DIABESITY IS THE unification of the words diabetes, referring to type 2, and obesity. Just like
the evocative “bromance,” it conveys the close relationship between these two ideas. Diabetes and obesity are truly one and the same disease. As strange as it may now sound, physicians did not always recognize this seemingly obvious and basic connection.
Back in 1990, when grunge was taking over the music scene and fanny packs were growing in popularity beyond the middle-aged dad tourist, Dr. Walter Willett, now Professor of Epidemiology and Nutrition at Harvard’s School of Public Health, identified the strong and consistent relationship between weight gain and type 2 diabetes.
The obesity epidemic had only just gotten underway in the late 1970s and was not yet the public health disaster it is today. Type 2 diabetes barely scratched the surface as a public health concern. Instead, AIDS was the hot topic of the day. And type 2 diabetes and obesity were not thought to be related in any way. Indeed, the Report of the Dietary Guidelines Advisory Committee issued by the U.S. Department of Agriculture in 1990 allowed that some weight gain after the age of thirty-five was consistent with good health.

That same year, Dr. Willett challenged the conventional thinking, reporting that weight gain after age eighteen was the major determinant of type 2 diabetes.
1 A weight gain of
20–35 kg (44–77 pounds) increased the risk of type 2 diabetes by 11,300 percent. Gaining more than 35 kg (77 pounds) increased the risk by 17,300 percent! Even smaller amounts of weight gain could raise the risk significantly. But this idea was not an easy sell to a sceptical medical profession.
“We had a hard time getting the first paper published showing that even slight overweight greatly increased the risk of diabetes,” Willett remembers. “They didn’t believe it.”
BODY MASS INDEX: THE RELATIONSHIP BETWEEN OBESITY AND DIABETES THE BODY MAS index is a standardized measurement of weight, and it is calculated by the
following formula:
Body mass index = Weight (kg)/Height (m2)

A body mass index of 25.0 or higher is considered overweight, while a body mass index
of between 18.5 and 24.9 is in the healthy range.
Table 4.1. Body mass index classifications
Body Mass Index Classification
< 18.5 Underweight
18.5–24.9 Normal weight
25.0–29.9 Overweight
30.0–34.9 Obese
35.0–39.9 Severe Obesity
> 40.0 Morbid Obesity
However, women with a body mass index of 23–23.9 have a 360-percent higher risk of developing type 2 diabetes than women with a body mass index of less than 22, which is even more stunning since a body mass index of 23.9 is considered well within the normal weight range.

By 1995, building on this new realization, researchers had determined that a weight gain
of only 5.0–7.9 kg (11–17.5 pounds) increased the risk of type 2 diabetes by 90 percent, and a weight gain of 8.0–10.9 kg (17.5–24 pounds) increased the risk by 270 percent. 

 By contrast, weight loss decreased risk by more than 50 percent. This result established an
intimate relationship between weight gain and type 2 diabetes. But far more sinister, this
excess weight also significantly increased the risk of death.

More supporting evidence would soon surface. Dr. Frank Speizer from the Harvard
School of Public Health had established the original Nurses’ Health Study (NHS) in 1976. One
of the largest investigations into risk factors for cardiovascular disease and cancer, this long-term epidemiological study included 121,700 female nurses from around the Boston area.

Dr. Willett continued with the Nurses’ Health Study II, which collected data every two years on an additional 116,000 female nurses since 1989. At the start of the study, all the participants were relatively healthy, but over time, many of them developed chronic diseases such as diabetes and heart disease. By looking back at the collected data, some idea of the risk factors for these diseases emerged. In 2001, Dr. Willett
 showed that, once again, the single most important risk factor for the development of type 2 diabetes was obesity.


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