Objective This study determines effects of elevated body mass index (BMI) on type 2 diabetes mellitus (DM) onset and its complications among U.S. elderly. Design and Methods Data came from the Medicare Current Beneficiary Survey (MCBS), 1991-2010. A Cox proportional hazard model was used to assess effects of elevated BMI at the first MCBS interview on DM diagnosis, complications, and insulin dependence onset among Medicare beneficiaries with no prior DM diagnosis and not enrolled in Medicare Advantage (N=14,657). Results Among DM-diagnosed individuals, elevated BMIs were associated with progressively higher risk of adverse outcomes. For women, hazard ratio (HR) of insulin dependence ranged from a 1.77 at 25 ≤ BMI ≤ 27.49 to 3.57 at BMI ≥ 40. A similar pattern was observed in risk for cardiovascular (HR=1.34 to HR=2.45), cerebrovascular (HR=1.30 to HR=2.00), renal (HR=1.31 to HR=2.23), and lower extremity complications (HR=1.41 to HR=2.95). In men, increased risks for DM complications occurred at higher BMI (27.5 ≤ BMI ≤ 29.99) levels than in women. Ocular complications occurred at higher BMI levels than other complication types in both genders. Conclusions Having even moderately elevated BMI is associated with increased risk of developing DM complications.

Obesity is an important risk factor for cardiovascular diseases and non-insulin-dependent diabetes, which are chronic diseases that afflict American Indians and Alaska Natives today. Because American Indians are not represented in most national health and nutrition surveys, there is a paucity of data on actual prevalence of obesity in American Indians. We estimated prevalence of overweight and obesity for American Indian adults, school-age children, and preschool children from existing data. The prevalence of obesity in adults was estimated from self-reported weights and heights obtained from a special survey of American Indians performed as part of the 1987 National Medical Expenditure Survey. Prevalence of obesity in American Indians was 13.7% for men and 16.5% for women, which was higher than the US rates of 9.1% and 8.2%, respectively. Obesity rates in American Indian adolescents and preschool children were higher than the respective rates for US all-races combined.

This study demonstrates an immediate and lasting reduction in the rates of breast cancer screening among women of all age groups after the 2009 revision of screening guidelines by the USPSTF.