A population perspective on diabetes prevention: whom should we target for preventing weight gain?
OBJECTIVE
To examine the influence of obesity and prevention of weight gain on the incidence of type 2 diabetes.


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/m(2)), overweight (> or =25 kg/m(2) and <30 kg/m(2)), obese (> or =30 kg/m(2) and <35 kg/m(2)), and very obese (> or =35 kg/m(2)). 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.
Burke
James P
JP
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA. jburke@mayo.edu
Williams
Ken
K
Narayan
K M Venkat
KM
Leibson
Cynthia
C
Haffner
Steven M
SM
Stern
Michael P
MP
D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D017058:Mexican Americans; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D012306:Risk; D013781:Texas; D014481:United States; D015430:Weight Gain; D044465:White People