A 32-year-old teacher with what many consider a normal weight and seemingly clean and healthy eating habits was diagnosed with type 2 diabetes, and sadly, new research shows she is far from alone.
Even people who don’t fit the usual risk profile, including being obese or consuming sugary foods and drinks, can be diagnosed with the condition. These cases shed light on how modern diets, genetics, body fat distribution, and metabolic health all combine in ways that can surprise us.
A review published in Diabetologia shows that among people with normal or even below-normal Body Mass Index (BMI), type 2 diabetes still occurs at signifficant rates. In many Asian and African populations, between 24% to 66% of diabetes cases are in non-overweight or normal-weight individuals. While the incidence of diabetes among normal-weight adults is lower than in overweight or obese adults, it is increasing over time.
This indicates that although being overweight is a strong risk factor, it’s definitely not the only one.
Other key mechanisms and lifestyle factors can lead to diabetes even among people who look healthy.
Fat distribution, especially visceral fat– Even when BMI is “normal,” fat stored around the organs, known as visceral fat, or in and around the liver or pancreas can lead to insulin resistance or impair insulin secretion. Studies using imaging (CT scans) have found that “lean” individuals with type 2 diabetes often have abdominal fat signatures similar to those in overweight people, like increased visceral fat, altered muscle fat content, or pancreatic fat.
Metabolic dysfunction despite “normal” metrics– People with what is sometimes called the “metabolically unhealthy normal weight” (MUNW) phenotype may have normal BMI but still experience insulin resistance, elevated fasting glucose, abnormal lipid profiles, or high inflammation markers. These markers are risk factors for diabetes but often go unnoticed because the person is not overweight.
Diet quality beyond sugar– Modern diets often include ultra-processed foods that, while low in visible sugar, are filled with additives, refined carbs, and unhealthy fats that disrupt metabolic health. A recent study from The Journal of the Academy of Nutrition and Dietetics found that greater consumption of ultra-processed foods correlates with worse blood sugar control (higher HbA1c), even for people not consuming a lot of sugary treats.
