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at more than 114,000 women, ages 30 to 55, who had taken part in the long-running Nurses’Health Study between 1976 and 1990. 10
    Not surprisingly, the researchers found that among these women, body mass index was the dominant predictor of diabetes. The higher their BMI, the greater the risk. Even women who were at the high end of normal weight,with a BMI of 24,had an elevated risk.
    The heavier a woman is, the greater her risk of diabetes, as shown in the following chart:
     
BMI
DIABETES RISK
22
<1
25–26.9
8.1 times greater
29–30.9
27.6 times greater
35+
93.2 times greater
     
    The researchers also looked at the women’s weight gain over the 14 years of the study. Compared with women whose weight stayed pretty much the same or went up by fewer than 11 pounds,women who experienced more weight gain had a greater risk of diabetes, as shown in the following chart:
     
14-YEAR WEIGHT GAIN
RELATIVE RISK OF DIABETES
Up to 11-lb. gain
(no change)
11- to 17-lb. gain
1.9 times greater
17- to 24-lb. gain
2.7 times greater
44-lb. gain
12.3 times greater
 
     
    Even among the women who fell into the normal BMI category, modest amounts of weight gain increased the risk of diabetes. The women who started the study with BMIs between 22 and 25 and gained only 11 to 15 pounds (5 to 6.9 kg) over 14 years still had 1.6 times the risk of diabetes. In other words, even though at the end of the study period they were still within the guidelines for normal weight, the weight they did gain was enough to nearly double their risk of diabetes. 11
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    THE HEALTH RISKS OF BEING OVERWEIGHT
    If you are carrying around extra pounds, you are tempting fate in more ways than one. Overall, being obese significantly increases your risk of developing the metabolic syndrome and all its potential complications. It is so important that you understand this condition that we have devoted an entire chapter to it. Without an understanding of the abnormal changes in your chemistry, it will be impossible for you to comprehend why controlling carbs is a key to prevention of diabetes. Being overweight also is implicated in gallbladder disease, a number of forms of cancer, osteoarthritis, asthma, sleep apnea, breathing difficulties, complications of pregnancy, polycystic ovary syndrome (PCOS), and increased surgical risk. 12
    If you’re overweight and also have low HDL cholesterol and high triglycerides, there’s a pretty good chance that you’re also insulin resistant and could be well on your way to prediabetes or diabetes. Add in high blood pressure or any other diabetes risk factor and the odds are even greater. Even if you’re not yet insulin resistant and have normal cholesterol and blood pressure, you’re still not immune to diabetes and other health problems. The following table gives you a good idea of exactly how your risk for a number of chronic diseases increases if you’re overweight or obese, compared with your risk if your weight is normal (BMI of 24.9 or less).
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    INCREASED RISK OF WEIGHT-RELATED DISEASES
D ISEASE
BMI 25
OR LESS
BMI 25–30
BMI 30–35
BMI 35+
Arthritis
1.00
1.56
1.87
2.39
Heart disease
1.00
1.39
1.86
1.67
Type 2 diabetes
1.00
2.42
3.35
6.16
Gallstones
1.00
1.97
3.30
5.48
Hypertension
1.00
1.92
2.82
3.77
Stroke
1.00
1.53
1.59
1.75
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    Source: The Lewin Group,“Costs of Obesity,”September 2000, available at:
http://www.lewin.com/Lewin_Publications/Uncategorised/Publication-8.htm
    THE INFAMOUS LOVE HANDLES
    Strange as it sounds, carrying most of your excess weight in the abdominal area—sometimes described as having an “apple” shape— gives you a higher risk of diabetes. This very important risk factor is discussed in the next chapter. Study after study has shown that having a high waist-to-hip ratio or a large waist is a powerful predictor of diabetes risk. Even if your weight is within the norm for your height, how your body fat is distributed plays an important role. The more abdominal fat you have, the greater