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A Population Perspective on Diabetes Prevention

Whom should we target for preventing weight gain?

¹ Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
² Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
³ National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

Address correspondence and reprint requests to James P. Burke, PhD, Dept. of Health Sciences Research, Harwick 6, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. E-mail: jburke{at}mayo.edu.

OBJECTIVE—To examine the influence of obesity and prevention of weight gain on the incidence of type 2 diabetes.

RESEARCH DESIGN AND METHODS—We examined participants in the San Antonio Heart Study, a prospective population-based study of Mexican Americans and non-Hispanic whites residing in San Antonio, Texas. BMI was stratified into four categories: normal (<25 kg/m²), overweight (≥25 kg/m² and <30 kg/m²), obese (≥30 kg/m² and <35 kg/m²), and very obese (≥35 kg/m²). The number and proportion of incident cases prevented by targeting each BMI category were estimated. In addition, we calculated the decrease in risk of developing type 2 diabetes associated with weight gain prevention across both the BMI and age spectra.

RESULTS—Preventing normal individuals from becoming overweight would result in the greatest reduction in incidence of type 2 diabetes. This would result in a 62 and 74% reduction in the incidence of type 2 diabetes in Mexican Americans and non-Hispanic whites, respectively. Preventing the entire population from gaining, on average, 1 BMI unit would result in a reduction in incidence of type 2 diabetes of 12.4 and 13.0% in Mexican Americans and non-Hispanic whites, respectively.

CONCLUSIONS—The majority of cases of type 2 diabetes were in individuals who were overweight or mildly obese with a family history of type 2 diabetes. Public health resources should be directed toward the prevention of weight gain among normal and overweight individuals in order to prevent the maximum number of cases of type 2 diabetes.

Abbreviations: SES, socioeconomic status

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