Recommended BMI for South Asians (Indians)
For South Asians including Indians, the recommended BMI cut-offs should be lower than standard thresholds, with overweight defined as BMI ≥23 kg/m² and obesity as BMI ≥25 kg/m². 1, 2
Why South Asians Need Different BMI Cut-offs
South Asians have distinct body composition characteristics that increase their cardiometabolic risk at lower BMI values:
- Higher body fat percentage at the same BMI compared to Caucasians 1
- Greater visceral and deep subcutaneous fat accumulation 1
- Higher rates of metabolic syndrome across all BMI ranges 1
- Increased insulin resistance even in lean individuals 1
- Greater abdominal adiposity and less lean muscle mass 1
Specific BMI Classification for South Asians
| Classification | BMI (kg/m²) |
|---|---|
| Underweight | <18.5 |
| Normal weight | 18.5-22.9 |
| Overweight | 23.0-24.9 |
| Obesity | ≥25.0 |
This classification is supported by multiple guidelines and research studies 1, 2, 3.
Clinical Implications
Cardiovascular Risk Assessment
- South Asians experience dyslipidemia and type 2 diabetes at lower BMI values 1
- High waist-to-hip ratio (WHR) is a stronger predictor of acute myocardial infarction than BMI in this population 1
- Abdominal obesity is an independent predictor of myocardial infarction in Indians 1
Diabetes Screening
- The American Diabetes Association recommends diabetes screening at BMI ≥23 kg/m² for all Asian Americans 1
- This lower threshold increases sensitivity for identifying at-risk individuals 1
Waist Circumference Thresholds
In addition to BMI, waist circumference should be measured with the following cut-offs:
- Men: ≥90 cm
- Women: ≥80 cm 1
Mortality Risk
Research on over 1.1 million Asians shows:
- For South Asians (Indians and Bangladeshis), underweight status (BMI ≤20) is associated with significantly increased mortality risk 4
- The relationship between high BMI and mortality differs between East Asians and South Asians, with South Asians showing less excess mortality at higher BMI levels 4
Intervention Recommendations
When BMI exceeds the recommended thresholds:
First-line approach: Comprehensive lifestyle intervention including culturally-appropriate diet modifications, increased physical activity, and behavioral therapy for 6-12 months 5
Pharmacotherapy: Consider for BMI ≥27 kg/m² or ≥25 kg/m² with obesity-related complications 1
Surgical options: Consider for BMI ≥35 kg/m² with comorbidities when other interventions have failed 5
Common Pitfalls to Avoid
- Using standard BMI cut-offs: Applying the universal BMI cut-offs (25 for overweight, 30 for obesity) will significantly underestimate health risks in South Asians
- Focusing only on BMI: Waist circumference and waist-hip ratio provide additional important information about cardiometabolic risk
- Overlooking normal-weight metabolic abnormalities: South Asians can have significant metabolic abnormalities even at "normal" BMI ranges by standard criteria
By using these lower BMI thresholds for South Asians, clinicians can better identify individuals at risk for cardiometabolic diseases and implement earlier interventions to reduce morbidity and mortality.