# Is adult-onset diabetes always linked to obesity? (I have type II, aka the "fat and forty" one) **URL:** \ **Category:** Factual Questions\ **Created:** [December 22, 2013, 6:08am UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940 "2013-12-22T06:08:23Z")\ **Posts on this page:** 15\ **Page:** 2
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 23, 2013, 2:25am UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/21 "2013-12-23T02:25:18Z")
You don’t need a gym membership. You \*need \*to exercise. Jumping jacks, burpees, jumping rope. Fill up some old plastic gallon milk bottles with water and do squats holding them, or thrusters (that’s just holding the bottles by the handles against your chest, squating down and in one motion explode up and thrust the bottles over your head, squat repeat.) You don’t need to spend lots of money; just a fairly small amount of time. ---
**Author:** ![purplehorseshoe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/purplehorseshoe/32/2996_2.png) [@purplehorseshoe](https://boards.straightdope.com/u/purplehorseshoe)\ **Post date:** [December 23, 2013, 4:55pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/22 "2013-12-23T16:55:35Z")
… burpees? ---
**Author:** ![Telemark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/telemark/32/372_2.png) [@Telemark](https://boards.straightdope.com/u/Telemark)\ **Post date:** [December 23, 2013, 5:04pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/23 "2013-12-23T17:04:28Z")
> [@purplehorseshoe](#): > > … burpees? [Burpees](http://en.wikipedia.org/wiki/Burpee_(exercise)) ---
**Author:** ![RaftPeople](https://avatars.discourse-cdn.com/v4/letter/r/6f9a4e/32.png) [@RaftPeople](https://boards.straightdope.com/u/RaftPeople)\ **Post date:** [December 23, 2013, 5:04pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/24 "2013-12-23T17:04:43Z")
Article about virus link to diabetes: > **[New evidence for role of specific virus causing type 1 diabetes](https://www.sciencedaily.com/releases/2013/10/131022091721.htm)** > > Type 1 diabetes is a disease caused by the destruction of the insulin-producing cells in the pancreas. It is often diagnosed in childhood and requires life-long treatment with daily insulin injections. It is associated with an increased risk for... ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 23, 2013, 8:26pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/25 "2013-12-23T20:26:17Z")
> [@Leo\_Bloom](#): > > –the “fit/not fit” thing we’re talking about is the predispositive case. _Getting_ fit, ie exercising, hasn’t nearly so many open questions. > > Ummm, right? > [@DSeid](#): > > Not sure if I understand the question… It took a bit but I think I understand what confused me about your question. The fit/not fit that you initially refer to is about weight and how the normal weight individuals with a new diagnosis have a worse prognosis than those who are overweight or obese at diagnosis! I didn’t get that because to me those who are normal weight are not necessarily fit and those who are fat may be fit. ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [December 23, 2013, 9:52pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/26 "2013-12-23T21:52:09Z")
> [@DSeid](#): > > It took a bit but I think I understand what confused me about your question. The fit/not fit that you initially refer to is about weight and how the normal weight individuals with a new diagnosis have a worse prognosis than those who are overweight or obese at diagnosis! I didn’t get that because to me those who are normal weight are not necessarily fit and those who are fat may be fit. Yes, thanks for both your interest, and for your explanation, which adds another fact against ignorance. To be even simpler, my thought was even before that, pre-diagnosis: “aah, you’re fat and forty, you’re gonna get diabetes.” That epidemiological kettle of fish. ---
**Author:** ![Surreal](https://avatars.discourse-cdn.com/v4/letter/s/eada6e/32.png) [@Surreal](https://boards.straightdope.com/u/Surreal)\ **Post date:** [December 28, 2013, 9:03am UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/27 "2013-12-28T09:03:34Z")
Well at least one study found that diet and exercise did not help Type 2 diabetics: > **[Diabetes Study Ends Early With a Surprising Result (Published 2012)](https://www.nytimes.com/2012/10/20/health/in-study-weight-loss-did-not-prevent-heart-attacks-in-diabetics.html?_r=1&)** > > Diet and weight loss did not prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes. > [@](#): > > The study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved **1,200 to 1,500 calories a day** for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was **at least 175 minutes a week of moderate exercise.** > > But 11 years after the study began, researchers concluded it was futile to continue — **the two groups had nearly identical rates of heart attacks, strokes and cardiovascular deaths.** ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [December 28, 2013, 2:39pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/28 "2013-12-28T14:39:59Z")
