Obesity and diabetes in African American women

ABNF Journal, The, May-June, 2003 by 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).