From the Guidelines
South Asians should use a BMI cutoff of 23 kg/m² or above to indicate overweight, as recommended by the most recent consensus on care and management of obesity in South and Southeast Asia 1. This is because South Asians typically have higher body fat percentages and greater abdominal obesity at lower BMI levels than other ethnic groups, which increases their risk of cardiometabolic diseases such as type 2 diabetes, hypertension, and heart disease 1. The use of lower BMI cutoffs for South Asians is supported by epidemiological data, which demonstrates that high BMI is associated with increased risk of mortality, cardiometabolic disease, and certain cancers 1. Key points to consider when assessing and managing obesity in South Asian populations include:
- Using lower BMI cutoffs for overweight (BMI ≥ 23 kg/m²) and obesity (although the exact cutoff for obesity is not specified in the most recent studies, the focus is on earlier intervention) 1
- Monitoring waist circumference, which is an important measure for South Asians, as it can indicate increased risk of health complications 1
- Implementing lifestyle modifications, such as diet changes and regular physical activity, at the lower BMI thresholds to prevent health complications 1
- Considering pharmacotherapy or surgery for individuals with severe obesity or obesity-related complications, as recommended by the International Federation for the Surgery of Obesity and Metabolic Disorders Asia Pacific Chapter (IFSO-APC) guidelines 1.
From the Research
Body Mass Index (BMI) Criteria for South Asians
The BMI criteria for South Asians are as follows:
- The proposed cut-offs for BMI are 23-24.9 kg/m(2) for overweight and ≥ 25 kg/m(2) for obesity 2
- South Asians develop type 2 diabetes and cardiovascular disease at a lower body mass index (BMI) compared to other racial groups 3
- The "high body fat-normal BMI-low muscle mass" phenotype is characteristic of South Asians, with higher body fat and lower skeletal muscle mass at the same or lower BMIs compared to white people 4
- Abdominal obesity is a significant risk factor for metabolic syndrome and type 2 diabetes mellitus in South Asians, with excessive ectopic fat deposition in the liver and lower skeletal muscle mass contributing to the risk 5
Comparison with Other Populations
- Asian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI) than other ethnic groups 6
- The BMI distribution of Surinamese South Asian children differs considerably from the WHO reference and universal BMI criteria, with a similar distribution to the Asian Indian reference 6
Recommended Cut-offs for South Asian Children
- The calculated BMI cut-offs corresponding to a BMI of 15,23,25, and 27.5 kg/m(2) at 18y are at the 7.1,81.1,89.8, and 95.5 percentile respectively in boys, and at the 2.7,79.5,89.2, and 95.2 percentile in girls 6
- These cut-offs are recommended for use in South Asian children in the Netherlands to better reflect the health risks associated with thinness, overweight, and obesity 6