Hormonal
Obesity is not a sufficient cause of non-insulin-dependent diabetes mellitus (NIDDM); insulin resistance acts as the primary mechanistic link between obesity and diabetes risk, with genetic/familial factors accounting for significant variance in insulin action independent of body fat percentage.
Focus on insulin sensitivity, not just weight. While obesity increases risk, it does not guarantee diabetes. Genetic predisposition and the degree of insulin resistance are key. For those with high body fat, reducing fat mass helps, but for those with strong family history, monitoring insulin action (via glucose tolerance) is more important than BMI alone.
Obesity is therefore not a sufficient abnormality to cause diabetes. Other risk factors for the development of diabetes among the Pimas, independent of degree of obesity, include duration of obesity, and parental diabetes status... insulin resistance has been hypothesized as the mechanism of the association of obesity with an increased risk of diabetes.
Why this rating
Large cohort (n>4000), longitudinal data, rigorous metabolic clamping techniques, but observational/correlational regarding genetic factors.
Source
Obesity and insulin resistance: Lessons learned from the Pima indians
Stephen Lillioja et al. · Diabetes/Metabolism Reviews · 1988
DOI 10.1002/dmr.5610040508
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