Using appropriate body mass index cut points for overweight and obesity among Asian Americans

Abstract

Objective: Asian Americans have low prevalence of overweight/obesity based on standard BMI cut points yet have higher rates of diabetes. We examined the prevalence of overweight/obesity, using lower BMI cut points recommended by the World Health Organization (WHO) for Asians, and diabetes in Asian American subgroups in California.

Method: Secondary analysis of the 2009 adult California Health Interview Survey (n=45,946) of non-Hispanic Whites (NHW), African Americans, Hispanics and Asians (Vietnamese, Chinese, Korean, Filipino, South Asian and Japanese). WHO Asian BMI cut points (overweight=23-27.5kg/m(2); obese≥27.5kg/m(2)) were used for Asian subgroups. Standard BMI cut points (overweight=25-29.9kg/m(2); obese≥30kg/m(2)) were applied for other groups.

Results: Among Asian subgroups, overweight/obesity was highest among Filipinos (78.6%), which was higher than NHWs (p<0.001) but similar to African Americans and Hispanics. Compared to NHW, diabetes prevalence was higher for Vietnamese, Koreans, Filipinos and South Asians with BMI=23-24.9kg/m(2) and Koreans, Filipinos and Japanese with BMI=27.5-29.9kg/m(2), the ranges WHO recommends as overweight or obese for Asians but not for other groups.

Conclusions: Filipinos should be a priority population for overweight/obesity screening. Filipinos, Vietnamese, Korean, South Asians and Japanese have higher diabetes prevalence at lower BMI cut points. WHO Asian BMI cut points may have clinical utility to identify at-risk Asian Americans.

Keywords: Asian Americans; Minority health; Obesity; Overweight; Type 2 diabetes mellitus.

Fig. 1

Weighted prevalence of overweight/obesity by racial/ethnic group adjusting for age, sex and nativity in a multinomial logistic model from the 2009 California Health Interview Survey. For non-Hispanic Whites (NHW), African American and Hispanic groups, bar represents overweight (BMI = 25–29.9 kg/m²) and obesity (body mass index [BMI] ≥ 30 kg/m²) using standard BMI cut points. For each Asian subgroup, bar represents overweight (BMI = 23–27.49 kg/m²) and obesity (BMI ≥ 27.5 kg/m²) using the World Health Organization Asian-specific BMI cut points. Prevalence of overweight/obesity among Asian subgroups was compared to other racial/ethnic groups. Statistically significant differences (p < 0.05) are indicated as follows: *versus NHW, ^†versus African American, ^‡versus Hispanic and ^versus NHW, African American and Hispanic.

Fig. 2

Weighted age, sex and nativity adjusted prevalence of type 2 diabetes by body mass index (BMI, kg/m²) strata for each racial/ethnic group from the 2009 California Health Interview Survey. BMI strata incorporate cut points from the standard and World Health Organization (WHO) Asian BMI scale. The prevalence of diabetes in each BMI strata in Asian subgroups was compared to non-Hispanic Whites (NHW) in the same BMI strata. Statistically significant differences (p < 0.05) are indicated as follows: *versus NHW, ^†versus African American, ^‡versus Hispanic and ^versus NHW, African American and Hispanic.