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Obesity

Obesity and Abdominal Obesity 

  • Atherogenic risk factor clustering is exceedingly common among Asian Indians and worsens with weight gain and obesity.1 At any given body mass index (BMI) Asians Indians (as well as other Asians) have greater fat mass (5-7%) and greater metabolic abnormalities including  increased risk of hypertension, diabetes, dyslipidemia, and  heart disease.2
  • Several studies have suggested that the optimum BMI is much lower for Indians than for Europids.3-6 Various National and international organizations including the World Health Organization  have defined specific lower BMI cut points obesity and waist circumference cut points for abdominal obesity in Asian Indians but remain largely unnoticed by the vast majority of medical community and the general public.2                 
BMI, body mass index; WC, waist circumference              


Table 124A.Cut points for obesity and abdominal obesity for Asian Indians and Europids2, 7-9
Generalized obesity Asian Indians Europids
     Normal weight BMI 18.0-22.9 BMI 18.5-24.9
      Overweight BMI 23.0- 24.9 BMI 25.0- 29.0
      Obesity BMI >25.0 BMI >30.0
Abdominal Obesity
   Men WC >90 cm WC > 102  cm
   Women WC > 80cm WC > 88cm
BMI, body mass index; WC, waist circumference

 

  • For Asian Indians, the optimum BMI for both men and women is <23 kg/m2, which is 2 units lower than BMI <25 recommended for Europids. 2, 5, 7, 8, 10, 11 A BMI 23 to 25 is considered overweight for Asian Indians as opposed to 25-25.9 for Europids. 2, 7, 8, 10
  •  The cut point for obesity is 5 units for lower in Asian Indians than Europids. A BMI >25 is considered obese for Asian Indians as opposed to >30 for Europids. 2, 7, 8, 10, 12 
  • The cut point for abdominal obesity is 12 cm lower in Asian Indian men and 8 cm lower for Asian Indian women compared to Europid men and women.2, 7, 8, 10  An Asian Indian is considered to have abdominal obesity when the waist girth is >90cm in men and >80cm in women as opposed to >102cm and 88cm for Europid men and women respectively. 2, 7, 8, 10
  • These lower thresholds for obesity and abdominal obesity among Asian Indians have enormous public health importance. Two contemporary cross sectional studies of Asian Indians in the US showed a mean BMI of 25- 26units. Using the standard criteria only 11% – 17% were obese, which increased to 50 -70% when Asia Pacific and/or Indian criteria were used. Another 25% were overweight.13, 14 Thus, Asian Indians in the US have a higher prevalence of obesity since the overall prevalence of obesity in the country is only 35%. 
  • Likewise, the prevalence of abdominal obesity among Indians in the US increases from 23% to 61% when the Asian Indian specific criteria are applied.13Also see Obesity and Abdominal Obesity.   

Sources

1. Ramachandran A, Snehalatha C, Latha E, Satyavani K, Vijay V. Clustering of cardiovascular risk factors in urban Asian Indians. Diabetes Care. 1998;21(6):967-971.

2. Asia  Pacific Perspective:Redefing obesity and its treatmentf   World Health Organization, Western Pacific  Region;2000.

3. Dudeja V, Misra A, Pandey RM, Devina G, Kumar G, Vikram NK. BMI does not accurately predict overweight in Asian Indians in northern India. The British journal of nutrition. 2001;86(1):105-112.

4. Misra A., Khurana L. Obesity-related non-communicable diseases: South Asians vs White Caucasians. International journal of obesity (2005). Jul 20 2010.

5. Deurenberg-Yap M, Chew SK, Deurenberg P. Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians. Obes Rev. Aug 2002;3(3):209-215.

6. Deurenberg P, Yap M, van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord. Dec 1998;22(12):1164-1171.

7. Misra A , Chowbey P, Makkar B. Consensus statement for diagnosis of obesity, abdominal obesity, and metabolic syndrome, for Asian Indians and recomendations for physical activity, medical and surgical management. JAPI. 2009;57:163-170.

8. Enas  EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian heart journal. 2009;61:265-74.

9. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and international association for the Study of Obesity. Circulation. Oct 20 2009;120(16):1640-1645.

10. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor SG, Chennikkara H. Metabolic Syndrome among Asian Indians: A population with high rates of diabetes and premature heart disease. . J CardioMetabolic Syndrome. 2007;(in press).

11. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141-146.

12. Razak F, Anand S, Vuksan V, et al. Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities: a cross-sectional population-based study. Int J Obes Relat Metab Disord. Jun 2005;29(6):656-667.

13. Misra R, Patel T, Kotha P, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. Journal of diabetes and its complications. Mar 18 2009.

14. Palaniappan L P, Wong EC, Shin JJ, Fortmann SP, Lauderdale DS. Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index. International journal of obesity (2005). Aug 3 2010.

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