Diabetes-related weight change in a Canadian First Nation cohort

Do Weight trajectories influence diabetes control? A prospective study in Switzerland (CoLaus study)

OBJECTIVE

Identify anthropometric trajectories among subjects with type 2 diabetes mellitus (T2DM), and associate them with glycaemic control.

METHODS

Prospective study including 268 community-dwelling participants with T2DM (34% women, mean age 68.7 ± 8.9 years) followed for 10.7 years (range: 8.8-13.6 years). T2DM control was considered for 1) fasting plasma glucose (FPG) < 7.0 mmol/L, or 2) HbA1c < 7.0% (53 nmol/mol). Changes in weight or waist and weight variability were considered.

RESULTS

One half (FPG) and one third (HbA1c) of participants presented with uncontrolled T2DM. Half of the participants presented with obesity and 75% with abdominal obesity. During follow-up, half of the participants maintained their weight, 25% gained > 5 kg, and 25% lost < 5 kg; almost half increased their waist by > 5 cm. Using FPG as criterion, participants who lost > 5 cm waist were more likely to be controlled: multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI): 3.10 (1.23-7.78). Participants with controlled T2DM also presented with a higher weight variability: multivariable adjusted mean ± standard error 4.8 ± 0.3 vs. 3.9 ± 0.3 kg, p = 0.028. Using HbA1c as criterion, participants who lost > 5 kg were less likely to be controlled: OR and (95% CI): 0.35 (0.18-0.66). Similar findings were obtained when restricting the analysis to participants who were diabetic throughout the whole study period.

CONCLUSION

In a Swiss community-based sample of participants with T2DM, T2DM control rates could be implemented. Neither weight nor waist variability was significantly and consistently associated with T2DM control.

(Re)claiming our bodies using a Two-Eyed Seeing approach: Health-At-Every-Size (HAES®) and Indigenous knowledge

We originally proposed a study to examine changes in disparities in "obesity" between Indigenous and non-Indigenous Canadian populations, as called for in the Truth and Reconciliation Commission, Article 19 (2015), which calls for ongoing monitoring of disparities in health outcomes. Instead, we questioned the importance of reducing the prevalence of "obesity" as a health goal for Indigenous peoples. This critical commentary provides an overview of Canadian Indigenous populations' weight, its relationship with health outcomes, and weight stigma and discrimination, using an Indigenous feminist lens. We introduce the applicability of a Two-Eyed Seeing approach utilizing a Health-At-Every-Size (HAES®) model and Indigenous ways of knowing, as a starting point, to understand weight, health, and our bodies. A new paradigm is needed to identify and close health gaps as noted in Article 19 of the Truth and Reconciliation Calls to Action (2015). We respectfully call upon health professionals and public health bodies to acknowledge the harm of weight stigma and discrimination in their practice and policies, and we encourage Indigenous peoples to (re)claim and (re)vitalize body sovereignty.