Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Ike Okosun

Second Advisor

Dr. Reynolds Morrison


Background: Type 2 diabetes is the second leading cause of death in the United States. Obesity and physical inactivity are positively associated with increased risk of type 2 diabetes. However, little information is known about how these two risk factors coexist to influence Type 2 diabetes across different racial/ethnic groups (Non-Hispanic Blacks, Non-Hispanic Whites and Mexican Americans). Understanding the relationship in the joint occurrence of obesity and physical inactivity with the risk of diabetes is of importance in framing robust public health interventions to alleviate health disparities in the US.

AIM: To examine the association of the joint occurrence of obesity and physical inactivity with Type 2 diabetes in adults 18 years old or greater stratified by race.

Methods: A nationally representative data (N=5992), the 2015-2016 wave of the National Health and Nutritional Examination Survey (NHANES) including adults aged 18-65+ years was used for this study. Chi square tests and logistic regression were used to determine the joint occurrence of the two risk factors with type 2 diabetes by proportion and the odds ratio across racial groups respectively. Diabetes was defined as a history of a prior diagnosis of diabetes, use of diabetes medication or Glycohemoglobin (A1c) of 6.5% or higher.

Results: The prevalence of diabetes was observed to be higher among Non-Hispanic blacks (37.52%) than Mexican Americans (29.72%) and Non-Hispanic Whites (24.36%). Increased number of risk factors was associated increased odds of diabetes among these ethnic groups. In the joint association of obesity and physical inactivity was associated with increased odds of type 2 diabetes in NHW (OR=1.81; 95% CI=1.11-2.97), NHB (OR: 2.33; 95% CI=1.74-3.11) and MA (OR=1.70 95% CI=1.12-2.59) after adjusting for age, gender, educational level, income, diet and smoking

Conclusion: The positive significant association between the joint occurrence of obesity and physical inactivity with increased risk of type 2 diabetes has a public implication. The results call for diabetes intervention tailored toward addressing the co-occurrence of obesity and physical inactivity.