Modest Weight Gain and the Development of Diabetes: Another Perspective

Significant obesity is associated with metabolic abnormalities that are considered to be risk factors for cardiovascular disease, including impaired glucose tolerance and non-insulin-dependent diabetes mellitus, hypertension, and an abnormal lipoprotein profile [1-3]. The National Institutes of Health Consensus Development Panel [4] concluded in 1985 that “the evidence is now overwhelming that obesity, defined as excessive storage of energy in the form of fat, has adverse effects on health and longevity.” If obesity is defined as a body mass index of 20% above the desirable index (roughly a body mass index of 27 kg/m²), approximately 34 million adult Americans can be considered obese [5]. Nevertheless, the 1990 guidelines of recommended weights for adults published by the U.S. Department of Agriculture [6] suggests that a weight gain of 7 kg for persons 35 years and older is desirable. The article by Colditz and colleagues [7] in this issue raises serious questions about such recommendations.

Colditz and colleagues [7] used the Nurse's Health Study cohort of 114 824 women to quantify the relations between change in adult weight and the risk for non-insulin-dependent diabetes during a 14-year follow-up. They observed that the risk for developing diabetes increased monotonically with levels of body mass index greater than 22 kg/m². They also noted …