> [@Leo\_Bloom](#): > > Unless I missed it, why again is fat around the belly different than fat around your butt/thighs, say, different as far as your endocrine system cares? To add to what’s already been said, I’ll offer two (more) ‘explanations’: (as background, please note that when people use the term “fat”, they are actually referring to [triglycerides](http://www.webmd.com/cholesterol-management/lowering-triglyceride-levels)) 1. Fat (triglycerides) around the belly is inherently more metabolically active than fat around the hips (e.g. although tough to do, you _can_ lose fat around your belly by “lifestyle measures” whereas once fat is deposited around the hips, it is almost impossible to lose). By “metabolically active”, I am referring specifically to the equilibrium that exists between fat (i.e. triglyceride) and its breakdown components called fatty acids and glycerol ([here is a clear picture](http://thepsychologyoffitness.com/wp-content/uploads/2012/03/Triglycerides-and-Glycerol1.jpg)). So, fat (triglyceride) around the belly is constantly breaking down into its core constituents of fatty acids and glycerol, but fat (triglyceride) around the hips tends not to breakdown nearly as much and thus doesn’t produce as much fatty acids and glycerol. But here’s the thing: fatty acids released from fat, as occurs from fat in the belly, leads to insulin resistance and also signals the liver to start making sugar. In other words, it’s a double whammy - insulin is made less effective by fatty acids and fatty acids also signal the liver to produce sugar. The net effect is a tendency to high blood sugar. (Fatty acids also have other effects which, as you guessed, also lead to high blood sugar). 1. Not only is belly fat more likely to generate the sugar-elevating fatty acids than hip fat, but any fatty acids so released tend to go directly to the liver, with the liver being a central player is sugar metabolism. Phrased differently, even if hip fat did break down into fatty acids to the same extent as belly fat, any fatty acids so released would not go directly to the liver and thus have a more modest impact on sugar metabolism - i.e. belly fat ‘drains’ into the liver but hip fat drains away from it. (For those with a physiological background, belly fat drains into the _portal system_, but hip fat goes _systemically_). ---
**Author:** ![Sattua](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sattua/32/11906_2.png) [@Sattua](https://boards.straightdope.com/u/Sattua)\ **Post date:** [December 28, 2013, 3:01pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/29 "2013-12-28T15:01:52Z")
> [@CatherineZeta](#): > > My mom was diagnosed with Type II when she was in her mid 40s and she told me it was because her pancreas had been producing too much insulin and then suddenly stopped. I have no idea, I was around 17 then and didn’t do much research on it. Is something like that possible? I could try looking that up. She’s not obese, but does have fat in her abdominal area which is know is considered to be worse than having a more even distribution of fat. Sounds like she may have had polycystic ovary syndrome. The disease process with that involves the pancreas dumping too much insulin, until eventually it burns itself out. It’s incidental that insulin is so similar to an ovulation-inducing hormone that it binds to the same receptors and interferes with ovulation, though that’s usually the symptom that gets women diagnosed. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [December 28, 2013, 4:27pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/30 "2013-12-28T16:27:47Z")
By the way, if anyone wants to learn more about the relationship between fatty acids and (rising) blood glucose levels, it’s described by the [Randle Cycle](https://en.wikipedia.org/wiki/Randle_cycle). > [@me](#): > > To add to what’s already been said, I’ll offer two (more) ‘explanations’: > > (as background, please note that when people use the term “fat”, they are actually referring to [triglycerides](http://www.webmd.com/cholesterol-management/lowering-triglyceride-levels)) > > 1. Fat (triglycerides) around the belly is inherently more metabolically active than fat around the hips (e.g. although tough to do, you _can_ lose fat around your belly by “lifestyle measures” whereas once fat is deposited around the hips, it is almost impossible to lose). > > By “metabolically active”, I am referring specifically to the equilibrium that exists between fat (i.e. triglyceride) and its breakdown components called fatty acids and glycerol ([here is a clear picture](http://thepsychologyoffitness.com/wp-content/uploads/2012/03/Triglycerides-and-Glycerol1.jpg)). > > So, fat (triglyceride) around the belly is constantly breaking down into its core constituents of fatty acids and glycerol, but fat (triglyceride) around the hips tends not to breakdown nearly as much and thus doesn’t produce as much fatty acids and glycerol. > > But here’s the thing: fatty acids released from fat, as occurs from fat in the belly, leads to insulin resistance and