Type 2 diabetes, mortality and the obesity paradox: the weight management dilemma

s there a survival advantage in obese patients with diabetes? The so-called ‘obesity paradox’, with reported lower risk of mortality mostly for body mass index (BMI) category of 25‐30kg/m 2 , is neither entirely explained nor widely accepted. 1 This apparent reverse epidemiology has also been reported in various retrospective longitudinal studies for other chronic disease such as heart failure, stroke and end-stage renal disease, as well as certain groups such as the very elderly. 2‐6 Table 1 gives a summary of important studies that describe the obesity paradox phenomenon in type 2 diabetes cohorts. 7‐10