Obesity and diabetes in African American women

ABNF Journal, The, May-June, 2003 by Joan Tilghman

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).