Body Weight Issues in Preventing and Treating Type 2 Diabetes

The health topic of greatest concern for health care professionals and community leaders alike is the alarming rise in the prevalence of overweight and obesity. Based on the most recent National Health and Nutrition Examination Survey data (1999–2000), the estimated age-adjusted prevalence of overweight (BMI 25.0–29.9 kg/m²) is 64.5% and obesity (BMI ≥ 30 kg/m²) is 30.5% in adults in the United States.1 The increase in overweight and obesity is evident in both men and women, across all age groups, and across all ethnic groups, although rates are highest among African-American women (77.3%) and Mexican-American men (74.7%) and women (71.9%). The prevalence of overweight is ∼15% in children ages 6–19, with an additional 15% at risk for overweight (BMI for age between 85th and 95th percentile).2

A BMI > 25 kg/m², particularly when body fat is distributed in the abdominal or visceral fat region, is associated with several metabolic abnormalities and diseases, including type 2 diabetes, which in turn are associated with high mortality and morbidity rates. Even an 11-kg weight gain during midlife increases the risk of developing diabetes by 21 times when compared to a weight gain of < 5 kg after the age of 21.3

Body weight plays a central role in the pathway for both the development and treatment of type 2 diabetes (Figure 1). Based on population studies, obesity, particularly visceral obesity, is by far the most common risk factor associated with the prediabetic state.4 This implies that preventing obesity in adults and children could reduce the incidence of type 2 diabetes in the future.

A population-based approach to preventing obesity suggests that strategies need to be put in place to influence both the environmental and physiological causes of obesity.5 Public policies and social changes that …