{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:53:27Z","timestamp":1791406407356,"version":"4.3.3"},"reference-count":50,"publisher":"Portland Press Ltd.","issue":"7","content-domain":{"domain":["portlandpress.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,4,1]]},"abstract":"<jats:p>Type 2 diabetes (T2DM) is frequently regarded as a disease of obesity and its occurrence in individuals of normal body mass index (BMI) is often regarded as indicating a non-obesity-related subtype. However, the evidence for such a distinct, common subtype is lacking. The United Kingdom Prospective Diabetes Study (UKPDS) cohort of people diagnosed with T2DM in the 1970s and 1980s had a median BMI of only 28\u00a0kg\/m2. UKPDS data form the basis of current understanding of the condition even though one in three of those studied had a BMI of less than 25\u00a0kg\/m2. BMI, though, is a population measure and not a rigid personal guide. Weight loss is considered de rigueur for treating obese diabetic individuals, but it is not usually considered for those deemed to have a normal BMI. Given the new evidence that early T2DM can be reversed to normal glucose tolerance by substantial weight loss, it is important to explain why non-overweight people respond to this intervention as well as obese individuals. We hypothesize that each individual has a personal fat threshold (PFT) which, if exceeded, makes likely the development of T2DM. Subsequent weight loss to take the individual below their level of susceptibility should allow return to normal glucose control. Crucially, the hypothesized PFT is independent of BMI. It allows both understanding of development of T2DM in the non-obese and remission of diabetes after substantial weight loss in people who remain obese by definition. To illustrate this concept, we present the distribution curve of BMI at diagnosis for the UKPDS cohort, together with a diagram explaining individual behaviour within the population. The concept of PFT is of practical benefit in explaining the onset of diabetes and its logical management to the non-obese majority of people with T2DM.<\/jats:p>","DOI":"10.1042\/cs20140553","type":"journal-article","created":{"date-parts":[[2014,12,9]],"date-time":"2014-12-09T09:12:33Z","timestamp":1418116353000},"page":"405-410","update-policy":"https:\/\/doi.org\/10.1042\/crossmark_policy","source":"Crossref","is-referenced-by-count":175,"title":["Normal weight individuals who develop Type\u00a02 diabetes: the personal fat threshold"],"prefix":"10.1042","volume":"128","author":[{"given":"Roy","family":"Taylor","sequence":"first","affiliation":[{"name":"Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rury\u00a0R.","family":"Holman","sequence":"additional","affiliation":[{"name":"Diabetes Trials Unit, University of Oxford, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"288","published-online":{"date-parts":[[2014,12,9]]},"reference":[{"key":"2021113010360253200_B1","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1016\/S0140-6736(76)91739-6","article-title":"Insulin rather than glucose homoeostasis in the pathophysiology of diabetes","volume":"i","author":"Turner","year":"1976","journal-title":"Lancet"},{"key":"2021113010360253200_B2","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2337\/diab.28.3.227","article-title":"Maintenance of basal plasma glucose and insulin concentrations in maturity-onset diabetes","volume":"28","author":"Holman","year":"1979","journal-title":"Diabetes"},{"key":"2021113010360253200_B3","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1016\/0026-0495(79)90146-X","article-title":"Insulin deficiency and insulin resistance interaction in diabetes: estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrations","volume":"28","author":"Turner","year":"1979","journal-title":"Metabolism"},{"key":"2021113010360253200_B4","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.2337\/dc11-0447","article-title":"Obesity and type\u00a02 diabetes: what can be unified and what needs to be individualized?","volume":"34","author":"Eckel","year":"2011","journal-title":"Diabetes Care"},{"key":"2021113010360253200_B5","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1139\/H07-100","article-title":"Non-obese patients with type\u00a02 diabetes and prediabetic subjects: distinct phenotypes requiring special diabetes treatment and (or) prevention?","volume":"32","author":"Vaag","year":"2007","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"2021113010360253200_B6","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/BF00423146","article-title":"Worsening to diabetes in men with impaired glucose tolerance (\u201cborderline diabetes\u201d)","volume":"16","author":"Jarrett","year":"1979","journal-title":"Diabetologia"},{"key":"2021113010360253200_B7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/oxfordjournals.bmb.a072322","article-title":"Aetiology of non-insulin dependent diabetes","volume":"45","author":"Taylor","year":"1989","journal-title":"Br. Med. Bull."