An estimated 97 million adults in the United States are either overweight or obese, and approximately 75 percent engage in no or only minimal physical activity on a regular basis (National Institutes of Health, 1998; U.S. Department of Health and Human Services, 1996). Smoking cessation, increased physical activity, and dietary regulation are prime targets for intervention, as these changes would reduce weight, lower low-density lipoproteins, increase high density lipoproteins, and improve glucose tolerance. Factors working against such interventions in diverse populations include the adoption of “Westernized” lifestyles, inadequate community and economic resources to access diabetes-safe diets (such as absence and/or high cost of appropriate foods in markets), and some traditional dietary practices. These factors, which are at extreme levels in many diverse communities, may be responsible for increasing rates of obesity in these communities and their disproportionate rates of Type 2 diabetes (Nakamura, 1999).

The same factors—high-fat diets and little physical activity— are likely to be the cause of the recently reported surge in Type 2 diabetes among U.S. children, many of whom are of African-American, Hispanic, or Native American/Alaskan Native descent (Libman et al., 1998; Neufeld et al., 1998; Pinhas-Hamiel et al., 1996; Rosenbloom et al., 1999; Scott et al., 1997). As many as 8 to 45 percent of children newly diagnosed with diabetes have Type 2. Libman and Arslanian (1999) reported that in 1994, 33 percent of the individuals diagnosed with diabetes were 10 to 19 years of age. Children at highest risk have a family history of diabetes, are in the middle to later years of puberty (age 10 or older), and are overweight.

Although much remains to be learned about the interacting processes responsible for the onset of Type 2 diabetes, the correlations among these risk factors and their association with Type 2 diabetes across ethnic groups reinforce the assumption that interventions effective in initiating and maintaining lifestyle changes do reduce the prevalence of this disease (Diabetes Prevention Program Research Group, 2002; Black, 2002).



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