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Key Takeaways
Did you know there is an Asian-specific body mass index (BMI)? Asian American and Pacific Islander (AAPI) Heritage Month is a great time to consider health equity through the lens of Asian America health, as there remains a general lack of knowledge about metabolic and cardiovascular concerns specific to this community.
Asians have a higher risk of type 2 diabetes and cardiovascular disease at BMIs lower than the existing general cut-off points for overweight, meaning that they could be overlooked when it comes to screening for these conditions if the traditional categories are used instead of the Asian-specific BMI cut-offs. Read on to learn more about BMI limitations specific to this community and how to reframe conversations around health.
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Asian American and Pacific Islander (AAPI) Heritage Month, observed each May, is a great time to think about how you’re serving this community and whether blind spots exist in your understanding of their unique health and fitness needs. Despite being one of the fastest-growing racial and ethnic groups in the U.S., there remains a general lack of knowledge when it comes to metabolic and cardiovascular concerns specific to the Asian community. Body mass index (BMI) is a perfect example of where a general understanding of a topic may not be adequate to optimize your coaching or training with a particular client or ethnic group. Before we explore why we may have to shift our understanding of BMI when working with members of the AAPI community, let’s review the pros and cons of this commonly cited value, which is simply a ratio of a person’s weight and height: BMI = weight (kg)/height2 (m).
What BMI Does Well – and Where It Falls Short
BMI has some well-documented limitations, but it remains in widespread use, particularly in the healthcare space, where it serves as an initial screening tool, especially in public health settings where simple and scalable measures are needed to evaluate the collective health status of large populations. At an individual level, BMI can serve as a starting point for identifying potential health risks and prompting deeper evaluations.
That said, use of BMI on an individual level, where it’s used as a criterion for determining eligibility for certain medical treatments, including anti-obesity medications, is a cause for concern. The primary issue is that BMI does not distinguish between muscle mass and fat mass. A person who is very muscular might qualify for medication despite being metabolically healthy, while another with high visceral fat (i.e., a dangerous type of fat that accumulates around the internal organs), but a “normal” BMI, might be overlooked.
Why BMI Falls Short for the AAPI Community
The commonly cited BMI categories used in research and clinical practice are as follows: a BMI of 30 kg/m2 or greater equates to obesity, while a BMI of 25.0 to 29.9 kg/m2 means a client has overweight. But, did you know that those numbers are not accurate for members of the AAPI community?
Asian Americans have a low prevalence of overweight and obesity based on those standard BMI cut points, but they have higher rates of diabetes. The issue here is that members of this community may not receive the diagnostic screenings to identify diabetes if the initial BMI screening does not define them as being at risk. For example, if a patient has a BMI of 24.2 kg/m2, they may not be screened for diabetes, as they are considered to be of a healthy weight.
According to the American Heart Association, “Asian Americans are more likely to have better overall cardiovascular health than white Americans, but they lose that standing when the comparison is made using a lower, Asian-specific threshold for body mass index.”
And, a study on cardiovascular health among Asian Americans found that, while this population was found to be 42% more likely to have “ideal” cardiovascular health compared to the non-Hispanic white population, that difference vanished when using a lower BMI threshold to define the overweight and obesity categories.
This type of research reveals the reason for a shift in our understanding of BMI—and a shift in the values themselves—for the Asian community: The World Health Organization recommends the following BMI cut points for Asians:
- Overweight = 23.0 to 27.4 kg/m2
- Obesity = 27.5 kg/m2 or greater
What This Means to Health and Fitness Professionals
So, what does this all mean? Because Asians have a higher risk of type 2 diabetes and cardiovascular disease at BMIs lower than the existing general cut-off point for overweight (i.e., 25.0 kg/m2), they should be screened for metabolic and cardiovascular conditions and perhaps be eligible for appropriate interventions at lower BMIs than the rest of the population.
As a health coach or exercise professional, it’s important that you don’t assume a certain level of health just because a client “looks” leaner or has a lower BMI. The existence of Asian-specific BMI categories may also help clients frame their health choices differently and perhaps use additional metrics to know where they stand and to set and pursue goals. A client may have a “healthy” BMI based on the general categories but still need to be mindful of their health.
AAPI Heritage Month is a timely reminder to ensure that all communities are included in conversations around health equity. By broadening your understanding and approach, you can more effectively support the well-being of your AAPI clients and help close the gaps in care that persist across our healthcare and fitness systems.
