Researchers challenge the link between weight gain and diabetes

Conventional wisdom about type 2 diabetes suggests that it's usually preceded by substantial weight gain.
But a new study from Denmark researchers suggests there may be much more to the story when it comes to the weight gain-diabetes link, particularly that a large increase in body weight isn't necessarily the textbook pattern that causes diabetes development. The findings suggest that type 2 diabetes isn't "a single disease entity, but rather a heterogeneous disease with different pathophysiological pathways depending on the level and development of obesity," the authors wrote in PLOS Medicine.

Different changes mean different risk factors

The study included 6,705 participants who were free of diabetes at the beginning of the trial. Every five years, they were tested for diabetes, and the researchers recorded measurements of body mass index to record patterns of weight gain or loss.
Three groups were identified when it came to how diabetes developed: one that was "stably overweight," who showed little change in their BMIs over the years before developing diabetes; one comprised of those who had gained weight consistently before diagnosis; and one made up of people who were persistently obese during the entire study period before developing the condition.
The three distinct patterns seen suggest that there are different changes in metabolic health over time that affect diabetes risk. Therefore, discussion about diabetes should address the fact that prevention need not only be focused on helping obese people lose weight.
"Strategies focusing on small weight reductions for the entire population may be more beneficial than predominantly focusing on weight loss for high-risk individuals," the authors wrote.