Location, rather than amount of excess weight determines diabetes risk

Your weight or body mass index (BMI) tell you very little about your overall health. As readers of Obesity Panacea, you’ve all heard us repeat this point ad nauseam over the past 4 years.

But the concept is crucial. In fact, if you take away just one thing from the hundreds of issues we’ve discussed on this blog, let it be this: the connection between weight and health is VERY tenuous.

A study published today in PLoS Medicine confirms the notion that where you store excess weight is much more important than how much excess weight you carry. In the study, Claudia Langenberg and colleagues report that an elevated waist circumference (a marker of abdominal obesity) is associated with greater risk of type 2 diabetes, independently of body mass index (BMI). In other words, whether you are “normal weight”, “overweight”, or “obese” by BMI standards, having a big belly puts you at increased risk of diabetes.

Are these findings surprising? Not even close.

In fact, back in 2007, I published a study with Drs. Janssen and Ross in the journal Diabetes Care  (read in full here), which was the first to clearly demonstrate that even after you account for your BMI as well as common clinical markers, those that are apple-shaped (elevated waist circumference) carry a significantly higher risk of diabetes.

Another study published in the New England Journal of Medicine in 2008 demonstrated that an elevated waist circumference predicts greater risk of death from all causes regardless of BMI level. Based on a ~10 year follow-up of about 360,000 Europeans, the authors  of this study found that for a given BMI, an increase in waist circumference of 5cm was associated with a 13-17% increased chance of death in both men and women

The new results by Langenberg et al, along with countless prior studies, are in complete agreement with current clinical guidelines which recommend that physicians measure waist circumference along with BMI to assess a patient’s risk of disease.

Thus, if your waist circumference is greater than 102cm (men) or 88cm (women), you may be at risk of disease and premature death even if you are at a healthy weight. Conversely, if your BMI is in the overweight or obese range, but your waist circumference falls below the above cutpoints, you may not have much to worry about.

Peter

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14 Responses to Location, rather than amount of excess weight determines diabetes risk

  1. Pingback: Diabetes and Weight | MIDRU

  2. freeman dennis says:

    exellent info as usual. however what is one experiencing excess waist measurement, especially older people who have “weight shift” in which one tends to get more apple shaped as we age.to do. is it as nih recommends that we redouble our exercise and weight loss efforts? also with me at least waist is the last area to respond to loss,not the first as one reads because weight is lost in reverse order that iit is deposited.

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    • Jim Jozwiak says:

      You are not trying to reduce weight. You
      are trying to reduce fat mass and therefore
      waist circumference. As we get older, our
      glucose tolerance can decrease so that a
      low-fat regimen that reduces fat mass does
      not provide enough calories and a switch can
      be required to more calories from fat and
      fewer from carbohydrate.

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  3. Pingback: Overweight people with large waists have almost equal risk of developing diabetes as obese people – CBS News – Signs For Diabetes

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  6. Otto Hunt says:

    Great information. I included this latest PLOS study in my health file at https://docs.google.com/document/d/1iKNgGAkXzXinwWlUnkCugH2wKu9Qz8Y9TZoTqWyzbRo/edit?pli=1.

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  12. It might be interesting to compare the risk of having a large waist measurement to the risk from having a family history of diabetes, age, not exercising, and other risk factors.

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  13. Denny says:

    I’m female, and a serious apple. People always tell me how skinny I am because even though I do weights and other exercise regularly my arms and legs are thin. On a height-weight scale, when I get my waist to 80cm, I register as underweight. If my waist circumference gets to over 88cm and I am working to reduce it (cutting out sugar etc) I don’t tell people because they give me a hard time – “you don’t need to lose weight”.

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