There is a need for adjusted BMI criteria for Asian Americans, given their higher risk of obesity-related health problems at lower BMIs and increased likelihood of developing central obesity, according to a recent study.
Obesity is a growing public health crisis in the United States and worldwide. Body mass index (BMI) is the most widely used tool for assessing the prevalence of obesity in any population group. In the United States, a person is considered obese if their BMI is ≥30.0 kg/m2. This criteria is for all ethnic/racial groups.
Based on these criteria, the prevalence of obesity is lowest among Asian Americans. However, the prevalence of obesity-related disorders is highest among this group. This means that BMI cutoff criteria should be different for Asian Americans. Moreover, a World Health Organization (WHO) panel also recommends reducing the BMI cutoff to ≥27.5 kg/m2 for Asian people.
This literature review, published in the journal Obesity, explores the evidence for the health effects of obesity in Asian Americans and various sub-populations and discusses the strategies and challenges of implementing a different obesity cutoff for Asian Americans.
Obesity in Asian People
Obesity has been increasing in all population groups in the US. Evidence has shown that obesity is not merely a passive accumulation of fat but rather a condition that causes adipose tissue, endocrine, and central nervous system dysfunction. Per the 2019 Census Bureau, 5.7% of U.S. residents are of Asian origin. However, the Asian population is highly diverse, including Chinese, Indian, Japanese, Korean, Filipino, and Vietnamese people. There is also significant diversity in their socioeconomic status.
Asian people are prone to central obesity. Thus, despite their lower obesity rates, they tend to have a higher waist-to-weight ratio than white people. This predisposition to central obesity increases their risk of adiposity-associated comorbidities. Based on existing criteria, Asians have lower obesity rates, though there have been few studies on the Asian population. However, if the WHO’s recommended criteria are used (BMI ≥ 27.5), obesity prevalence in Asians is similar to or even higher than that in White people.
Asians are also more likely to develop comorbidities at lower BMIs. United Kingdom diabetes studies suggest a significant increase in diabetes risk in Asians at a BMI of 25.2 kg/m2 or above. U.S. studies show that Asian Indian and Filipino people have the highest average BMI (among Asian people) and type 2 diabetes rates, at 21.3% and 25.3%, respectively. In contrast, the diabetes rate is just 8.1% in Whites.
There are a few challenges to overcoming these disparities. The Asian population is highly diverse. This means that there is a need for race-specific obesity criteria. Since obesity has much to do with dietary choices, it would be challenging to develop dietary recommendations for Asians. Similarly, the cultural diversity of the population also makes countering obesity challenging.
The Bottom Line
The authors of this literature review suggest that appropriate BMI criteria must be considered for Asian people. Additionally, these criteria must be different for various Asian groups due to the population’s heterogeneity. Other changes that need to be implemented include culturally tailored recommendations for lifestyle management, ensuring patient education in the patient’s native language, and enhancing early access to obesity treatment. There is also a need to develop race-specific obesity medical and surgical treatment guidelines.
Source:
Li, Z., Daniel, S., Fujioka, K., & Umashanker, D. (2023). Obesity among Asian American people in the United States : A review. Obesity, 31(2), 316–328. https://doi.org/10.1002/oby.23639