},{"key":"2021113010360253200_B8","first-page":"53","article-title":"Genetics of Diabetes","volume-title":"The Diabetes Annual\/1","author":"Leslie","year":"1985"},{"key":"2021113010360253200_B9","doi-asserted-by":"publisher","first-page":"102","DOI":"10.2337\/diabetes.52.1.102","article-title":"Beta-cell deficit and increased beta-cell apoptosis in humans with type\u00a02 diabetes","volume":"52","author":"Butler","year":"2003","journal-title":"Diabetes"},{"key":"2021113010360253200_B10","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1111\/j.1463-1326.2007.00787.x","article-title":"Islet gene expression and function in type\u00a02 diabetes; studies in the Goto-Kakizaki rat and humans","volume":"9","author":"Ostenson","year":"2007","journal-title":"Diabetes Obes. Metab."},{"key":"2021113010360253200_B11","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.2337\/dc12-1654","article-title":"Metabolically healthy obesity and risk of mortality: does the definition of metabolic health matter?","volume":"36","author":"Hinnouho","year":"2013","journal-title":"Diabetes Care"},{"key":"2021113010360253200_B12","doi-asserted-by":"publisher","first-page":"622","DOI":"10.2337\/diab.33.7.622","article-title":"A comparison of the relative effects of obesity and non-insulin dependent diabetes mellitus on in\u00a0vivo insulin stimulated glucose utilization","volume":"33","author":"Hollenbeck","year":"1984","journal-title":"Diabetes"},{"key":"2021113010360253200_B13","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1111\/dme.12434","article-title":"Similar weight-adjusted insulin secretion and insulin sensitivity in short-duration late autoimmune diabetes of adulthood (LADA) and type\u00a02 diabetes: Action LADA 8","volume":"38","author":"Juhl","year":"2014","journal-title":"Diabet. Med."},{"key":"2021113010360253200_B14","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF00745134","article-title":"Glucose control of basal insulin secretion in diabetes","volume":"13","author":"McCarthy","year":"1977","journal-title":"Diabetologia"},{"key":"2021113010360253200_B15","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1136\/bmj.1.6020.1252","article-title":"Beta-cell function improved by supplementing basal insulin secretion in mild diabetes","volume":"1","author":"Turner","year":"1976","journal-title":"Br. Med. J."},{"key":"2021113010360253200_B16","first-page":"44","article-title":"Plasma insulin, C-peptide, and proinsulin concentrations in obese and nonobese individuals with varying degrees of glucose tolerance","volume":"76","author":"Reaven","year":"1993","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"2021113010360253200_B17","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1007\/s00125-012-2534-0","article-title":"Management of hyperglycaemia in type\u00a02 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"55","author":"Inzucchi","year":"2012","journal-title":"Diabetologia"},{"key":"2021113010360253200_B18","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1002\/dmrr.2443","article-title":"The beneficial effect of metformin on \u03b2-cell function in non-obese Chinese subjects with newly diagnosed type\u00a02 diabetes","volume":"29","author":"Bi","year":"2013","journal-title":"Diabetes Metab. Res. Rev."},{"key":"2021113010360253200_B19","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/1743-7075-7-83","article-title":"Long-term effect of metformin on blood glucose control in non-obese patients with type\u00a02 diabetes mellitus","volume":"7","author":"Ito","year":"2010","journal-title":"Nutr. Metab."},{"key":"2021113010360253200_B20","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1007\/BF00400195","article-title":"UK Prospective Diabetes Study (UKPDS). VIII. Study design, progress and performance","volume":"34","author":"UKPDS","year":"1991","journal-title":"Diabetologia"},{"key":"2021113010360253200_B21","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1080\/03014468500007621","article-title":"A survey of heights and weights of adults in Great Britain, 1980","volume":"12","author":"Rosenbaum","year":"1985","journal-title":"Ann. Hum. Biol."