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We know that obesity is a major factor in diabetes, and a key focus area for many workplace wellness programs. But a new study shows that obesity may be an even bigger factor than many thought.

The New York Times reports that “Carrying excess weight may have a greater impact on the risk for diabetes than it does on the risk for heart disease or early death.”

The report is based on a study in the Journal of the American Medical Association (JAMA) titled “Risks of Myocardial Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Indexes.” The study sought “to compare the risk of myocardial infarction (MI), type 2 diabetes, and death in monozygotic (MZ) twin pairs discordant for body mass index (BMI).”

According to Nutrition Insight, the study “looked at a group of 4046 twin pairs. Of the pairs, one twin was overweight, and the other within a healthy weight range.”

“Over a period of 6 years, from March 17, 1998, to January 16, 2003, with a follow-up regarding incident outcomes until December 31, 2013, twins were examined based on their weight, their amount of physical activity, smoking habits and educational level.”

The NYT reports that “After accounting for physical activity, smoking and educational level, the researchers found that having a higher body mass index, or B.M.I. — even among those in the obese range of 30 or higher — was not associated with an increased risk for heart attack or death. But a high B.M.I. was associated with an increased risk for diabetes.”

The result may provide an important understanding of the connection between obesity and diabetes, one on which workplace wellness programs can focus.

Said lead author Peter Nordstrom, a professor of geriatric medicine at Umea University: “Based on these results, the association between obesity and cardiovascular disease is explained by genetic, not environmental, factors. Unfortunately, this also means that environmental factors that reduce obesity do not reduce the risk of cardiovascular disease or death. But they most certainly decrease the risk for diabetes.”