As extensively discussed in section I of this book, obesity and weight gain clearly seem to be associated with an increased risk of diabetes, although there are some studies that don't show the association (44-46). Each year, 300,000 U.S. adults die of causes related to obesity (44). In 2000, the prevalence of obesity was 19.8 percent among U.S. adults (65.5 percent of men and 47.6 percent of women), which was a 61 percent increase from 1991 (44, 45). Weight gain, excess BMI, waist-hip ratio, and waist circumference are major risk factors for diabetes, with the waist circumference displaying the greatest relative risk (44, 47). In a national sample of adults, for every 1-kilogram increase in measured weight, the risk of diabetes increased by 4.5 percent (44). There seems to be an association between race and modification of diabetes risk by BMI, with African Americans having an increased risk at lower BMIs (i.e., adjusted RR for African Americans; for Caucasians, it was 2.83 for men and 3.13 for women at a BMI < 20 kg/m2) when compared to Caucasians, but an equivalent risk at high BMIs (at BMI > 32 kg/m2, adjusted RR decreased to 1.14 for men and 1.09 for women) (48). The cause for this difference is not fully understood. One hypothesis is that the difference could be attributed to differences in fat distribution between African Americans and Caucasians (48).
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