Most Fat People Don’t Get Diabetes?

I’ve had it banged over my head for decades that “OMG you’re going to get diabetes!!!!”, so when I read this I was a bit flummoxed:

Roughly 20% of the people with Type 2 diabetes are thin, and 75% of obese people never get it.

All those years of worry, of dieting to try to avoid diabetes, of being told that I ABSOLUTELY would get diabetes if I didn’t lose weight permanently, and … 75% of obese people never get it?

Yes, if 25% of obese people get diabetes in their lifetime, that is a large precentage.  But the impression I’d been given was that it was closer to 80% or 90%.   Was I just totally misunderstanding all these years, or just listening to too many scare tactics?

Edited to add: This CDC report from 2004 includes more information on the number of diabetics who are overweight or obese across various ages and ethnicities.  It notes that it did not include people living in nursing homes.

Edited to add: This Gallup poll reports that 11% of Americans overall have diabetes, which would put the rate of diabetics who are fat higher than those who are officially “normal weight”.  Considering diabetes causes insulin resistance and weight gain, this is not suprising.

50 thoughts on “Most Fat People Don’t Get Diabetes?

    • That I haven’t found. I see references to the relative risk of diabetes being between 2 times to 4 times greater if you’re fat, but not what the risk ratios are.

      I do know that research has changed the understanding of diabetes faster than the media’s been keeping up. The genetic component is better understood now–in the class I sat in on, it was stated that having 1 parent with type 2 diabetes means a 25% chance of getting diabetes in one’s lifetime, and 2 parents with type 2 means a 75% chance.

      Also: insulin resistance causes weight gain. So someone in the early stages may very well be gaining weight due to the disease.

      • Yes, exactly. I think that some people gain weight as a symptom of the underlying insulin disorder that also produces diabetes, rather than getting diabetes because they gained weight.

  1. That is a common use of statistical information. Saying something like “3 out of 4 obese people will never develop diabetes” isn’t terrifying and doesn’t serve the same purpose as “OMG 60% OF EVERYBODY IS FAT AND 25% OF THOSE FATTIES WILL GET WILFRED BRIMLELY DISEASE OH NOES!!!!”

  2. Agreed — if it’s 25% of fat people, and then they say 20% of persons with diabetes are thin, that suggests the other other 80% are not, and that “not” implies fat. Which in turn still suggests that being overweight puts a person at higher risk for developing type II than someone who is not overweight. Still, what is the percentage of the thin population — and does it work out that that the odds are actually about the same no matter what your body type? That’s important information — because if a person is thin, they need to know they don’t get a free pass.

    But, I do totally agree with your main point — there is a huge difference between being told you have a 1 out of 4 chance of having something happen then the current scare tactics, which make it sound like if a person is fat it’s just a given he or she is going to develop Type II. And obvious it’s not that clear cut.

    Anyway, I would have liked to have seen where the reporter pulled those statistics from, although I do think the money quote is in that same paragraph: “People think it’s their fault, but that’s not true,”

    Kind of a weird article — I got the impression the doctor was trying to make the point that people need to look at their genetic history and get screened regardless of their body type or apparent fitness level if there’s diabetes in the family tree, but the reporter pulls it all back to the old cliches of lose weight and exercise.

    • But if weight gain is a symptom of type II diabetes/insulin resistance, I’d say that still casts some doubt on the usefulness of fat as a risk factor. In other words, there are fat people who get diabetes and thin people who get diabetes, and it sure sounds like there may also be thin people who become fat(ter) people by getting diabetes. Which category do you think they’re counting those folks in? I would guess that it’s the fat category.

      • Exactly. I’ve always wondered which comes first, i.e., which is the symptom and which is the cause, and the dominant paradigm now is that weight gain is the cause with every bad following from it.

