Asians in NYC are the least obese, but does that mean much?

April 1st, 2018

Recently, the New York Post reported the NYC Department of Health findings that Asians are the ethnic group with the lowest rates of obesity in an article titled “Asians are the least obese demographic in NYC: survey”.  While this is likely true based on Body Mass Index (commonly a BMI>25 is considered overweight and a BMI >30 is obese), it does not mean Asians are not suffering from weight related problems including diabetes, hypertension (high blood pressure), and heart disease.  Currently, there is an epidemic of all of these diseases in the Asian and Asian-American community (including people from China, Korea, Philippines, India, Bangladesh, among others)  Why is there a discrepancy?  Essentially the BMI is not a good measure for obesity for the Asian population.  Many studies have shown that the Asian body type tends to accumulate fat inside the abdomen, which is a place where increased fat dramatically increases risks for many diseases.  The abdomen is where the major organs involved in metabolism (e.g. liver produces cholesterol and sugar, pancreas secretes insulin which helps to process sugar, kidney regulates blood pressure, etc.), and having excess fat in that area literally can “choke” off these organs and cause them to function improperly.  So while their weight may be the same as other races, the fat distribution is more localized rather than distributed evenly throughout the body.  Years ago, there were studies showing that people with body types that looked like apples (larger midsection) have higher rates of cardiovascular disease than people whose bodies looked like pears (larger hips and thighs).  Generally speaking, most Asians have apple shaped bodies.

I’m very concerned these recent study findings will limit resources allotted to health education for the Asian population in New York.  It gives the impression that this population does not need preventive health initiatives since they “are not fat”, but this is a dramatic misconception that they are not at risk for many serious diseases.

What is a better measure for obesity among Asians?  BMI can be used, with lower cutoffs (23-26.9 as being overweight and above 27 would be obese).  The abdominal waist circumference would be an even better tool with ethnic specific cutoffs for Asians with cut offs being 35 inches (90 cm) for men and 31 inches (80 cm) for women.  To properly measure a waist circumference, you should take a fabric tape measure and wrap it around at the level of your belly button.  Pant or belt sizes are normally not accurate as we normally wear our pants below the belly button and hence they would typically be lower than the clinical waist circumference measurement.  These standards for obesity already exist and should have been used in the NYC DOH study rather than BMI alone.  I’m quite surprised and disappointed that a health authority who should have been knowledgeable about health among the diverse population in New York would not have acknowledged the proper way to assess obesity among Asians.