While I was aiming for a BMI of 25, it turns out that someone moved the goalposts for Asian Americans. BMI is short for “Body Mass Index”. It reflects height and weight proportions, and various organizations have drawn the lines between categories such as Obese, Overweight, Normal, and Underweight. For example, the World Health Organization defines Normal as 18.5 to 25.

Then, I discovered the Joslin Diabetes Centre associated with the Harvard Medical School. Turns out that Asian Americans should aim for a BMI of 23, not 25. Bottom line, I need to lose 15 pounds, not 5. The explanation? Asian Americans are “fatter” at a lower BMI than Caucasian Americans. This translates to an increased risk of diabetes and other health problems at lower weights.

Asian Americans at Higher Risk

The rates of diabetes are higher for Asians living in America than for those living a traditional lifestyle - for example, Chinese living in American versus Chinese in rural China. As well, Asian Americans have a higher rate of diabetes than Caucasian Americans. That trend continues through the generations of Asian Americans, according to the Joslin site:

“. . . second and third generation Japanese Americans, who are well acculturated in the mainstream American lifestyle, still have higher diabetes rates compared with Caucasians, suggesting genetics to also be an important factor.”

That would suggest that both environment and genetics are factors in developing diabetes.  Perhaps this phenomenon is similar to the Pima Indians in the southwest USA having a “thrifty gene” that works against them in times of too-abundant calories.

Interestingly, Pacific Islanders have a higher “normal” BMI than Asians and Caucasians, which means they can carry more weight, without increasing the risk of diabetes. BMI is a tool, an average statistic and not a predictor of health for individuals. Very muscular people will have a higher BMI, but that does not make them “too fat” - muscle weighs more than fat. However, I’m not in danger of being too muscular - there’s no doubt, I’m fatter than I thought.

What’s Your BMI? The Joslin Diabetes Centre provides a handy BMI calculator for Asians, Caucasians, and Pacific Islanders. It’s also in pounds and kilograms: BMI calculator in KG or LB for Asians, Caucasians and Pacific Islanders.

WHO Study

In 2002, the World Health Organization convened a Consulation of Experts on Appropriate body-mass index for Asian populations. The report, “The Asia-Pacific Perspective: Redefining Obesity and its Treatment” confirmed that the risk of health problems including diabetes occurs at a lower BMI for Asian and South Asians. For example, for Hong Kong Chinese, a 1999 study suggested that Type 2 diabetes is predicted by a BMI greater than 24.3 for men, and 23.2 for women [Ibid, p.24].

The study states that in some cases, obesity alone may be sufficient to trigger diabetes, and of the lifestyle factors that we can change outselves, generalized obesity and central obesity (around the middle) are “probably the most important ones”. [Ibid, p.24].

There were other interesting points. In Japan and Korea, diabetes is more often associated with decreased insulin production, rather than insulin resistance. [Ibid, p.24]

While the experts agreed that Asians have a higher risk of cardiovascular disease and Type 2 diabetes at a lower BMI, no change was made to the WHO International classifications. The reason:

“. . . the cut-off point for observed risk varies from 22 kg/m2 to 25 kg/m2 in different Asian populations and for high risk, it varies from 26 kg/m2 to 31 kg/m2 . The Consultation, therefore, recommended that the current WHO BMI cut-off points (Table 1) should be retained as the international classification.”

It seems that because risk varied in a range below the Normal range, and high risk also varied among different Asian populations, no change would be made. This clearly does a disservice to unsuspecting Asian populations.

Unsuspected Risk

Deception Pass

Because many Asian Americans and their doctors are not aware that the BMI goalposts for Asian Americans are lower than for Caucasian Americans, Asian Americans may appear to be of “Normal” weight, when in fact, they are above their optimal weight and at increased risk of diabetes and other health problems.

If healthcare providers do not perceive the risk, and fail to test Asian Americans, they and the patients lose the opportunity to address blood glucose levels before they reach diabetic levels.

What about Racialized Medicine?

Racialized medicine is controversial. Some say that there is only one race: the human race. They argue that science should address the problems of all people, not focus on particular groups. Indeed, there is a danger that the health problems of certain groups will be addressed, while other groups’ problems languish.

We know that sometimes, poor outcomes may be due to lower income and its effects on nutrition, early detection and access to quality treatment. There is a danger that if we assume that the differences in outcome are due to race or ethnicity, we could miss the opportunity to address the root social factors in question.

Some worry that potential employers or insurers will penalize persons from groups perceived to be at higher risk of health problems. Will racialized science create classes of “bad risks” who will have to pay higher premiums, or be unable to buy insurance at all?

On the other side, we have a precedent in the identified differences between male and female physiology, gender being a genetic distinction. At one time, research and drug trials were often done with white male subjects. For example, as set out in this article on the evolution of gender-related health research, the Physicians’ Health Study, published in 1989, in the New England Journal of Medicine, enrolled 22,071 male physicians and ZERO female physicians to study of the effects of aspirin on cardiovascular disease.

The struggle for women’s rights and opportunity has moved beyond the notion of equality meaning “sameness”. As we have learned, women react differently to drugs and even experience different signs of a heart attack than do men - see for example, this MayoClinic article.

If there are differences caused by accidents of birth, I hope we explore those possibilities, while remaining alert to the dangers of abuse. Count me among those who want to know what comes bundled with my heritage.

NOTE: The images are from oil paintings I’ve done.