The great majority of patients in a recent study had only a modest weight gain prior to receiving a diagnosis of type 2 diabetes, suggesting that strategies focusing on small weight reductions for the entire population may be more beneficial than concentrating on weight loss for high-risk individuals.

Researchers evaluated data from 6,705 white men and women from Whitehall II, an observational prospective cohort study of civil servants based in London. All individuals were free of diabetes at enrollment. Over a median follow-up of 14.1 years, type 2 diabetes developed in 645 of the participants.

Three patterns of BMI changes were identified among those with diabetes: Most of these individuals (604, or 94%) fell into the “stable overweight” category, with an overweight but relatively constant BMI level throughout follow-up.

The 15 “progressive weight gainers” gained weight consistently prior to diagnosis. The remaining 26 patients were “persistently obese”; they were severely obese for 18 years before diagnosis.

The stable-overweight patients experienced slight worsening of beta cell function and insulin sensitivity from five years prediagnosis. In the progressive-weight-gain group, the additional pounds were accompanied by linear increases in BP and an exponential increase in insulin resistance a few years before diagnosis.

The persistently obese individuals showed relatively stable insulin sensitivity but an initial beta cell compensation followed by loss of beta cell function.


  1. Ma RCW et al. PLoS Med. 2014;11(2):e1001602.