMI which, as discussed above, cannot differentiate between weight due to fat or muscle. This could skew the results in such a study. Muscle mass actually reduces insulin resistance and improves diabetes. Such ‘obese’ patients may be healthy.

The past studies that were evaluated also had several pitfalls.

• They did not consider whether a weight change in a person could affect the risk of death
• The type of diabetes could not be confirmed in all the studies as type 2 diabetes
• The fitness levels of the individuals, whether young or old, was not ascertained in these studies

Thus, at least for now, nothing beats lifestyle changes that include a healthy diet, adequate exercise and reduced stress to keep yourself healthy and happy!
Reference:

1. Gao F. Impact of obesity on mortality in patients with diabetes: Meta-analysis of 20 studies including 250,016 patients 2017; DOI: 10.1111/jdi.12677

Source-Medindia