},{"key":"2021113010360253200_B22","article-title":"Physiological and medical observations amongs the Indians of southwestern United States and north Mexico","volume-title":"Smithsonian Institute BoAE","author":"Hrdlicka","year":"1908"},{"key":"2021113010360253200_B23","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.1001\/jama.1940.02810500001001","article-title":"The universality of diabetes: a survey of diabetes mortality in Arizona","volume":"115","author":"Joslin","year":"1940","journal-title":"JAMA"},{"key":"2021113010360253200_B24","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/oxfordjournals.aje.a113079","article-title":"Diabetes incidence in Pima indians: contributions of obesity and parental diabetes","volume":"113","author":"Knowler","year":"1981","journal-title":"Am. J. Epidemiol."},{"key":"2021113010360253200_B25","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.2337\/dc06-0138","article-title":"Effects of traditional and western environments on prevalence of type\u00a02 diabetes in Pima Indians in Mexico and the U.S","volume":"29","author":"Schulz","year":"2006","journal-title":"Diabetes Care"},{"key":"2021113010360253200_B26","doi-asserted-by":"publisher","first-page":"2905","DOI":"10.2337\/db08-0210","article-title":"Human obesity: a heritable neurobehavioral disorder that is highly sensitive to environmental conditions","volume":"57","author":"O\u2019Rahilly","year":"2008","journal-title":"Diabetes"},{"key":"2021113010360253200_B27","doi-asserted-by":"publisher","first-page":"f1515","DOI":"10.1136\/bmj.f1515","article-title":"Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980\u20132010: repeated cross sectional surveys and ecological comparison of secular trends","volume":"346","author":"Franco","year":"2013","journal-title":"BMJ"},{"key":"2021113010360253200_B28","first-page":"323","article-title":"Diet in the etiology of human diabetes","volume":"42","author":"Himsworth","year":"1949","journal-title":"Proc. Roy. Soc. Med."},{"key":"2021113010360253200_B29","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1056\/NEJMoa010492","article-title":"Diet, lifestyle, and the risk of type\u00a02 diabetes mellitus in women","volume":"345","author":"Hu","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"2021113010360253200_B30","doi-asserted-by":"publisher","first-page":"2506","DOI":"10.1007\/s00125-011-2204-7","article-title":"Reversal of type\u00a02 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol","volume":"54","author":"Lim","year":"2011","journal-title":"Diabetologia"},{"key":"2021113010360253200_B31","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.2337\/dc12-1805","article-title":"Type 2 diabetes: etiology and reversibility","volume":"36","author":"Taylor","year":"2013","journal-title":"Diabetes Care"},{"key":"2021113010360253200_B32","doi-asserted-by":"publisher","first-page":"2489","DOI":"10.1001\/jama.2012.67929","article-title":"Association of an intensive lifestyle intervention with remission of type\u00a02 diabetes","volume":"308","author":"Gregg","year":"2012","journal-title":"JAMA"},{"key":"2021113010360253200_B33","doi-asserted-by":"publisher","first-page":"990","DOI":"10.2337\/diab.35.9.990","article-title":"Effects of weight loss on mechanisms of hyperglycaemia in obese non-insulin dependent diabetes mellitus","volume":"35","author":"Henry","year":"1986","journal-title":"Diabetes"},{"key":"2021113010360253200_B34","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1016\/0026-0495(90)90299-R","article-title":"UK Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type\u00a0II diabetic paitents, UKPDS group","volume":"39","author":"UKPDS","year":"1990","journal-title":"Metabolism"},{"key":"2021113010360253200_B35","doi-asserted-by":"publisher","first-page":"e135","DOI":"10.1111\/dme.12116","article-title":"Population response to information on reversibility of type\u00a02 diabetes","volume":"30","author":"Steven","year":"2013","journal-title":"Diabet. Med."},{"key":"2021113010360253200_B36","article-title":"Type 2 diabetes and the diet that cured me","volume-title":"The Guardian","author":"Doughty","year":"2013"},{"key":"2021113010360253200_B37","doi-asserted-by":"publisher","first-page":"E462","DOI":"10.1152\/ajpendo.00064.2004","article-title":"Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population","volume":"288","author":"Szczepaniak","year":"2005","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"2021113010360253200_B38","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1038\/nature13478","article-title":"The role of hepatic lipids in hepatic insulin resistance and type\u00a02 diabetes","volume":"510","author":"Perry","year":"2014","journal-title":"Nature"},{"key":"2021113010360253200_B39","doi-asserted-by":"publisher","first-page":"2616","DOI":"10.2337\/db09-0279","article-title":"Dissociation