also signals the liver to start making sugar. In other words, it’s a double whammy - insulin is made less effective by fatty acids and fatty acids also signal the liver to produce sugar. The net effect is a tendency to high blood sugar. (Fatty acids also have other effects which, as you guessed, also lead to high blood sugar). > > 1. Not only is belly fat more likely to generate the sugar-elevating fatty acids than hip fat, but any fatty acids so released tend to go directly to the liver, with the liver being a central player is sugar metabolism. Phrased differently, even if hip fat did break down into fatty acids to the same extent as belly fat, any fatty acids so released would not go directly to the liver and thus have a more modest impact on sugar metabolism - i.e. belly fat ‘drains’ into the liver but hip fat drains away from it. (For those with a physiological background, belly fat drains into the _portal system_, but hip fat goes _systemically_). ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 28, 2013, 5:29pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/31 "2013-12-28T17:29:01Z")
> [@Surreal](#): > > Well at least one study found that diet and exercise did not help Type 2 diabetics: > > [http://www.nytimes.com/2012/10/20/health/in-study-weight-loss-did-not-prevent-heart-attacks-in-diabetics.html?\_r=1&](http://www.nytimes.com/2012/10/20/health/in-study-weight-loss-did-not-prevent-heart-attacks-in-diabetics.html?_r=1&) First off the discussion here was asking about the cause of diabetes and preventing it. That study was designed to analyze preventing the complications of in people who already have it. What is buried[in the actual data](http://www.nejm.org/doi/full/10.1056/NEJMoa1212914#t=articleResults) is what was hinted in the NYT article. Odds are the exercise and improved diet group needed much less medicine to achieve the same results (Insulin, other injectable hypoglycemics, statins, BP meds, etc.). > [@the NYT article](#): > > Dr. Nathan, though, said the results meant that people with diabetes might have a choice. The group assigned to diet and exercise ended up with about the same levels of cholesterol, blood pressure and blood sugar as those in the control group, but the dieters used fewer medications. > > “That may be the choice we are highlighting,” Dr. Nathan said. “You can take more medications — and more, I should say, expensive medications — or you can chose a lifestyle intervention and use fewer drugs and come to the same cardiovascular disease risk.” > [@the NEJM article](#): > > … the increased use of statins in the control group, as compared with the intervention group, may have lessened the difference between the two groups. In addition, the intensification of medical management of cardiovascular risk factors17 in routine medical care in the two study groups may have made the relative benefit of the intensive lifestyle intervention more difficult to demonstrate. … > > … Patients in the intervention group had clinically meaningful improvements in glycated hemoglobin levels, which were greatest during the first year but were at least partly sustained throughout follow-up. This positive effect may explain why patients in the intervention group were less likely to be treated with insulin during this period. Furthermore, we recently reported that patients in the intervention group were more likely to have a partial remission of diabetes during the first 4 years of the trial than were those in the control group.19 Other benefits that were identified during the early years of the trial included reductions in urinary incontinence,20 sleep apnea,21 and depression22 and improvements in quality of life,23 physical functioning,24 and mobility.25 Intensive lifestyle intervention has also been shown to prevent or delay the development of type 2 diabetes in other studies.15,26 Not listed but also previously found, less risk of [erectile dysfunction](http://www.ncbi.nlm.nih.gov/m/pubmed/19694925/?i=5&from=/20876408/related) as well. [Also](http://www.medscape.com/viewarticle/806816) > [@](#): > > … a 31% reduction in the risk of advanced kidney disease … a significant 14% reduction in the risk of diabetic retinopathy Concluding that it “did not help” is not accurate. It reduced the need for medications, reduced some signficant complications, and improved quality of life. Compared to intensive medication management coupled with standard exhortations to eat right and exercise (which resulted n some gradual weight loss in the control group as well) it was no better in reduction of cardiovascular complications. People are disappointed by that. Go figure. Poking around here’s [someone else’s](http://www.huffingtonpost.com/david-katz-md/health-news-reporting_b_3519222.html) analysis (HuffPo): > [@](#): > > Look AHEAD resulted in reduced rates of kidney disease, eye disease, and depression in the intervention group. There was also improved overall quality of life, fewer hospitalizations, enhanced mobility, and reduced medication use. And all of these benefits were seen despite the modest