People of All Body Types Are at Risk for Type 2 Diabetes

Know the signs of diabetes and what you can do to lower your risk.

a group of four female friends of different body types are walking for exercise in the park

Medically reviewed in August 2021

Updated on March 22, 2022

You probably know that diabetes is a big health problem in the United States. More than 37 million Americans—nearly 1 in 10 people—have diabetes, according to the Centers for Disease Control and Prevention.

And we have all heard the description of a stereotypical patient with type 2 diabetes: They are overweight or obese and sedentary.

But you may be surprised to learn that people who are slender and active can also develop type 2 diabetes, and the symptoms for the majority of those affected (regardless of body type) can be subtle.

Where body fat resides matters
Interestingly, the risk for diabetes is more about the fat you have inside your body than what is visible. What I’m talking about is visceral fat, the fat surrounding your organs.

There is a condition known as Thin Outside, Fat Inside, or TOFI for short. These are people who look trim but have visceral fat, which can lead to inflammation and possibly diabetes.

While normal weight men can certainly develop diabetes, the typical TOFI folks are women who watch their calorie intake to keep their weight down, but they don’t eat quality calories.

As an example, skipping breakfast, eating a small bag of potato chips for lunch, pasta for dinner and salad with regular dressing, and drinking diet soda all day may be the kind of diet the aforementioned people might eat. You probably won’t gain weight on this diet, but you will likely increase your internal fat.

The other culprit is yo-yo dieting. When you lose weight, you lose fat and muscle. When you yo-yo back up the scale, fat settles where muscle used to be.

Stress is also a factor
Stress can also contribute to visceral fat. When a person is constantly stressed out there is an outpouring of cortisol and other stress hormones in the body. Your body goes into “fight or flight” mode, which prompts the need for the body’s metabolic mechanism to store fat so there is some quick energy on hand.

To add insult to injury, cortisol increases blood sugar levels. When blood sugar is out of control, inflammation ensues. This can lead to blindness, limb loss, heart attack and stroke, to name just a few problems if diabetes is left untreated.

Identifying risk
Unfortunately, most patients and physicians are not on the lookout for diabetes in an adult who appears to be thin or of "normal" weight. What further complicates matters for diabetes in general is that the symptoms can be easy to miss. They may include none, one, or several of the following:

  • Excessive thirst and increased urination
  • Hunger
  • Fatigue
  • Tingling of the fingers and toes that can be intermittent
  • Blurred vision
  • Frequent colds
  • Yeast infections
  • Cuts that seem to take forever to heal
  • Gum disease
  • Weight loss

Because of the relatively silent nature of diabetes, it is generally recommended that all adults have fasting blood sugar or hemoglobin A1C checked every three years.

Type 2 diabetes is treatable with diet, exercise, and medications (if need be). It is important that regardless of whether you’re a man or woman, large or small, round or tall, you get regular checkups, pay attention to any changes in your body, and report any of the above symptoms to your healthcare provider.

If you are in tune, you will be able to pick up these subtle signs before you have full blown type 2 diabetes and your need for care becomes a medical emergency.

Article sources open article sources

Centers for Disease Control and Prevention. The Facts, Stats, and Impacts of Diabetes. Page last reviewed: January 24, 2022.
Zdrojewicz Z, Popowicz E, Szyca M, Michalik T, Śmieszniak B. TOFI phenotype - its effect on the occurrence of diabetes. Pediatr Endocrinol Diabetes Metab. 2017;23(2):96-100.
Centers for Disease Control and Prevention. Not Just Your Grandma’s Diabetes. Page last reviewed: April 23, 2021.
Centers for Disease Control and Prevention. Diabetes Symptoms. Page last reviewed: April 27, 2021.

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