Although being overweight significantly increases your risk of developing diabetes, it’s not the only risk factor. In fact, many people with type 2 diabetes are at a normal weight or only moderately overweight. Meanwhile, most overweight individuals never develop the condition, according to the American Diabetes Association.

Diabetes risk is also higher in many ethnic groups, even in individuals not considered conventionally overweight. Additionally, there are types of diabetes in which being skinny is the norm rather than the exception, says Amber Taylor, MD, director of The Diabetes Center at Mercy Medical Center in Baltimore.

Normal Weight People and Diabetes

Individuals who appear thin can be metabolically fat—that is, they can have health issues associated with obesity. Such people can be at increased risk of disease, says Mark Hyman, MD, a functional medicine physician in Lenox, MA, and the author of The Blood Sugar Solution. In fact, Hyman says, 37 percent of skinny children and 23 percent of skinny adults have prediabetes, or higher than normal blood sugar levels. This problem of “skinny fat” people—especially children—is increasing. Today, 13 percent of normal weight kids are either diabetic or prediabetic.

This is especially worrisome because type 2 diabetes is more deadly in healthy weight individuals: They have double the risk of dying from heart disease and other causes than overweight diabetes patients, according to Harvard Medical School.

Just what is going on here?

Understanding the Problem

Experts believe the increased risk is due to fat tucked away between the organs, also known as visceral fat. You can’t see it or feel it, but it affects the levels of adipokines (substances associated with inflammation) secreted, which can have adverse metabolic effects. Taylor says genetics may also influence why some people develop type 2 diabetes even though they have a healthy body mass index (BMI, a measure of body fat).

Where a person accumulates fat is as important as how much he has: People who accumulate weight around their waists (those with “apple” shaped bodies) are more likely to have visceral fat, putting them at increased risk of heart disease, stroke, and type 2 diabetes. A recent study found that people with type 2 diabetes who were overweight or slightly obese—but had reasonable waist sizes—had better prognoses.

Hyman blames this serious condition on the typical U.S. diet, which tends to be full of high fructose corn syrup, added sugars, trans fats, flour, processed foods, and the mistaken belief that all calories are created equally. Hyman says the quality of what we eat is important: Food contains information that controls hormones, genes, and protein networks. Eating a wholesome diet is critical to diabetes prevention and management and exercise helps reduce insulin resistance.

Amber Taylor, MD, reviewed this article.


Amber Taylor, MD, Mercy Medical Center, Baltimore.

"Diabetes Myths." American Diabetes Association. Accessed April 18, 2014. 

Howard LeWine, MD. "Diabetes Can Strike—Hard—Even When Weight Is Normal." Harvard Health Blog, August 08, 2012, accessed April 18, 2014. 

Mark Hyman, MD. "Skinny Fat People: Why Being Skinny Doesn’t Protect Us Against Diabetes and Death." Last Updated February 21, 2013, accessed April 18, 2014. 

Lisa Nainggolan. "Thin Asians at Risk for Diabetes Due to Hidden Body Fat." Medscape Medical News, February 11, 2013. 

Ruderman Neil, Donald Chisholm, Xavier Pi-Sunyer and Stephen Schneider. "The Metabolically Obese, Normal-Weight Individual Revisited." Diabetes 47 No. 5 (1998): 699-713.