Research
Mixed
In individuals with Type 2 Diabetes, the 'obesity paradox' exists where the lowest mortality risk is observed in the BMI range of 25–35 kg/m2, but this is largely explained by higher cardiorespiratory fitness (CRF) rather than body weight itself.
Do not fear being overweight if you are fit. In Type 2 Diabetes, the lowest mortality risk is found in those with a BMI of 25-35, but this is because they tend to be more fit. Focus on building fitness. An obese person with high fitness has lower mortality risk than a normal-weight person with low fitness.
GoodQualifiesHIGH confidence
Because this 'obesity paradox' has been consistently demonstrated in 7 meta-analyses, the lower mortality risk for individuals with T2D in this BMI range may not be all that paradoxical.
Why this rating
Based on 7 meta-analyses and large cohort studies (Henry Ford, Look AHEAD).
Source
Type 2 Diabetes Incidence and Mortality: Associations with Physical Activity, Fitness, Weight Loss, and Weight Cycling
Glenn A. Gaesser · Reviews in Cardiovascular Medicine · 2022
DOI 10.31083/j.rcm2311364
narrative_reviewCited 10×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
More from this paper
- Higher levels of physical activity (PA), cardiorespiratory fitness (CRF), and muscular fitness (MF) are associated with a significantly reduced risk of Type 2 Diabetes incidence and reduced all-cause and cardiovascular mortality in individuals with T2D, independent of body weight.Strong
- Intentional weight loss in individuals with Type 2 Diabetes (T2D) is not consistently associated with reduced mortality risk and may be associated with higher mortality in obese subgroups, whereas weight cycling (body weight variability) is consistently associated with significantly increased all-cause and cardiovascular disease mortality.Good
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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