  3. I really think that 99 percent of the world is looking at the diabetes-fat connection in totally the wrong way. Why is it that nobody seems to consider that it’s possible that being genetically predisposed to diabetes makes it more likely that a person be prone to fat? We all know the role that insulin resistance plays in weight gain, so why is it such a crazy notion that perhaps some fat people get diabetes because diabetes makes people gain weight? (Not to mention that most diabetes treatments themselves cause weight gain…)

    • genetically predisposed to diabetes makes it more likely that a person be prone to fat

      This is where I think there’s something to the concept of metabolic syndrome – those things do tend to cluster together, but whether it's just heredity or common causes or what I don’t know.

  4. My husband has type 2 diabetes, 4 of his 6 brothers have it, and both of his parents had it. I don’t think it’s coincidence, it’s very probably genetics. I may or may not get it, my mother’s grandmother had diabetes, but I don’t know if it was type 1 or type 2, and my dad was diagnosed with type 2 a few years ago (he’s 76, so either it took a long time to show up, or it took a long time for them to diagnose it). I’m not going to worry about it, if I happen to wind up with it, at least I know it’s a very treatable disease that can be lived with for a long time (and no, it’s not something I want to happen, but if it does, I know it didn’t happen simply because I’m fat, it happened because the genetics in our family finally caught up to me).
    As for the weight gain, DH managed to maintain his weight for 13 years after he was diagnosed, until he was put on insulin. He’s not eating any differently than he was before the insulin was started (well, maybe fewer carbs), and in 2 years of insulin use, he’s gained 30 lbs and is not happy with that. I don’t know what to tell him, his doctor insists it’s calories in/out and restrict portion sizes (and we all know how well that works).

    • God, that makes me furious. He maintains for 13 years, and then suddenly it changes, which happens to coincide with the introduction of a new med. To then assume the patient needs calories in/out advice… Like, are you STUPID as well as fatphobic?

      Which I know is exactly what you just said, but I felt the need to reiterate it. AAAAAAHHH.

  5. My stepfather has Type II and actually stopped taking his insulin for about a year because he was gaining weight. You can guess how well that went. Now he’s skinny as a stick (which doesn’t suit him at all, IMHO), but his health is awful and he has to work much harder to control his sugars.

    Vesta, can your husband find a new doctor? My stepfather finally admitted to his doc that he was resisting taking the insulin because of the weight gain, and his doctor prescribed a different kind (different formulation? different dose? I’m not sure) that is supposed to reduce that side effect. So my stepfather has the medication he needs and doesn’t seem to be regaining the weight (possibly to his detriment at this point, but at least he’s treating the disease now).

  6. I’d be interested in more information. I asked my doctor about it, during my appointment today. He is generally very fat positive, but mentioned that while he doesn’t doubt this statistic is true, it too is misleading, and a result of two facts:

    1) The very low BMI threshold for obesity.
    2) The over-general grouping of the study.

    He mentions that a much more significant proportion of those who have over 100 pounds to lose get diabetes, but that the vast majority of the population who is “obese” only has 25-40 pounds to lose before their BMIs are “normal”. That much weight isn’t correlated with an increased risk of developing diabetes (though interestingly, PCOS risks increase more quickly at lower weights). But “morbid” obesity, or “death fat” or whatever you want to call it, poses much more of a risk.

    He said there would be similar elevated risk factors among people predisposed to weight gain in their stomachs, no matter their actual weight, and those with a genetic history of the disease- again regardless of their actual weights.

    He didn’t have studies on hand and was leary of using numbers. But he’s going to try and look them up, and in the meantime, it sounded plausible to me.

  7. I’m going to do my best to answer this question from my public health background, but I’m not an epidemiologist, so this is really just me doing my best. (Is there an epidemiologist in the house? I know a few but I don’t think they hang out here.)

    The overall estimated rate of diabetes in the population for adults in 2007 was 7.8%. If the rate of diabetes among people who are in the overweight or obese categories is 25%, then it is clear that people who are in those categories are more likely to have diabetes than those who are not. There’s a statistic used in public health called “risk ratio” which describes the difference — and I’ll see if I can locate the risk ratio associated with BMI and diabetes.
    Risk ratio is a way of expressing the increased risk associated with two related things — i.e. smoking and lung cancer.
    But I think Nicole’s comment is interesting and accurate.

