The American Diabetes Association (ADA) is lowering the Body Mass Index (BMI) cutpoint for screening Asian-Americans for type 2 diabetes to a BMI of >23kg/m2. In the new article, the evidence for a lower BMI cutpoint is discussed. The authors note the presence of Asian-Americans and the projections for their increasing population, especially in 10 states, including California, New York, Texas, New Jersey, Hawaii, Illinois, Washington, Florida, West Virginia, and Pennsylvania. The authors also note the limitations of current measurement techniques, observing that BMI does not into account the relative proportions of fat and lean tissue and cannot distinguish the location of fat distribution. There is a propensity for Asians to develop visceral versus peripheral adiposity which is more closely associated with insulin resistance and type 2 diabetes. The new standard is not a measure of increased mortality or morbidity but a guide how to use BMI to screen for the presence of type 2 diabetes, with a focus on reacting to BMI cut-offs for eligibility of weight-reduction services or treatment reimbursable by payers.
There a couple of points. First, it is unfortunate that the ADA is not taking on the use of BMI for criteria for products (such as anti-obesity drugs) or services. Changing the BMI cut-offs to accommodate a poor public policy only adds to the distortion of our understanding of excess adipose tissue. The paper understates the fact that the BMI is such a poor standard for use in clinical settings. Third, aside from the literature about cut-offs, the problem is “Who is an Asian-American?” In addition to covering a number of various ethnic groups, determining whether one is “Asian-American” has a host of problems, including the issue of inter-marriage. Demographers are having a hard time determining just what “Asian-American” means. The problem originates with the Census Bureau criteria, as well as the problem of inter-marriage and self-identification as Asian-American versus White. Historically, the Census Bureau has combined Asians, Native Hawaiians and other Pacific Islanders, even though there are significant differences in physiology and body composition between Asians and the other two groups. Listen to this interesting discussion on the Diane Rehm Show on NPR on January 5, 2015 on this very topic.