Body Mass Index Thresholds for Asians: A Race Correction in Need of Correction?
Simar S. Bajaj, Anthony Zhong, Angela L. Zhang, Fatima Cody Stanford
Abstract
Due to a higher tendency toward central adiposity, Asian Americans face a substantial risk for type 2 diabetes, cardiovascular disease, and other comorbidities at lower body mass indices (BMIs) than other populations (1, 2).As such, in 2004, the World Health Organization (WHO) suggested new BMI categories for many Asian populations, based primarily on data measuring body fat percentage: 18.5 to 22.9 kg/m 2 for increasing but acceptable risk (normal weight), 23 to 27.5 kg/m 2 for increased risk (overweight), and 27.5 kg/m 2 or greater for high risk (obesity) (1).BMI is primarily based on data from non-Hispanic White people (3); however, the WHO recognized this metric's utility by lowering Asian cutoffs to reduce bias.Twenty years later, the United States still has not developed more granular BMI categories despite heterogeneity among Asian American ethnic groups (4, 5).With recent pushes toward disaggregated data and personalized medicine, we believe that increasing granularity for Asian Americans can pave the way for similar efforts among all racial and ethnic groups, making BMI more accurate, tailored, and equitable.Although its expert consultation explained variations in health risks between Asian subgroups, the WHO did not attempt to redefine cutoffs for each population separately; instead, it provided guidance for countries to create their own definitions (1).As such,