    One of the biggest issues in this is the assumption that weight gain is preventable. If it is, then some cases of diabetes can be prevented or delayed. The studies that show that onset of diabetes among those with prediabetes can be prevented or delayed by losing weight are compelling, but the amount of weight lost didn’t make fat people thin, it was along the lines of 10% of weight. I guess my thinking is that if being more active and shifting what a person eats can help prevent the onset of diabetes, and a person chooses to do that, whether weight is lost or not, that’s fine. I suppose that for someone with a family history of diabetes, getting regular movement and eating well is prevention. It’s not a moral issue.

    I have much more to say about this, obviously. I wish I had all the information I need at my fingertips, but I’m being persuaded to go into the closet right now by a superhero princess so I have to leave the computer. Ah, the sacrificies of being a parent!

    • Thanks for the info.

      The studies that show that onset of diabetes among those with prediabetes can be prevented or delayed by losing weight are compelling, but the amount of weight lost didn’t make fat people thin, it was along the lines of 10% of weight.

      I also wonder if the improvement is necessarily due to weight loss itself or to exercise and adjusting foods to help moderate blood sugar. Exercise alone can improve insulin sensitivity and help prevent diabetes.

      Basically I wonder how much people focus on weight because it’s visible and miss the rest.

  8. Here’s an article that talks about BMI and risk of developing diabetes among adult women based on the Nurses’ Health Study:
    http://www.nature.com/oby/journal/v12/n2/full/oby200434a.html

    Again, I think the question at hand is whether or not fatness is preventable.

    Rather than thinking of the messages around the association of fatness and diabetes as “don’t be fat” — maybe it would be more helpful to think of them as “if you are fat, here’s something to pay attention to or be on to look out for” — and “if you have diabetes in your family, here’s something to look out for.”

    In part, this is an exciting discussion to the public health geek side of me because I would love to interview a diabetes expert from a fat acceptance perspective to see what the common messages could be to promote good health from a HAES perspective.

  9. Then there’s the fun of being fat and having your blood sugar go up and having it *not* be Diabetes.

    You go in and your eternally normal blood glucose (OMG it can’t be normal in someone your size. You simply *have* to be Diabetic. Are you sure you don’t want Glucophage, just to ward it off?) is suddenly shockingly high. So they give you Glucophage and Bayetta and Glipizide and offer you a few more. And you smile and nod and go home.

    You’re having a WTF moment because your diet is already low in carbs and they’re mostly whole grain carbs and you already workout and you avoid HFCS like the plague it is. And to top it all off you’re body fat is only 32%, which is high but isn’t enormous. (You know this because they tested you *four times*, refusing to believe that you are actually carrying around 280 of bone and muscle, that you only need to lose 60 lbs to get to a “normal” ratio, or that the only way to get your BMI to “normal” would be to start hacking off limbs.) So you go home, and you don’t start on the stronger drugs right away. You start with the Glucophage, and 500mg is fine, you have a bit more energy during the day. You up it to 1,000mg a day (they want you at 2,000) and start feeling…not right. You’d swear you were having low blood sugar reactions, even though the meter they want you to use 5 times a day keeps saying you’re over 100. And after a few weeks you feel like hell.

    So you go look it up. You look it all up. And then you decide to do your own thing.

    Three months later you go back for your check-up and your blood sugar is NORMAL. Yep, completely BACK TO NORMAL. And all the doctors are just thrilled. See, all the medications are working! They did it! Yea for them!

    Then you tell them that you stopped the Glucophage and never did take the Bayetta or the Glipizide. You also STOPPED TAKING THE STEROID FOR YOUR ASTHMA.

    See, you had to go on Prednizone after a bad case of bronchitis over the winter, which caused your asthma to flare up. And Prednizone causes your blood sugar to go up. And you TOLD THEM you had been taking it back when the tests were done. But they skipped right over that because OMG you’re a fattie and everyone knows all fatties become Diabetic and then just fall over dead.

    Then, you change doctors.

