Obesity and diabetes in African American women

Obesity and diabetes in African American women

Joan Tilghman

Abstract: Obesity has reached near epidemic proportions in the United States. The prevalence of obesity is high among African Americans, particularly African American women. The risk of diabetes is significantly related to obesity. The risks of morbidity and mortality associated with diabetes poses serious problems for the African American community. It is vital that nurses be at the forefront in initiating research studies, developing strategies for use in practice and providing education to the public about the potentially deadly consequences of obesity.

Key Words: Obesity, Diabetes, African American Women

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The incidence of obesity has continued to increase significantly for Americans of all ages.

Between 2000 and 2001, obesity increased from 19.8 percent of American adults to 20.9 percent of American adults (CDC, 2002). Based on clinical height and weight measurements from the 1999 National Health and Nutrition Examination Survey (NHANES) 34 percent of US adults ages 20 to 74 years are overweight, and an additional 27 percent are obese (CDC, 2002). Estimates for the total cost of overweight and obesity is $117 billion dollars in 2000, nearly 10 percent of the United States health care expenditure (Weisberg, 2002).

Obesity and diabetes are major causes of morbidity and mortality in the United States (Mokdad, 2001). It is estimated that 300,000 adults die from causes related to obesity each year (Mokdad, 2001). There has been a concurrent increase in the incidence of diabetes that correlates with obesity. Diabetes increased from 7.3 percent to 7.9 percent during the same period (CDC, 2002). These increases were noted regardless of sex, race, age and educational level.

INDICATORS OF OBESITY

A widely used method to measure overweight and obesity is the body mass index (BMI). The BMI provides a relative measure of weight adjusted for height (BMI=weight kg/height [m.sup.2] (McCance & Heuther, 2002). Obesity is defined as a condition characterized by excess body fat, which normally accounts for approximately 25 percent of weight in females and 18 percent of weight in males (Wadden, 2002). The BMI indicator for overweight is defined as a BMI of 25.0 to 29.9 kg/[m.sup.2], while the indicator for obesity is a BMI greater than or equal to 30kg/[m.sup.2] (Wadden, 2002). Another method currently being used to determine the distribution of body fat is waist circumference measurements. The presence of excess fat in the abdomen is an independent predictor of risk factors and mortality. Waist circumferences of 35 inches or greater in women have been associated with increased health risks (NIH, 1998). A more recent indicator is the waist to hip ratio to determine health related risk. Waist-to-hip ratio (WHR) is the ratio of a person’s waist circumference to hip circumference, mathematically calculated as the waist circumference divided by the hip circumference. A waist hip ratio greater than 0.8 in women has been associated with increased health risks (CDC, 2002).

According to NIH Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, all adults (aged 18 years or older) who have a BMI of 25 or more are considered at risk for premature death and disability as a consequence of overweight and obesity (NIH, 1998). These health risks increase as the severity of an individual’s weight increases. Obesity gradually increases the risks of diseases such as diabetes, heart disease, stroke and cancer (Weisberg, 2002).

OBESITY IN AFRICAN AMERICAN WOMEN

Women of racial and ethnic minorities are affected disproportionately by obesity. Among African Americans, the proportion of women who are obese is 80 percent higher than the proportion of men who are obese(USDHHS, 2000). When compared to non-Hispanic white women, 69 percent of African American women are overweight or obese (Klauer, 2002). The prevalence of obesity increases up to age 60 after which there is a decline (Klauer, 2002).

Data obtained from the National Health and Nutrition Examination Survey (NHANES) II have shown that the prevalence of obesity among African American women is twice that of European American women (Flegal, 2002). The tendency to become obese appears to occur gradually with a higher prevalence among African American women.

Using data from the 1979 National Longitudinal Survey of Youth researchers examined early adult weight development in 9,179 African American, Hispanic, and white persons born between 1957 and 1964. Participants were followed for eight years and self reported their weight and height 12 times from ages 17 to 24 years until ages 35 to 37 years (McTigue, 2002). Overall, 28% of women and 26% of men were obese using BMI measurements (McTigue, 2002).

In the Youth Survey, African American women were more likely than men to become obese. The findings revealed 66 percent of the African American women with a BMI of 24 to 25 when they were in their early twenties were obese by the ages of 35 to 37 years, whereas 47% of Hispanic and 42% of white women became obese (McTigue, 2002).

DIABETES AND OBESITY

Diabetes is the sixth leading cause of death in the United States (CDC, 2002). It is estimated that 14 million Americans had diabetes in 1995 and that number is expected to increase to 22 million in the year 2025 (El-Kebbi, 2003). Diabetes is a major health problem for African Americans for whom the prevalence rate is 1.6 times the rate for whites (El-Kebbi, 2003).

Results from studies indicate that there is a relationship between obesity and the increased risk of diabetes mellitus (Ford, 1997; Labib, 2003; Resnick, 2000). A weight loss of 5-10 percent of pretreatment body weight has been associated with significant improvements in medical disorders such as type 2 diabetes, hypertension and cardiovascular disease (Labib, 2003).

The Diabetes Prevention Program Research Group conducted a large, randomized clinical trial involving adults in the United States who were at high risk for the development of type 2 diabetes. The study was designed to determine if lifestyle intervention or treatment with an anti hyperglycemic agent, prevented or delayed the onset of diabetes. All 3,234-study participants were non-diabetic, overweight, most were obese, and most had a family history of type 2 diabetes (Knowler, 2002). Women comprised 68 percent of the sample, and 45 percent were members of minority groups (Knowler, 2002).

