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Overweight most important type 2 diabetes risk for poor

Kathleen Blanchard's picture
BMI most important risk for type 2 diabetes among the poor, finds BMJ study.

Much focus has been placed on finding ways to tackle type 2 diabetes that disproportionately affects lower income groups. A team of researchers recently explored social risk factors contributing to the disease, finding that being overweight is one of the single most important risk factors for diabetes among the poor and socially disadvantaged.

Lifestyle changes needed for targeted socioeconomic group

The finding, published in the British Medical Journal, is important because it shows lifestyle factors that contribute to type 2 diabetes may have been underestimated. The authors say the study shows an ‘urgent’ need for lifestyle changes that can prevent overweight and obesity in the identified population.

According to background information from the authors, "availability or affordability of healthy foods or places to exercise, differential access to healthcare services and health information, and differences in health related behaviours between socioeconomic groups have all been proposed as potential explanations for the social patterning of type 2 diabetes", but those factors only account for about 1/3 of social differences contributing to type 2 diabetes.

For their study, an international team of researchers looked at diabetes risk factors among British civil servants over a period of 14 years, finding that people in the lowest occupational category were 1.86 time more likely to develop diabetes, compared to people with higher level occupations.

The participants were part of the Whitehall II study that includes 10,000 British civil servants who were between 35 and 55 – years old in 1985.

The Whitehall II study was launched to assess the effect of social and economic factors on long-term health. Occupational status was used to find out which socioeconomic factors affect health because it reflects education, income, social status and work responsibility.

Over 14 years, 818 people developed type 2 diabetes. The investigation included measurements of smoking, alcohol consumption, diet and physical activity, body mass index and blood pressure and lipid levels.

Up to 45% of diabetes risk factors were attributable to health behaviors and body mass index in both men and women that occurred over time. After further adjustments for biological risk factors, a total of 53% of socioeconomic factors accounting for differences in lifestyle were identified, including smoking, alcohol consumption, diet and physical activity.

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The single most important risk for type 2 diabetes found was being overweight, accounting for 20% of socioeconomic differences. Smoking and alcohol consumption only modestly contributed to risk of the disease.

The study also found diet and physical activity had little impact on whether the civil servants studied would develop diabetes.

According to a May 2012 report published in the journal Population and Health Management, “…the pending epidemics of obesity and diabetes” won’t be reduced “unless society…changes its values and structures to make healthy living an easy and natural part of our lives”.

Though the finding from the new study isn't a surprise, it lends support to the importance of identifying and intervening to help a specific group minimize their risk factors for the disease that is forecasted to cost $514 billion in the U.S. by the year 2025.

"The fact that unhealthy behaviours and body mass index explained up to 45 per cent of the socioeconomic gradient in Type 2 diabetes in this population in early old age has important public health implications", write the authors.

Work stress and having no control over workplace activities were factors recently reported in the Journal of the Society of Occupational Medicine to boost the chances of diabetes in a Canadian research finding, especially for women; correlating with the BMJ report.

The researchers emphasize the study shows targeted lifestyle changes aimed at preventing excess weight among the socially disadvantaged is ‘urgently needed’ to curb the burden of rising rates of type 2 diabetes.

BMJ 2012;345:e5452
August 21, 2012

Image credit: Morguefile