Did you know the number of people with diabetes has increased fourfold since 1980? Experts believe obesity and lack of physical activity can explain the rise in this disease that can damage multiple organs in the body, including the heart, kidneys, and eyes. According to research, type 2 diabetes can shorten a person’s lifespan by a decade. Plus, the damage elevated blood sugars due to cells and tissues speeds up aging.
Diabetes is most pervasive in Western countries, and prediabetes is even more common. In the United States, about 12% of the population already has a diagnosis of diabetes while some have it but don’t know it. Even more startling is the fact that 1 out of 3 adults have prediabetes. Their fasting blood sugar level is still not at diabetic levels but it’s above normal when they fast. Doctors check a blood glucose level after a person fasts for at least 12 hours to get this value. Even better is a hemoglobin A1C test that looks at blood glucose control for the prior 3 months. A fasting blood glucose gives you only one value in time.
One of the best ways to lower your risk of type 2 diabetes is to lose weight if you’re overweight or obese. Type 2 diabetes is so strongly linked with obesity that scientists use the term diabesity to describe the link between the two. However, being a normal body weight doesn’t guarantee that you won’t develop the disease. It often surprises people of normal weight when they discover their blood sugars are in the prediabetic or diabetic range and wonder why. How can we explain these findings?
Why Normal-Weight People Get Diabetes
If obesity is a driving force behind type 2 diabetes, why do people who aren’t overweight or obese get it too? There is a genetic component to type 2 diabetes in people of normal weight. The odds of developing type 2 diabetes if you’re a healthy body weight is higher if you fall into certain ethnic groups. Usually, you see the risk of prediabetes and type 2 diabetes go up with increasing body weight and BMI. However, people who are Asian, Hispanic, or who have Pacific Islander genetics are at greater risk even at a normal or low body weight. People who fall into these groups may need to check their fasting blood glucose more often to monitor for changes. Prediabetes and even type 2 diabetes often cause no symptoms and you can have it for years without knowing it, all the while it’s damaging your organs and tissues.
Why are certain ethnic groups at higher risk of prediabetes and type 2 diabetes at a normal or low body weight? We mentioned the role of genetics. It’s possible that people in high-risk ethnic groups have genes that predispose them to insulin resistance. But there’s another factor. Studies show that, for example, Asians tend to have more visceral fat, deep belly fat linked with inflammation, than Caucasians of similar BMI or body weight. According to research, having more visceral fat increases the risk of a number of health problems, including type 2 diabetes and cardiovascular disease. Therefore, being in a high-risk group also means you should monitor your waist size more. A “red flag” waist size is anything above 35 inches for women and 40 inches for men.
A larger waist size appears to be a strong marker for type 2 diabetes risk. When researchers in the United Kingdom measured the waist size of 30,000 European and followed them for 17 years, they found higher rates of type 2 diabetes among those with larger waist sizes. The cut-off was 40 inches for men and 35 inches for women. Beyond that, the risk of type 2 diabetes climbs precipitously. Even if you’re a normal body weight but have a large waist, your risk of type 2 diabetes is elevated. This study also suggests that we should monitor waist size as much as body weight and BMI. A large waist size is a marker of more visceral fat, deep belly fat that releases inflammatory cytokines, inflammatory chemicals that reduce insulin sensitivity and make it harder to regulate blood sugar. Plus, these inflammatory chemicals increase the risk of cardiovascular disease too.
Diagnosis is Happening Too Late
A study discussed on Cardiology Advisor points out that doctors aren’t diagnosing prediabetes early enough and even when they do, they aren’t treating it in a timely manner. Research shows that if you diagnose it early and begin treating it through lifestyle changes or medications, it can slow the progression and keep type 2 diabetes from developing. In one study of individuals over age 45 with prediabetes, only 23% were treating it. Studies show that some complications of type 2 diabetes begin while a person is still prediabetic. For example, 8% of people with prediabetes already have retinopathy, damage to the retina that can lead to blindness.
Other Risk Factors for Type 2 Diabetes
Are you familiar with other risk factors for type 2 diabetes, beyond body weight? Here are some established by science:
- Having close relatives with diabetes
- Not meeting the physical activity guidelines
- Sitting over 6 hours per day
- Being over the age of 45
- Having elevated blood sugars during pregnancy
- Giving birth to a baby that weighed over 9 pounds
- Have high blood pressure
- Have a low HDL-cholesterol or a high LDL-cholesterol
As you can see from the risk factors, lifestyle changes can lower the odds of developing prediabetes and type 2 diabetes. Move more by doing structured workouts but also by sitting less. Break up time spent at your desk by stretching, walking around, and doing bodyweight exercises. Even short periods of physical activity improve insulin sensitivity. Reevaluate your diet, sleep habits, and stress management strategies, as these all impact body weight. Losing weight, especially belly fat, is the most important thing you can do to lower your risk.
The Bottom Line
You can get type 2 diabetes even if you’re of normal weight or underweight. Your risk is higher if you have a strong family history of diabetes, your ethnicity is at high risk, or if you have a large amount of visceral fat, as suggested by a large waist measurement. Still, making lifestyle changes can reduce your risk. So take advantage of what you can control!
- com. “You Could Have Diabetes While at a Healthy Weight: Here’s How”
- Centers for Disease Control and Prevention. “About Prediabetes & Type 2 Diabetes”
- com. “Waist size signals diabetes risk”
- Cardiology Advisor. “Prediabetes Has Increased in Adults With Normal BMIs”
- Cardiology Advisor. “Study Suggests Doctors Miss Opportunities to Treat Prediabetes”
- Healio Ocular Surgery News. “Diabetic retinopathy found in 8% of pre-diabetic patients”
- National Institute of Diabetes and Digestive, and Kidney Diseases. “Risk Factors for Type 2 Diabetes”