The participants who made lifestyle changes through diet and exercise reduced their risk of getting type 2 diabetes by 58 percent (Knowler, 2002). These effects were similar in men and women and in all racial and ethnic groups. The study findings supported the hypothesis that type 2 diabetes can be prevented or delayed in persons at high risk for the disease.

IMPLICATIONS FOR NURSING CARE

The role of the nurse to provide care aimed at decreasing the incidence of obesity is an integral component of health care. Nutrition and overweight are among the focus areas of Healthy People 2010 (USDHHS, 2000). Strategies to address this focus area would be to reduce the proportion of adults who are obese (USDHHS, 2000).

It is important for nurses to be able to recognize the influence of cultural, physiological and socioeconomic variables that can contribute to obesity. Prior to developing strategies aimed at reducing obesity, the nurse must establish effective modes of communicating with clients. The nurse needs to develop a therapeutic relationship with clients that provide an atmosphere in which clients can discuss their concerns regarding weight.

WEIGHT MANAGEMENT

The increased health risks due to obesity can be minimized and frequently eliminated through interventions aimed at decreasing obesity. When assessing a client for obesity the nurse should be aware of the importance of obtaining a BMI and measuring the clients waist, and waist to hip ratio as indictors for obesity.

There is evidence to infer that the risks of mortality and morbidity associated with obesity can be decreased with weight loss. An expert panel has concluded that weight losses of 5 to 15 percent of initial weight are a successful outcome (Labib, 2003). In the Diabetes Prevention Program a 7 kg weight loss combined with 150 minutes a week of physical activity decreased the incidence of developing type 2 diabetes by 58 percent in overweight individuals with impaired glucose (Knowler, 2002).

ASSESSMENT OF HEALTH STATUS

The nurse should assess the client to identify potential risk factors that could lead to diabetes or other chronic illnesses. The nurse should obtain information from the client about dietary history, physical activities and weight history to establish a baseline for providing care. The nurse has to be vigilant and question the client regarding possible indicators of Type 2 diabetes to determine whether the client is at risk for diabetes and other chronic illnesses.

CONCLUSIONS

Providing information to the client about the linkage between obesity and diabetes should be a component of teaching. Helping clients to understand the risk of chronic illness associated with diabetes is needed to foster compliance with prescribed lifestyle modifications. The nurse has to remain actively involved in conducting obesity research and utilizing applicable research findings in care giving to aid in decreasing obesity and the related health consequences including diabetes associated with obesity.

REFERENCES

CDC. (2002). Overweight and Obesity: Obesity Trends among Adults–1985-2001. National Center for Chronic Disease Prevention and Health Promotion.

CDC, (2002). CDC Statement on Results of Diabetes Prevention Program.: United States Department of Health and Human Services Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion.

El-Kebbi, I. M., Cook, C.B., Zeimer, D.C., Miller, C.D., Gallina, D.I., Phillips, L.S. (2003). Association of Younger Age with Poor Glycemic Control and Obesity in Urban African Americans with Type 2 Diabetes. Archives Internal Medicine, 163, 69-75.

Flegal, K. M., Carroll, M.D., Ogden, C.L., Johnson, C.L. (2002).Prevalence and Trends in Obesity among Us Adults, 1999-2000. The Journal of the American Medical Association, 288(14), 1723-1727.

Klauer, J., & Aronne, L. J., (2002). Managing Overweight and Obesity in Women. Clinical Obstetrics & Gynecology, 45(4), 1080-1088.

Knowler, W. C., Barrett-Connor, E., Fowler, S.E., Hamman, R.F., Lachin, J.M., Walker, E.A., Nathan, D. M. (2002). Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. New England Journal of Medicine, 346(6), 393-403.

Labib, M. (2003). The Investigation and Management of Obesity. Journal of Clinical Pathology, 56, 17-25.

McCance, K., & Heuther, S. (2002). Pathophysiology the Biologic Basis for Disease in Adults and Children. St. Louis: Mosby.

McTigue, K.M.. Garrett, J.M., Popkin, B.M.(2002). Are Young Overweight Adults Destined for Obesity? Clinician Reviews, 12(9), 29.

Mokdad, A.H; Bowman, B. A., Ford, E. S., Bowman, B. A., Ford, E.S., Vinicor, F. Marks, J. S. Koplan, J. P. (2001). The Continuing Epidemics of Obesity and Diabetes in the United States. The Journal of the American Medical Association, 286(10), 1195-1200.

NIH, (1998). Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults. The Evidence Report. National Heart Lung and Blood Institute in Cooperation with the National Institutes of Diabetes and Digestive and Kidney Disease. Rockville, Md.: National Institutes of Health. Publication no. 98-4083.

CDC, (2002). National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2000. Atlanta, Ga.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Resnick, H. E., Valsani, P., Halter J. B., Lin, X.,. (2000). Relation of Weight Gain and Weight Loss on Subsequent Diabetes Risk in Overweight Adults. Journal of Epidemiology and Community Health, 54(8), 596-602.

U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000

Wadden, T. A., Brownell, K. D., Foster, G.D. (2002). Obesity: Responding to the Global Epidemic. Journal of Counseling and Clinical Psychology, 70(3), 510-525.

Weisberg, S. P. (2002). Societal Change to Prevent Obesity. The Journal of the American Medical Association, 288(17), 217.

Joan Tilghman, PhD, is an assistant professor in the Division of Nursing at Howard University, and is a nationally certified Women’s Health Nurse Practitioner. Dr. Tilghman teaches in the Graduate and Undergraduate Programs in the Division of Nursing College of Pharmacy Nursing and Allied Health Sciences, 500 Bryant Street NW, Howard University, Washington, DC 20059.

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