between fatty liver and insulin resistance in humans carrying a variant of the patatin-like phospholipase 3 gene","volume":"58","author":"Kantartzis","year":"2009","journal-title":"Diabetes"},{"key":"2021113010360253200_B40","doi-asserted-by":"publisher","first-page":"2377","DOI":"10.2337\/dc12-0701","article-title":"Pancreatic steatosis and its relationship to \u03b2-cell dysfunction in humans: racial and ethnic variations","volume":"35","author":"Szczepaniak","year":"2012","journal-title":"Diabetes Care"},{"key":"2021113010360253200_B41","doi-asserted-by":"publisher","first-page":"10878","DOI":"10.1073\/pnas.91.23.10878","article-title":"Beta-cell lipotoxicity in the pathogenesis of non-insulin-dependent diabetes mellitus of obese rats: impairment in adipocyte-beta-cell relationships","volume":"91","author":"Lee","year":"1994","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"key":"2021113010360253200_B42","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1007\/s00125-010-1663-6","article-title":"The impact of liver fat vs visceral fat in determining categories of prediabetes","volume":"53","author":"Kantartzis","year":"2010","journal-title":"Diabetologia"},{"key":"2021113010360253200_B43","doi-asserted-by":"publisher","first-page":"15430","DOI":"10.1073\/pnas.0904944106","article-title":"Intrahepatic fat, not visceral fat, is linked with metabolic complications of obesity","volume":"106","author":"Fabbrini","year":"2009","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"key":"2021113010360253200_B44","article-title":"Ethnicity-specific obesity cut-points in the development of type\u00a02 diabetes\u2013a prospective study including three ethnic groups in the United Kingdom","author":"Tillin","year":"2014","journal-title":"Diabet. Med. doi: 10.1111\/dme.12576"},{"key":"2021113010360253200_B45","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1038\/nrgastro.2013.34","article-title":"NAFLD in Asia\u2013as common and important as in the West","volume":"10","author":"Farrell","year":"2013","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"2021113010360253200_B46","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.2337\/db13-1483","article-title":"Body fat partitioning does not explain the interethnic variation in insulin sensitivity among Asian ethnicity: the Singapore adults metabolism study","volume":"63","author":"Khoo","year":"2014","journal-title":"Diabetes"},{"key":"2021113010360253200_B47","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.2337\/dc07-0792","article-title":"Nonalcoholic fatty liver disease is a risk factor for type\u00a02 diabetes in middle-aged Japanese men","volume":"30","author":"Shibata","year":"2007","journal-title":"Diabetes Care"},{"key":"2021113010360253200_B48","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2337\/diabetes.51.1.7","article-title":"Banting lecture 2001: dysregulation of fatty acid metabolism in the etiology of type\u00a02 diabetes","volume":"51","author":"McGarry","year":"2002","journal-title":"Diabetes"},{"key":"2021113010360253200_B49","doi-asserted-by":"publisher","first-page":"863","DOI":"10.2337\/diab.44.8.863","article-title":"Lipotoxicity in the pathogenesis of obesity-dependent NIDDM. Genetic and clinical implications","volume":"44","author":"Unger","year":"1995","journal-title":"Diabetes"},{"key":"2021113010360253200_B50","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/S0026-0495(03)00102-1","article-title":"Insulin secretion after short- and long-term low-grade free fatty acid infusion in men with increased risk of developing type\u00a02 diabetes","volume":"52","author":"Storgaard","year":"2003","journal-title":"Metabolism"}],"container-title":["Clinical Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/portlandpress.com\/clinsci\/article-pdf\/128\/7\/405\/446677\/cs1280405.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/portlandpress.com\/clinsci\/article-pdf\/128\/7\/405\/446677\/cs1280405.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T06:27:47Z","timestamp":1638253667000},"score":1,"resource":{"primary":{"URL":"https:\/\/portlandpress.com\/clinsci\/article\/128\/7\/405\/71158\/Normal-weight-individuals-who-develop-Type-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1,1]]},"references-count":50,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2015,4,1]]}},"URL":"https:\/\/doi.org\/10.1042\/cs20140553","relation":{},"ISSN":["0143-5221","1470-8736"],"issn-type":[{"value":"0143-5221","type":"print"},{"value":"1470-8736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1,1]]}}}