2 tables omitted
Obesity in persons with diabetes is associated with poorer control of
blood glucose levels, blood pressure, and cholesterol,1 placing
persons with diabetes at higher risk for both cardiovascular and microvascular
disease.2 Conversely, intentional weight loss
is associated with reduced mortality among overweight persons with diabetes.3 CDC analyzed the prevalence of overweight and obesity
among U.S. adults aged ≥20 years with previously diagnosed diabetes by
using data from two surveys: the Third National Health and Nutrition Examination
Survey (NHANES III), 1988-1994, and NHANES 1999-2002. This report summarizes
the results of that analysis, which indicated that most adults with diagnosed
diabetes were overweight or obese. During 1999-2002, the prevalence of overweight
or obesity was 85.2%, and the prevalence of obesity was 54.8%. Encouraging
patients to achieve and maintain a healthy weight should be a priority for
all diabetes-care programs.
NHANES is a continuous survey of the health and nutritional status of
the U.S. civilian, noninstitutionalized population; samples are selected through
a complex, multistage probability design. Diabetes status was determined in
household interviews with participants aged ≥20 years. In NHANES III, 1988-1994,
participants were asked, “Have you ever been told by a doctor that you
have diabetes or sugar diabetes?” For women, the question was preceded
by “other than during pregnancy.” In NHANES 1999-2002, the same
questions were asked, but “doctor” was replaced with “doctor
or health-care professional.” Participants who responded “yes”
were categorized as having diagnosed diabetes. The body mass index (BMI) of
each participant was calculated as weight in kilograms divided by height in
meters squared. Overweight was defined as a BMI of 25.0-29.9 and obesity as
a BMI of ≥30.0.4,5 Pregnant
women were excluded from the analysis.
Data were analyzed with sample weights to account for differential probabilities
in the sample selection, nonresponses, and sample noncoverage. Two sample
t-tests were used to test differences in proportions and determine the statistical
significance (p<0.05) of differences in results by age, racial/ethnic population,
and survey period. Percentages of racial/ethnic populations and persons aged
≥20 years were age-standardized to the 2000 U.S. standard population.
Among all survey participants with diagnosed diabetes, the prevalence
of obesity was similar for the periods 1988-1994 (45.7%) and 1999-2002 (54.8%).
In the 1999-2002 survey, the prevalence of obesity among adults with diagnosed
diabetes was 57.9% for non-Hispanic whites, 63.0% for non-Hispanic blacks,
and 59.5% for Mexican Americans. Similar prevalences of overweight and obesity
were observed in these racial/ethnic populations during 1988-1994.
Among men in the 1999-2002 survey, the prevalence of overweight or obesity
was 86.3%, and the prevalence of obesity was 53.0%. Both the prevalence of
overweight or obesity and the prevalence of obesity were similar among men
aged 20-64 years and ≥65 years. Among women in the 1999-2002 survey, the
prevalence of overweight or obesity was 84.2%, and the prevalence of obesity
was 58.0%. Compared with women aged ≥65 years, women aged 20-64 years had
a significantly higher prevalence of obesity (64.7% versus 47.4%) (p<0.05).
Reported by: MS Eberhardt, PhD, C Ogden, PhD,
National Center for Health Statistics; M Engelgau, MD, B Cadwell PhD, Div
of Diabetes Translation, National Center for Chronic Disease Prevention and
Health Promotion; AA Hedley, PhD, SH Saydah, PhD, EIS officers, CDC.
CDC Editorial Note: The prevalence of obesity
among adults overall in the United States increased from 22.9% during 1988-1994
to 30.5% during 1999-20025,6 ;
the prevalence of obesity among adults with diagnosed diabetes remained high,
at 45.7% during 1988-1994 and 54.8% during 1999-2002. Weight management, through
healthy eating and physical activity, can help reduce the number of persons
at risk for diabetes and reduce the risk for complications and premature mortality
among those who already have diabetes.
The findings in this report are subject to at least three limitations.
First, the NHANES surveys exclude institutionalized persons, including those
in nursing homes, a population with a high rate of diabetes.7 Second,
the number of persons with diagnosed diabetes surveyed limited the power of
the analysis and precluded stratifying the results by multiple demographic
groups. Finally, greater clinical vigilance of overweight or obese persons
might have resulted in a greater proportion receiving diagnoses of diabetes.
The National Diabetes Education Program (NDEP), cosponsored by CDC and
the National Institutes of Health (NIH), has an ongoing community campaign
to reduce morbidity and mortality, Control Your Diabetes for Life, which educates
persons about healthy eating and weight control. Information about the campaign
is available from NDEP at http://www.ndep.nih.gov/campaigns/controlforlife/controlforlife_index.htm. Research into the effects of obesity on diabetes includes a multicenter
clinical trial, sponsored by NIH and CDC, to determine the long-term health
benefits of an intensive lifestyle intervention designed to achieve and maintain
The health consequences of diabetes are compounded by overweight and
obesity. However, the prevalence of overweight and obesity among persons with
diabetes has not been monitored regularly. Findings in this report provide
baseline data to track future trends that will enable public health agencies
to assess the scope of this public health concern, target programs, and allocate
Prevalence of Overweight and Obesity Among Adults With Diagnosed Diabetes—United States, 1988-1994 and 1999-2002. JAMA. 2005;293(5):546–547. doi:10.1001/jama.293.5.546