- Current health programs only target individuals at high-risk of developing diabetes which have limited potential to impact the prevalence of diabetes in the whole population.
- New study suggests to consider both high-risk and population-based strategies for diabetes prevention.
- The strategies should aim at preventing adult weight gain in the whole population, which would substantially reduce risk of developing diabetes.
Public health strategies that aim to prevent adult weight gain in the whole population have the potential to prevent twice as many cases of type 2 diabetes.
Current clinical practice and public health programs generally target those at high risk of type 2 diabetes, such as people who are obese and have higher than normal blood glucose (pre-diabetes).
But the evidence of impact of moderate weight loss or weight maintenance in adults across the whole population on the occurrence of type 2 diabetes is less.
In 2008, Europe had the second highest proportion of overweight or obese people behind the Americas, according to the World Health Organization (WHO).
Around 35% of the adults aged 20 years and over who were thought to be overweight or obese.
As part of the Västerbotten Intervention Programme (VIP), the researchers from the University of Cambridge and the Department of Public Health and Clinical Medicine at Umeå University analysed data from 33,184 people aged 30-60 years who attended two health examinations 10 years apart between 1990 and 2013.
The change in body weight between baseline and 10 year follow-up and its association with the occurrence of newly diagnosed diabetes at 10 year follow-up was analyzed.
They also assessed the impact of population-level shifts in body weight on the occurrence of diabetes.
The researchers controlled for confounding factors, including sex, age, calendar year, family history of diabetes, tobacco use, education and marital status.
During 10 years of follow-up, the following were the findings:
- 1,087 or 3.3% study participants developed diabetes
- 17,876 or 53.9% study participants gained more than 1 kg/m2 as compared to their starting weight
- 12,020 or 36.2% maintained their weight which was defined as change of less than ±1 kg/m2
People who gained more than 1 kg/m2 over a 10 year follow-up period, had a 52% higher risk of diabetes, compared to those who maintained their weight.
Researchers estimated that one in five of all type 2 diabetes cases in the population could have been prevented, if everyone who gained weight had maintained their weight, regardless of their starting weight.
Based on previous research, the researchers also estimated, that if everyone in the population having a BMI over 30 kg/m2, who were at high risk of diabetes was referred to a commercial weight management program, only 1 in 10 cases of type 2 diabetes could be prevented.
Dr Adina Feldman, from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, who is first author on the paper said "We have shown that a population-based strategy that promotes prevention of weight gain in adulthood has the potential to prevent more than twice as many diabetes cases as a strategy that only promotes weight loss in obese individuals at high risk of diabetes. Thus, when it comes to body weight and diabetes, from a public health perspective it would be advisable to consider both high-risk and population-based strategies for diabetes prevention."
The study is published in the journal BMC Public Health.
- Overweight and obesity - BMI statistics - (http://ec.europa.eu/eurostat/statistics-explained/index.php/Overweight_and_obesity_-_BMI_statistics)
- Adina Feldmanet al. Impact of weight maintenance and loss on diabetes risk and burden: A population based study in 33,184 participants. BMC Public Health ; (2017)