Research
Mixed
The observed 'obesity paradox' in diabetes is likely non-causal and explained by biases such as reverse causation, confounding by fitness, and body composition differences (muscle mass).
Do not interpret the 'obesity paradox' as a reason to gain weight. The survival advantage seen in obese diabetics is likely due to them having more muscle, being fitter, or having less severe disease at diagnosis, not the fat itself. Weight loss interventions are safe and recommended.
GoodRefutesHIGH confidence
We believe that the obesity paradox most likely represents a non-causal association between higher BMI and mortality in diabetes, but await a comprehensive explanation of the remaining loose ends.
Why this rating
Based on a comprehensive review of multiple large cohort studies and critical analysis of their limitations.
Source
The Evidence for an Obesity Paradox in Type 2 Diabetes Mellitus
Seung Jin Han et al. · Diabetes & Metabolism Journal · 2018
DOI 10.4093/dmj.2018.0055
narrative_reviewCited 118×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
More from this paper
- Higher cardiorespiratory fitness and greater muscle mass/strength are associated with lower mortality in diabetic patients, potentially explaining the obesity paradox.Good
- In patients with type 2 diabetes, higher BMI (overweight/obese) is associated with lower all-cause mortality compared to normal weight, a phenomenon known as the 'obesity paradox'.Moderate
Related findings · Mixed
- Bariatric surgery (VSG and RYGB) is the most effective and sustainable treatment for obesity, producing marked and sustained weight loss that non-surgical interventions cannot match.Strong
- Severely protein-deficient diets (2–3% energy) induce lean body mass loss and metabolic imbalance, whereas adequate protein intake (0.66 g/kg/d minimum) is a prerequisite for maintaining muscle, bone, and physiological function.Strong
- For patients with Class III obesity (BMI >39.9 kg/m2), metabolic bariatric surgery (MBS) is significantly more effective than any currently approved medication, with BilioPancreatic Diversion (BPD) showing the highest estimated weight loss.Strong
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