Elsevier

Journal of Diabetes and its Complications

Volume 24, Issue 6, November–December 2010, Pages 368-374
Journal of Diabetes and its Complications

Increasing BMI and waist circumference and prevalence of obesity among adults with Type 2 diabetes: the National Health and Nutrition Examination Surveys

https://doi.org/10.1016/j.jdiacomp.2009.10.001Get rights and content

Abstract

Objective

Obesity remains one of the most important modifiable risk factors for the prevention of Type 2 diabetes and its related comorbid conditions. The aim of this study was to examine trends in average body mass index (BMI), waist circumference, and obesity prevalence among adults with and without Type 2 diabetes.

Methods

Information on BMI and waist circumference among 4162 adults with and 40,376 adults without Type 2 diabetes was obtained from the National Health and Examination Surveys completed during years 1976–2006. Mean BMI, waist circumference and prevalence of total obesity (BMI ≥30 kg/m2) and obesity stage III (BMI ≥40 kg/m2) were determined by survey periods after adjustment for the survey period weights and age standardization to the US 2000 Census. Means and proportions between first and last survey periods were compared using Z scores.

Results

During this 20-year period, mean BMI increased from 29.2 kg/m2 to 34.2 kg/m2 among adults with Type 2 diabetes and from 25.2 kg/m2 to 28.1 kg/m2 among adults without diabetes (P<.0001 for both comparisons). Mean waist circumference increased substantially in all groups. Among adults with and without Type 2 diabetes, total obesity increased by 58% and 136%, respectively, while Class III obesity increased by 141% and 345%, respectively (P<.0001 for all comparisons).

Conclusions

Obesity prevalence is rising rapidly among adults with and without Type 2 diabetes. This has important implications for the likely growth of the population with Type 2 diabetes and diabetes related comorbid conditions.

Introduction

Obesity continues to influence an individual's health after the development of Type 2 diabetes and heightens the risk of risk of cardiovascular disease, polyneuropathy, (Ziegler et al., 2008) nonalcoholic fatty liver disease, (Ong & Younossi, 2007) sleep disordered breathing (Shaw et al., 2008) and end-stage kidney disease. (Hsu, McCulloch, Iribarren, Darbinian, & Go, 2006) Thus, the degree of obesity in an individual with Type 2 diabetes is an important modifiable risk factor for long-term health. Two previous studies (Centers for Disease Control and Prevention, 2004, Leibson et al., 2001) reported temporal increases in BMI among adults with Type 2 diabetes but both studies were limited to a small time frame and did not include information on waist circumference. We examined temporal trends in mean body mass index (BMI), waist circumference and prevalence of obesity among adults with and without Type 2 diabetes in the United States during years 1976–2006. We hypothesized that average BMI, waist circumference, and prevalence of obesity have significantly increased over the past 2 decades among adults with and without Type 2 diabetes.

Section snippets

Methods

Mean BMI, waist circumference and prevalence estimates of obesity were calculated using data from the National Health and Nutrition Examination Surveys (NHANES). We utilized data from surveys conducted during years 1976–1980 (NHANES II), 1988–1994 (NHANES III) and 1999–2006 (NHANES, 1999–2006). The National Health and Nutrition Examination Surveys are continuous cross-sectional probability samples of the total civilian noninstitutionalized population. Details of the survey designs have been

Results

To explore potential bias for exclusion of NHANES participants without fasting glucose values, BMI was compared between participants who did not fast or participate in the A.M. exam and those who fasted between 8 and 24 h and participated in the a.m. exam. No significant difference in BMI was noted between these two groups for any survey period.

A total of 4162 adults with Type 2 diabetes [diagnosed (n=3522) and undiagnosed (n=640)] were included in this study with 634 from NHANES II, 1512 from

Discussion

This study demonstrates that during the past 20 years, prevalence of obesity among adults with and without Type 2 diabetes has increased at an alarming rate. Approximately two thirds of the US population with Type 2 diabetes and approximately one third of the population without diabetes are now obese. What is most concerning is the rapid rise in Class III obesity prevalence, which has more than doubled over the past 2 decades. Among adults with Type 2 diabetes, Class III obesity is now present

Conclusion

Obesity prevalence continues to increase among adults with and without Type 2 diabetes with the fastest growth noted for Class III obesity. This has important implications for the likely growth of the US population with Type 2 diabetes and increase in diabetes associated comorbid conditions. Regardless of BMI or waist circumference, all individuals with diabetes should receive medical nutrition therapy according to the American Diabetes Association guidelines (Bantle et al., 2008). These

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