UMMS Affiliation

Department of Family Medicine and Community Health

Publication Date


Document Type



Comorbidity; Diabetes Mellitus, Type 2; Emigration and Immigration; Ethnic Groups; Female; Humans; Incidence; *Life Style; Male; Needs Assessment; Obesity; Poverty; Risk Factors; Severity of Illness Index; Socioeconomic Factors; Survival Analysis; United States; Urban Population; Vulnerable Populations


Community Health and Preventive Medicine | Life Sciences | Medicine and Health Sciences


Around the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting factors include events occurring during fetal life, maternal physiology and life context, the thrifty genotype, the nutritional transition, health impact of urbanization and immigration, social attributions and cultural perceptions of increased weight, and changes in food costs and availability resulting from globalization. Better appreciation of the complexity of causation underlying the worldwide epidemic of obesity and diabetes can refocus the work of clinicians and researchers to work at multiple levels to address prevention and treatment for these conditions among vulnerable populations.

DOI of Published Version



Ann Fam Med. 2007 Nov-Dec;5(6):547-56. Link to article on publisher's site

Journal/Book/Conference Title

Annals of family medicine

Related Resources

Link to Article in PubMed

PubMed ID