title: The epidemic of extreme obesity among American Indian and Alaska Native adults with diabetes.
abstract: BACKGROUND
  The purpose of this study was to describe the prevalence of obesity among American Indian and Alaska Native (AI/AN) adults with diabetes and to examine the temporal trends for class I, II, and III obesity in this high-risk group during a 10-year period.
  
  
  METHODS
  We used data on body mass index (BMI) from the annual Diabetes Care and Outcomes Audit to estimate the prevalence of class I, II, and III obesity (class I = 30.0-34.9 kg/m2, class II = 35.0-39.9 kg/m2, and class III > or = 40.0 kg/m2) in each year from 1995 through 2004. We also investigated trends in mean BMI during the 10-year period and the role of treatment in these trends using multivariable linear regression models.
  
  
  RESULTS
  Obesity was highly prevalent in this population in 2004 (class I, 28.9%; class II, 20.4%; class III, 20.3%). From 1995 through 2004, the percentage of obese adults increased from 16.7% to 20.4% in class II and 11.5% to 20.3% in class III (P < .001), and the mean BMI increased from 32.1 kg/m2 to 34.4 kg/m2. The increase in BMI was greater in the younger age groups. Adjusted mean BMI increased significantly over 10 years for each of three treatment categories.
  
  
  CONCLUSIONS
  Extreme degrees of obesity are a common and increasing problem among AI/AN adults with diabetes. We did not find an association between the type of diabetes treatment and the trend toward extreme degrees of obesity. The increase in extreme obesity could potentially affect the burden of morbidity and mortality among AI/AN adults with diabetes. Effective and culturally appropriate weight management interventions are needed.
authors.affiliation: Indian Health Service, Phoenix Indian Medical Center, 4212 N 16th Street, Phoenix, AZ 85016, USA. charlton.wilson@ihs.gov
authors.forename: Charlton
authors.initials: C
authors.lastname: Wilson
authors.forename: Susan
authors.initials: S
authors.lastname: Gilliland
authors.forename: Kelly
authors.initials: K
authors.lastname: Moore
authors.forename: Kelly
authors.initials: K
authors.lastname: Acton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000208:ethnology; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D014481:United States