  10. My mother was years ago put on oral diabetes medications (well, at one time, they had her on 8 or 9 different meds), the after several years, told that, oh, gee!, she wasn’t diabetic after all. And I am not good with the statistics thing, but it looks to me as if about 5% more fat people than thin people get Type II, which is more but not a great deal more, & one has to wonder how many of improperly diagnosed & medicated unnecessarily because ‘everyone knows’ that fat people are diabetic, etc. Also, as others have pointed out, diabetes can often cause weight gain. Also, what these geniuses love to keep quiet about is the fact that Type II is no more your FAULT or caused by lifestyle that Type I & is at least AS genetic & hereditary, possibly moreso.

    And, btw, Annie, my mother who had kidney disease inherited from her thin father & grandfather, who both died of it, lost her right kidney before she was 45 & was kept on Prednisone for MANY years (apparently, it would seem, the cause of the high blood sugar reading which led to yet more medication she didn’t need.) She, fortunately, inherited more genes from her mother’s side overall & lived to be 85 anyway.

  11. Ok, maybe this is my ignorance playing into this here, maybe I have it backwards or something, but for some reason I was under the impression that many of those who are fat and diabetic actually experience the weight gain as a symptom of the disease and not as a causation of the disease. I mean, I get that every case of diabetes is going to be different and that that must make it harder to differentiate causation from symptom (especially when the fat blaming public perception gets involved) but it’s confused me for a good long while now why trying to minimize one of the symptoms is seen as a cure or prevention for the disease.

    I dunno, maybe I’m babbling on stupidly here, but to me that’s almost like saying “if you have the flu and if you would just stop vomiting already your fever would go down too”. I mean, sure, when you start to get over something, usually when vomiting ceases that means good things are set to come, however, the vomiting isn’t what’s making you sick, heck the fever isn’t even making you sick. The virus is making you sick and because you’re sick you’re vomiting and your temperature’s going up.

    • Ok, maybe this is my ignorance playing into this here, maybe I have it backwards or something, but for some reason I was under the impression that many of those who are fat and diabetic actually experience the weight gain as a symptom of the disease and not as a causation of the disease.

      Basically it’s a question of whether type 2 (insulin resistant) diabetes causes weight gain or weight gain causes type 2 diabetes. For a long time it was assumed the latter, partly because the tests weren’t as accurate and you had to be really high to be considered diabetic.

      Now they have better tests, are diagnosing it earlier, and hm, weight gain tends to happen as you start to show the disease, but often if you exercise more and moderate your carb intake (in the sense of spreading them out through the day to help keep things even) then you can prevent it or control it that way and oh yeah you stop gaining weight and maybe lose a little weight. So weight loss, which is totally within your control, is a way to avoid diabetes! Right! (Argh)

      So…some people believe fat causes diabetes, others see it as diabetes causes fat, and others see them walking hand in hand.

      Meanwhile, one of the symptoms of type 1 (no insulin) diabetes is sudden weight loss and serious thirst. Generally with that one, you either get diagnosed pretty soon or you die.

      • Again, I think that is the other way around: if you have a mildish case of whatever syndrome messes with your insulin response, and you manage it through strict food control, you will also lose or maintain weight.

        My guess is that they will figure this out in a few years, and it will be as big a paradigm shift as when they discovered that ulcers were mostly caused by bacteria, and never caused by stress.

    • This may or may not be useful, but here’s how I explain it to my Type 2 diabetes patients (I’m an RN): when you develop insulin resistance, your body makes more and more insulin to try to overcome that resistance, and bring the blood sugar down. Some Type 2’s, in the early stages (even before they’re diagnosed with diabetes) are making 2 or 3 times the normal amount of insulin, to overcome this resistance. Insulin’s main job is to take the glucose from the blood and into your cells; but what we forget is that insulin’s second job is to promote fat storage–so the more insulin you have circulating, the more your body will store what you eat as fat. Which is why you see the association between fat and Type 2 diabetes–but it’s not the fat making you diabetic, it’s the insulin resistance-caused increase in circulating insulin making you fat! (This is all part of my lecture I privately call It’s Not Your Fault You Have Diabetes :)

  12. “Fat” is an emotional term. “BMI” is more objective, more scientific. Yes, people with higher BMI’s are more likely to develop diabetes.

