Written by Amy Brownstein, MS, RD
Yes, you can get type 2 diabetes without being overweight. Other factors contribute to type 2 diabetes besides weight. For example, you can be at risk for type 2 diabetes without being overweight due to factors such as family history or ethnicity. And it is possible to have unhealthy biomarkers — such as high blood pressure and elevated lipids — related to insulin resistance while being underweight or normal weight. Researchers describe these individuals as “metabolically unhealthy normal weight” (MUNW).
In this article, we’ll discuss risk factors, besides weight, that increase your chances of type 2 diabetes.
Non-Weight Related Risk Factors of Type 2 Diabetes
As mentioned, genetic and lifestyle factors can contribute to type 2 diabetes. Knowing your family history and health status can help you evaluate your risk for type 2 diabetes.
Smoking increases inflammation, which can lead to insulin resistance and hyperglycemia. Similarly, nicotine (the addictive chemical in tobacco) decreases muscle glucose uptake, contributing to insulin resistance. The risk of type 2 diabetes is proportional to the number of cigarettes smoked daily. [1,2]
Abnormal Lipid Levels
Abnormal lipid (fat compounds) levels (also known as dyslipidemia) are associated with type 2 diabetes. In particular, high triglycerides and LDL and low HDL cholesterol levels contribute to beta-cell dysfunction, leading to insulin resistance and type 2 diabetes. 
If you have a family history of type 2 diabetes, you may be more likely to develop the disease. Family history is associated with increased disease risk, regardless of lifestyle or body composition.  If you're interested in learning more, check out our post titled "Can You Prevent Type 2 Diabetes If It Runs In Your Family?."
Certain ethnicities have a higher risk of type 2 diabetes due to genetics and greater susceptibility to cardiometabolic complications. Type 2 diabetes occurs more frequently in Pacific Islander, Black, Native American, and Hispanic populations. [1,3]
A sedentary lifestyle is associated with an increased risk of type 2 diabetes. Physical inactivity decreases insulin sensitivity, which can lead to beta-cell dysfunction. Beta-cells in the pancreas produce and release insulin, the key that unlocks cells to let glucose into our muscles. With beta-cell dysfunction, the pancreas does not release enough insulin, so glucose stays in the bloodstream, raising blood sugar levels and contributing to type 2 diabetes. 
Gestational diabetes is glucose intolerance that begins during the second or third trimester of pregnancy. Women with gestational diabetes have a 9-10 fold increased risk of type 2 diabetes diagnosis later in life than women without gestational diabetes. [4,5] Older maternal age and a family history of type 2 diabetes contribute to the increased risk of diabetes mellitus following gestational diabetes. And the greatest likelihood of type 2 diabetes occurs within the first year postpartum. 
Adults born preterm are at a greater risk of developing type 2 diabetes than those born full-term. This is due to less time growing in the womb, which affects how glucose is broken down and used later in life. 
Abdominal/Visceral Fat Distribution
A greater accumulation of abdominal fat (visceral fat) correlates with a higher risk of type 2 diabetes, independent of weight. Visceral fat promotes the release of inflammatory molecules from fat cells, which leads to insulin resistance and can contribute to complications of type 2 diabetes. 
High Blood Pressure
High blood pressure (also known as hypertension) and type 2 diabetes are linked. The stress type 2 diabetes puts on the body can contribute to hypertension, and certain antihypertensive medications can lead to type 2 diabetes. Research is evolving as to whether hypertension itself causes type 2 diabetes. However, lowering blood pressure by 5 mmHg is associated with an 11% decreased risk of type 2 diabetes. 
Chronic emotional and work-related stress is a risk factor for type 2 diabetes. Persistent stress affects metabolism, inflammation, and health behaviors, including food choice, physical activity, and medication adherence, all risk factors for type 2 diabetes. [7,8]
Yo-yo dieting, the term for repeated weight loss followed by weight gain, leads to an increased risk of type 2 diabetes. A weight gain of just five pounds significantly affects the risk of developing type 2 diabetes in people highly susceptible to this chronic disease. 
What Can You Do to Reduce Your Risk of Type 2 Diabetes?
Some risk factors are out of your control. Others — such as smoking, physical activity, and diet — can be changed to reduce your chance of type 2 diabetes. Adopting overall dietary changes can reduce your risk of type 2 diabetes, as diet quality affects the risk of this disease.
Opt for whole grains
A diet full of whole grains significantly decreases the risk of type 2 diabetes. One large-scale review found that an increase in whole-grain consumption by 30 grams/day (the equivalent of two slices of whole-grain bread) reduced the risk of type 2 diabetes by about 13%.  Whole grains, which are rich in dietary fiber, slow the release of glucose into the bloodstream, lowering your postprandial insulin response and improving insulin sensitivity. Alternatively, high consumption of refined grains is associated with an increased risk of type 2 diabetes. [2,3]
Decrease intake of sugar-sweetened beverages and processed meat
Sugar-sweetened drinks and processed meat contribute to a greater risk of type 2 diabetes. And a diet high in sugar-sweetened beverages and processed meats is linked to other unhealthy behaviors (such as smoking and physical inactivity), which are associated with type 2 diabetes. [2,3]
Regularly engage in physical activity
Exercise is a powerful tool for preventing type 2 diabetes. Physical activity increases insulin sensitivity, improves glucose control, and can reduce HbA1c levels. The American Diabetes Association recommends 150 minutes of moderate-intensity aerobic exercise per week. When incorporating exercise into your routine, it is important to find an activity you enjoy — walking, weights, swimming, or cycling are great forms of exercise that can reduce your risk of type 2 diabetes. [11,12]
Let's Recap: Risk Factors for Type 2 Diabetes Besides Weight & The Best Ways to Prevent It
- It is possible to have type 2 diabetes without being overweight.
- Risk factors, besides weight, for type 2 diabetes include smoking, family history, dyslipidemia, ethnicity, physical inactivity, gestational diabetes, birth weight, visceral fat, and high blood pressure.
- Swap refined grains for whole grains, and aim to increase your fiber intake. 35 grams of fiber per day compared to the average 19 grams prevents prediabetes from transitioning into diabetes and reduces the risk of complications from diabetes. 
- Swap sugar-sweetened beverages for water or water flavored with fruit, and opt for lean or plant-based proteins over processed meat.
- Aim for 150 minutes of moderate-intensity exercise each week through walking, cycling, swimming, dancing, or any other movement you enjoy.
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