between-group differences noted above. > > There is another point I emphasized when this story broke in the fall, worth reiterating now. The intensive intervention of Look AHEAD was based on the methods of the Diabetes Prevention Program. That study showed this lifestyle intervention, producing an average weight loss of 7 percent, could prevent the onset of diabetes in nearly 60 percent of high-risk individuals. Look AHEAD does nothing to invalidate those findings. It just may be that a lifestyle intervention works better when applied earlier. Once diabetes is established, perhaps the returns diminish somewhat – although Look AHEAD indicates there clearly are still returns. > > A number of important messages issue from Look AHEAD. One is that very small intervention differences are apt to produce very small outcome differences. Another is that medicine of great value early may be of less value when administered late. Medication that can prevent asthma flairs is useless in treating an acute one. Ditto for migraine. This phenomenon is more common than not. If weight loss is medicine, the timing of its application may matter enormously. Yet even so, there was clear, and almost surprising, evidence of intervention benefit in Look AHEAD. > > Yet another message is the importance of how, and even how often, medical news is reported. If headlines say “weight loss is of no benefit in diabetes,” that is apt to be all readers take away. If the very same data could be reported as showing that “novel benefits are attached to weight loss in diabetics,” then perhaps a bit too much of what we think we know comes down to how things get spun. > > We may also be doing a disservice to the power of lifestyle interventions by focusing excessively on weight. While weight loss was a study goal, the real medicine was lifestyle. In the aggregate, the evidence is overwhelming that the same basic lifestyle prescription does prevent heart disease, and diabetes, along with every other major chronic disease. ---
**Author:** ![Surreal](https://avatars.discourse-cdn.com/v4/letter/s/eada6e/32.png) [@Surreal](https://boards.straightdope.com/u/Surreal)\ **Post date:** [December 28, 2013, 7:57pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/32 "2013-12-28T19:57:35Z")
> [@DSeid](#): > > First off the discussion here was asking about the cause of diabetes and preventing it. That study was designed to analyze preventing the complications of in people who already have it. No, it isn’t. The thread title states: [quote] **I have type II, aka the “fat and forty” one)** [quote] So my comments are completely relevant here. But the details of the Look AHEAD study you presented are duly noted. I suspect, however, that most diabetics would rather simply take more meds than make the effort to restrict calories and exercise regularly. ---
**Author:** ![KneadToKnow](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kneadtoknow/32/3999_2.png) [@KneadToKnow](https://boards.straightdope.com/u/KneadToKnow)\ **Post date:** [December 28, 2013, 8:21pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/33 "2013-12-28T20:21:41Z")
Fifth grade **KneadToKnow** just emailed me to say that “burpees” are more accurately described as “vomitees.” ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 29, 2013, 5:20pm UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/34 "2013-12-29T17:20:37Z")
**Surreal** on review the conversation had certainly moved into what to do about it now that he has it and the importance of exercise. Still I do think clarifying that that article was talking about prevention of complications, not prevention of diabetes, was im[portant to make. As far as taking more of more expensive meds (so long as they are covered) rather than serious diet and exercise, possibly. Increased risk of kidney failure, of going blind, of depression, of decreased mobility … yeah probably willing to live with those in many cases than actually eat well and exercise regularly. But erectile dysfunction! That might get a few to work at it some! ---
**Author:** ![CatherineZeta](https://avatars.discourse-cdn.com/v4/letter/c/e95f7d/32.png) [@CatherineZeta](https://boards.straightdope.com/u/CatherineZeta)\ **Post date:** [December 30, 2013, 5:56am UTC](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940/35 "2013-12-30T05:56:54Z")
> [@Sattua](#): > > Sounds like she may have had polycystic ovary syndrome. The disease process with that involves the pancreas dumping too much insulin, until eventually it burns itself out. It’s incidental that insulin is so similar to an ovulation-inducing hormone that it binds to the same receptors and interferes with ovulation, though that’s usually the symptom that gets women diagnosed. Hmm, as far as I’m aware though she doesn’t have any of the other symptoms of that. I would assume a gynecologist or the doctor she went to when she was pregnant with me would have noticed if she had it. [Previous page](https://boards.straightdope.com/t/is-adult-onset-diabetes-always-linked-to-obesity-i-have-type-ii-aka-the-fat-and-forty-one/676940.md?page=1)