    • “Fat” is being consciously reclaimed by the fat acceptance community as being a neutral descriptor. “BMI” is simply a height-weight ratio that any 4th grader should be able to calculate. “Overweight”, while having some value as an official term for people with BMI between 25 and 30 (after 1998) implies that there’s a correct weight range that ALL people should fit into. “Obese”, again, has some value as an official demarcation, but it also “diagnoses” what is often a natural state.

  13. Okay, I haven’t studied this; but it seems to me that if the general population is 66% overweight, and 80% of the diabetic population is overweight; then there may be some small correlation with overweight, but not a huge number.

    And I perfectly agree that diabetes could cause weight gain.

    • if the general population is 66% overweight, and 80% of the diabetic population is overweight; then there may be some small correlation with overweight, but not a huge number.

      Yes! Not “OMG you’re fat you’re GOING TO GET DIABETES 100%!!!”

  14. I love the tossed in line in the write-up “greater vigilance by the overweight/obese might have resulted in higher diagnosis of diabetes”. Because you know, those fatties never get to the doctor and obviously, more of them must be diabetic!

    Every time I read someone shrilly insisting that OMG your fat will make you DIE, I try to remember that they’re just afraid of their own death and want to feel like they’re doing stuff to prevent it.

    • Because you know, those fatties never get to the doctor and obviously, more of them must be diabetic!

      Yeah. Never mind the doctors who assume thin people won’t get it, and so they don’t test for it or even ask if there’s a family history….

  15. Statistics might be interesting to ponder but I’m not going to live my life by them or attempt to find some kind of justification or reassurance from them.

    I consider my own family history and my own medical history while consulting with medical, wellness, and fitness/training professionals I evaluate carefully before placing my trust.

    There isn’t ANYTHING I’d say with certainty “Oh that will never happen to me” just because some statistic suggests it might not.

  16. Here’s my hypothesis (about type II, not type I):

    If you corrected for the number of people whose insulin resistance (or taking insulin to manage the disease) makes them gain enough weight to be “overweight” and beyond (i.e., they would not be overweight/obese if they didn’t have diabetes), you would see no significant difference between the prevalence of diabetes amongst the different BMI “groups”.

    It will be interesting to see if any researchers test this or a similar hypothesis in the near future. If I were a diabetes researcher, it would be the next logical step given the greater knowledge about fat and diabetes that exists now compared to when the disease was first being understood.

  17. It’s like you’re in my head or something because I have developed a “new” issue with my blood sugar that is right up the alley of this post. From all my internet research, it looks as if I am hypoglycemic. Tremors, sweats, confusion, and extreme hunger symptoms have been creeping in over the past few months. I’ve always been a little “jittery” when I don’t eat ,for most of my life, but these latest symptoms come within a couple of hours after a small meal (like a bowl of cereal), usually breakfast. I bought a blood sugar monitor this weekend to actually see what the numbers are, and found that I am right around 50 when the symptoms are the worst. This is not good, but explains things tremendously. I will definitely be seeing my doctor about this asap.

    That being said, the “fat causing or being a symptom of” diabetes debate will be a topic I discuss with my doctor, but given my own history of hypoglycemic symptoms throughout my whole life, both fat and less fat, I’m certainly embracing the probability that it’s genetic.

    My mom had untreated diabetes (she was what we in the family called paranoid manic depressive and hated pills, doctors, and the government) for 20+ years. After having these escalating bouts with low blood sugar more recently, I can now understand her behaviors better upon reflection. She died at the young age of 70 from her second massive heart attack. The first was less than 2 years prior. That’s when she got the diabetes diagnosis and treatment. She stopped smoking, exercised, and took insulin pills for her diabetes. It seems like too little, too late now, looking back.

