Primary Risk Factor: High BMI and Sedentary Lifestyle
The greatest risk to this patient's future health is her high BMI (29 kg/m²) combined with sedentary lifestyle (Option D), which directly drives the development of type 2 diabetes, cardiovascular disease, and metabolic complications. 1
Why BMI and Sedentary Lifestyle Dominate Risk
Obesity is the single most important predictor of type 2 diabetes in young people. 2, 3 In adolescents and young adults with type 2 diabetes, 85% are obese, with reported mean BMI ranging from 27-38 kg/m². 2 This patient's BMI of 29 kg/m² places her squarely in this high-risk category.
The combination of obesity and physical inactivity represents modifiable risk that accounts for the vast majority of diabetes cases:
- 91% of type 2 diabetes cases could be prevented by adopting a healthier lifestyle, including maintaining healthy weight and regular physical activity. 3
- Lack of exercise and poor diet are independently associated with significantly increased diabetes risk, even after adjusting for BMI. 3
Why Other Risk Factors Are Secondary
Family History (Option C)
While family history is important, it explains far less of her immediate risk:
- Family history increases diabetes risk 2.7-fold, but established risk factors like BMI only modestly attenuate this association. 4
- Lifestyle, anthropometric, and genetic factors explain only a marginal proportion of family history-associated risk. 4
- In this patient, the family history amplifies her already-elevated risk from obesity and inactivity, but is not the primary driver. 2, 5
Elevated Blood Pressure (Option A)
Her borderline hypertension (135/95 mmHg) is likely a consequence of her obesity and sedentary lifestyle, not the primary risk:
- Hypertension in young people with obesity typically reflects insulin resistance and metabolic dysfunction already in progress. 2
- The elevated BP indicates early cardiovascular risk but is downstream from the fundamental problem of excess adiposity and inactivity. 1
Impaired Glucose (Option B - appears to be what "Fasting blood pressure" meant)
Her random glucose of 5.8 mmol/L (slightly above normal) suggests early glucose dysregulation:
- This indicates she may already have prediabetes, but this is a marker of disease progression rather than the root cause. 2, 6
- The impaired glucose homeostasis results from the insulin resistance driven by her obesity and inactivity. 7
Clinical Implications for This Patient
This 18-year-old has multiple risk factors that cluster together, creating a high-risk metabolic profile:
- BMI 29 kg/m² (overweight/obese)
- Waist circumference 95 cm (central adiposity)
- Sedentary lifestyle with poor diet
- Family history of type 2 diabetes
- Borderline hypertension
- Borderline glucose elevation
She requires immediate diabetes screening with fasting plasma glucose and HbA1c, as she meets multiple criteria for testing. 2, 6
The Path Forward
Intensive lifestyle modification is the most critical intervention, as it directly addresses the primary risk factors:
- Modest weight loss and increased physical activity prevent or delay diabetes progression in high-risk individuals with impaired glucose tolerance. 2
- The modifiable nature of obesity and sedentary lifestyle makes them both the greatest threat and the greatest opportunity for prevention. 1, 3
Common pitfall to avoid: Do not focus solely on the family history or single abnormal values while ignoring the fundamental metabolic derangement driven by excess weight and inactivity. 1 The clustering of risk factors in this young patient indicates she is already on the pathway to type 2 diabetes and cardiovascular disease, with obesity and inactivity as the primary drivers. 8