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Population weight control best for cutting diabetes prevalence

More cost-effective than targeting weight-loss programmes at overweight individuals

Louise Prime

Tuesday, 07 February 2017

Population-level public health strategies to prevent weight gain in adults could prevent twice as many cases of type 2 diabetes as targeting individuals at high risk of developing the disease because they are already obese, research has shown. The researchers behind the study*, published in BMC Public Health, advised that for maximum public health benefit both strategies for diabetes prevention should be considered.

Previous research has demonstrated the effectiveness of weight loss in reducing the risk of incident type 2 diabetes in individual obese people (body mass index (BMI) >30kg/m2) who have higher than normal blood glucose levels; and current clinical practice and public health programmes tend to concentrate on this approach. But there has been little evidence to show that it has much impact on population-level type 2 diabetes prevalence.

Researchers from the Medical Research Council Epidemiology Unit at the University of Cambridge collaborated with those from the Department of Public Health and Clinical Medicine at Umeå University in Sweden to study the impact of moderate weight loss or weight maintenance in adults across the whole population on the occurrence of type 2 diabetes. They looked at the potential to reduce the occurrence of diabetes, of different strategies that aim to shift the distribution of body weight in the whole population.

To do this, they analysed data covering 33,184 people aged 30-60 years who, as part of a large study (the Västerbotten Intervention Programme (VIP)), had had two health examinations 10 years apart between 1990 and 2013. They calculated the association between change in body weight between baseline and 10-year follow-up, and the occurrence of newly diagnosed diabetes at 10-year follow-up; then assessed the impact of population-level shifts in body weight on the occurrence of diabetes.
During 10 years’ follow-up, 3.3% of participants developed diabetes; 53.9% increased their BMI by at least one whole unit (equivalent to 3kg for an average-height adult in Sweden); and 36.2% maintained their weight so their BMI changed by less than one whole unit.

Having controlled for potential confounding factors – such as sex, age, calendar year, family history of diabetes, tobacco use, education and marital status – the researchers found that compared with people who had maintained their weight, those who gained >1kg/m2 had a 52% higher risk of diabetes.

They then calculated that regardless of people’s starting weight, maintaining (compared with gaining) weight could prevent more than a fifth (21.%) of all type 2 diabetes cases across the population. They also calculated that, based on previous research results, referring everyone in the at-risk population with a BMI over 30 to a commercial weight-loss programme would prevent fewer than one in ten (8.2%) type 2 diabetes cases.

The study authors acknowledged that their modelling was based on idealised conditions, so their outcomes should be interpreted with caution. They also admitted that reducing or preventing weight gain in middle age is challenging, but argued that it should be considered in contrast to the even more difficult challenge of weight loss and subsequent secondary weight maintenance.

They concluded: “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.”

* Feldman AL, Griffin SJ, Ahern AL et al. Impact of weight maintenance and loss on diabetes risk and burden: A population based study in 33,184 participants. BMC Public Health (2017); doi: 10.1186/s12889-017-4081-6.

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