Being underweight brings higher risk of early death than overweight

People who are underweight are at a higher risk of early death compared to those with a healthy weight, but those who are overweight or slightly obese carried no such risk, according to data from a large population-based study of 26,001 people 20 years and older in Chennai.

Conventional wisdom indicates that people who are overweight are at higher risk of disease and death. “There is no data from India. Our study indicated that instead of obsessing about body mass index (BMI), people should focus on cardiovascular fitness by being healthy and active,” said Dr Vishwanathan Mohan, director of the Madras Diabetes Research Foundation (MDRF), Chennai. The study, published PLOS One, used Chennai Urban Rural Epidemiology Study (CURES) data and had a median follow-up of 10.3 years.

The study supports the ‘obesity paradox’ that holds that carrying a few extra kilos doesn’t hurt if people are active and fit. “A person who runs but is slightly overweight will have a lower risk of dying than a person who has a healthy weight but is inactive,” said Dr Mohan.

A major compounding factor is the overall health of the population, as low weight could be driven by malnourishment, tuberculosis, cancer or other illnesses. “Underweight people are almost always not healthy, so this finding didn’t surprise. What was unusual was that those who were overweight and slightly obese did not have a higher risk of death compared to healthy people, which could have been because the mean body mass index (BMI) of the population studied was a low 24,” said Dr Ambrish Mithal, chairman, endocrinology, Medanta, Gurugram.

BMI is a height weight ratio used to determine healthy weight. “To compare, the mean BMI in people with diabetes being treated in an urban, private-paying environment is between 28 and 30,” said Dr Mithal

“We did not screen the population for underlying disease and there were not too many people who were severely obese as morbid obesity is not very common in India,” said Dr Mohan.

The study also found that people with diabetes have a three times higher risk of dying than healthy people. “Kidney disease and heart disease were the major cause of death in people with diabetes, which holds true across India,” said Dr Mithal. Premature death from diabetes was the most parked in the age groups of 51-70 years.

Controlling blood glucose levels with medicine, an active lifestyle and nutritious diet can add 50 or more healthy years to the life of people with type-2 diabetes. “Our studies show that diabetes patients with a healthy lifestyle also have a good control of glucose levels, lower blood pressure and blood lipids (cholesterol, triglycerides) live without complications related to diabetes for several decades,” said Dr Mohan.

Apart from diabetes, other modifiable contributors to early death are physical inactivity, dyslipidemia (high LDL cholesterol and triglycerides), high blood pressure, smoking and alcohol use.

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