The association of body mass index and odds of type 2 diabetes mellitus varies by race/ethnicity

Abstract

ObjectiveThis study aimed to examine the association between body mass index (BMI; weight [kilogram]/height2 [meter]) and type 2 diabetes mellitus (T2DM) among the largest three largest racial/ethnic groups in the United States. MethodsWe compiled 10 waves of the continuous National Health and Nutrition Examination Survey from 1999–2000 through 2017–2018. Participants (N = 45,514) were those who had data on BMI, HbA1c, and demographics. We estimated associations between BMI and prediabetes/T2DM odds for Black, Latine, and White participants. ResultsBMI was associated with 10% higher odds of prediabetes/T2DM vs. having normal HbA1c levels (odds ratio = 1.10, 95% confidence interval = 1.10–1.11) for Latine and White individuals. However, the association between BMI and prediabetes/T2DM was significantly weaker among Black individuals. When focusing on T2DM prevalence, the association with BMI for Black participants was even weaker (odds ratio = 0.97, 95% confidence interval = 0.95–0.98). ConclusionsThe unstable associations between BMI and T2DM across race indicate that BMI has received unwarranted focus as a prime predictor of T2DM. Relying on BMI introduces bias in T2DM risk estimations especially in Black individuals. Focusing on BMI places the onus on individuals to change and increases weight stigma, which can worsen health outcomes. Instead, policymakers should focus on social determinants of T2DM and its concomitant racial/ethnic disparities.