Research
Mixed
Higher cardiorespiratory fitness and greater muscle mass/strength are associated with lower mortality in diabetic patients, potentially explaining the obesity paradox.
Prioritize building muscle and improving cardiorespiratory fitness over focusing solely on BMI. These factors are stronger predictors of survival in diabetes than weight alone. Resistance training and aerobic exercise are key.
GoodSupportsHIGH confidence
The Aerobics Center Longitudinal Study showed no significant association between BMI and mortality after adjustment for fitness in males with diabetes, and furthermore observed that fitness predicted mortality independent of BMI.
Why this rating
Supported by specific longitudinal studies cited in the review.
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
- 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).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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