    I guess the conclusion I have drawn from this debate is that it doesn’t matter whether the fat makes me diabetic or the diabetes predisposition makes me fat. Getting tested and knowing your levels, as well as knowing your own body’s reaction to things and discussing them with a doctor who can see beyond the OMG UR FAT! fuckery will help me find the best options for living an optimal life…and living beyond the age of 70.

  18. Diabetes runs on my mom’s side of the family. My late grandmother was borderline diabetic, my grandfather is, one of his sisters is, and another is hypoglycemic. All got fat as they got older. Now my mom may be borderline diabetic—and she’s lost 60 lbs. So much for fatness causing the disease, because aren’t you supposed to be cured from diabetes after losing weight? *cue sarcasm*

    I think I have hypoglycemia as well. Rarely does my blood sugar go over 130, but there have been times when it’s been below 70 and I’ve felt terrible, with sweats, shakes, and headaches. We have a blood sugar tester at home, and when I start getting these symptoms, I make sure to get some food in my system.

    • It runs on my mother’s side too. Mom’s reaction to my initial musings about fat acceptance was “But you’ll regret it when you’re 40 and have diabetes!” and “I was healthy when I was younger but when you’re 40 and have diabetes you’ll wish you’d lost weight!” and so forth. I think that affected me more than the numerous doctors’ “chats” about needing to lose weight to prevent diabetes.

      20 years later it has finally occurred to me that diabetes isn’t on my dad’s side of the family. Just my mom’s. Which means I might not have inherited it. *TILT*

  19. Pingback: Weight-Loss Drugs Are About Health! Really! « Living ~400lbs

  20. Pingback: Symptoms of Fat People « Living ~400lbs

  21. Pingback: ADA: Not all fat people get diabetes « Living ~400lbs

  22. Pingback: Monthly Roundup (Nov & Dec) « Living ~400lbs

  23. Pingback: Correlation Humor « Living ~400lbs

  24. interesting thread. I’m 32 years old and have prediabetes,PCOS,progesterone deficiency (can cause menstrual cramps and fatty liver disease) and developed overt hypothyroidism (type 2 diabetics have a higher prevalence of hypothyroidism). I was almost obese. I had difficulity losing weight yet lost weight. My oldest aunt was a thin type 2 diabetic for years. fatty liver disease and hepatitis C can cause liver cirrhosis that can cause type 2 diabetes and insulin resistance. iodine deficiency can cause obesity. My dad has type 2 diabetes.

  25. Pingback: Abigail Saguy on Health Care Provider Bias | closetpuritan

  26. yes you are right most obese people don’t get type 2 diabetes. most type 2 diabetics have a parent that has type 2 diabetes so they have a hereditary predisposition. arsenic can cause type 2 diabetes (well studied) in those with a hereditary predisposition. studies show type 2 diabetics have higher levels of arsenic. maybe they can’t rid of it so it builds up. rice is high in arsenic and brown rice even more so. it’s fascinating how doctors push brown rice on type 2 diabetics.

    • Neither of my parents was diabetic. However, my maternal grandmother was, and so was my maternal great-grandmother. I can’t think of any instances of the disease in my father’s family.
      I was diagnosed with type 2 diabetes at the end of January. Prior to this I had been showing what I now know are signs that I had the disease or at the very least had insulin resistance, such as increased thirst, increased urination and urinary incontinence, and horrendous cravings for sweets. I’ve actually had cravings for sweets for most of my life. Not minor cravings either, ravenous, uncontrollable cravings. Of course doctors always told me “well, just don’t eat that stuff!” Silly fat woman binging on cake, tee hee.
      It made me furiously angry when I learned that insulin resistance can cause these kind of cravings and that it can also prompt weight gain and make weight loss nearly impossible. Especially combined with the Hashimoto’s Thyroiditis that was diagnosed when I was sixteen, I’ll wager.
      I’ve discovered that rice causes my blood sugar to spike. I can eat potatoes and bread in moderation with no problem, but I try to avoid rice.

  27. Pingback: Gut bacteria and blood sugar | closetpuritan

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s