Lifestyles for Lower Risk


Type 2 diabetes is preventable. Eat well. Exercise. It seems simple, but there is a reason why the billion-dollar diet industry exists. Eating well and getting in the recommended amount of exercise are notoriously hard. Scientists have spent decades grappling with the question, “Why is changing health behaviors so hard when the stakes are so high?”

Health behavior researchers have found that risk perception matters. Risk perception refers to your judgment of the likelihood that a negative event will happen. The higher the likelihood of that negative event, the greater the chance that you will act to reduce your risk. Believing you are at risk for developing type 2 diabetes can be a powerful motivator to eat healthier food, move more, and seek preventative diabetes care.

Understanding the factors that influence diabetes risk perception can help us design better public health messages and reduce the overall rate of type 2 diabetes in the US. Helping the groups most at risk for developing type 2 diabetes understand their risk is especially important. It was once widely believed that immigrants, who will account for 20% of the population by 2065, were relatively protected from developing “lifestyle conditions” like obesity, heart disease, and type 2 diabetes. However, recent evidence suggests that the foreign-born population is actually at greater risk for developing type 2 diabetes than their US-born peers.

We also know that once immigrants are diagnosed with type 2 diabetes, they are at risk of receiving less thorough type 2 diabetes care. These is a clear need pay closer attention to how public health efforts can help the growing immigrant population get healthy and stay healthy.

These findings point to the need for public health campaigns to increase diabetes risk knowledge among the foreign-born population living in the US.


To better understand diabetes risk perception among immigrants in the US, my colleagues and I turned to the 2011-2016 National Health and Nutrition Examination Survey. We analyzed data from the 11,000+ adults who had never been diagnosed with type 2 diabetes. We also statistically accounted for factors that determine diabetes risk, namely demographics factors (e.g., racial/ethnic background) and clinical indicators (e.g., laboratory-measured A1c values).

We found differences in diabetes risk perception along immigrant status lines. Those who immigrated to the US were less likely than respondents born in the US to say they might develop diabetes one day. Specifically, being an immigrant was associated with 27% decreased odds of feeling at risk.

Taking it further, we re-ran our analyses using the 3,000 adults who had clinically-indicated prediabetes (i.e., A1c value between 5.7 and 6.4). We chose to focus on this subgroup because prediabetes represents a critical window for intervention efforts to prevent or delay the development of type 2 diabetes. In this clinically at-risk group, the proportions became more uneven: being foreign-born became associated with 35% decreased odds of saying they felt like they were at risk.

Lower risk perception decreases the likelihood of engaging in lifestyle modifications to prevent or delay the onset of type 2 diabetes. These poor preventative behaviors and late detection of type 2 diabetes exacerbate health disparities between those born in the US and immigrants. These findings point to the need for public health campaigns to increase diabetes risk knowledge among the foreign-born population living in the US.

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