**Title: Tackling Obesity in the Asian American Community**
**Introduction**
Obesity is a growing concern worldwide, affecting people from all walks of life. However, recent studies have shown that obesity rates among Asian Americans are significantly lower compared to other ethnic groups. This raises the question of whether the standard criteria used to diagnose obesity, such as the Body Mass Index (BMI), accurately reflects the health risks faced by Asian Americans. In this article, we explore the unique challenges and implications of obesity in the Asian American community, shedding light on the importance of tailored healthcare and cultural sensitivity.
**Obesity Rates and Challenges**
According to the World Health Organization, the global obesity rate has nearly tripled since 1975, and in the United States alone, approximately 42% of American adults are categorized as obese. However, Asian Americans buck this trend, with an obesity rate of only 11%. These statistics suggest that the standard BMI criteria may not accurately capture the full picture of obesity in the Asian American community. Experts argue that alternate guidelines, such as considering a BMI of 23 or higher for overweight and 25 or higher for obesity among Asian Americans, may be more appropriate due to the higher prevalence of cardiovascular and metabolic diseases at lower body weights in this population.
**Varied Rates within the Asian American Community**
It is important to recognize that obesity rates may differ among different subgroups within the Asian American community. For example, Filipino Americans and South Asians tend to have higher rates of overweight and obesity compared to East Asians. Furthermore, research indicates that a longer duration of living in the United States is associated with higher average BMI. These findings highlight the influence of culture, lifestyle, and environmental factors on obesity trends within this community.
**Limitations of the BMI Standard**
Using a standard like the BMI, which is based on a population primarily comprised of Caucasians or those of European descent, to assess obesity across diverse populations can potentially overlook important variations. Each ethnic group carries different risks and predispositions, making it imperative to avoid a one-size-fits-all approach. Failure to consider these differences may result in underdiagnosing or underscreening certain populations, while overdiagnosing or overscreening others.
**Unique Factors for Asian Americans**
There are several misconceptions surrounding the issue of obesity in the Asian American community. Many individuals believe that being thin or adhering to a traditional Asian diet automatically safeguards them against obesity-related health problems. However, studies suggest that Asian Americans may experience cardiovascular and metabolic diseases at lower BMI levels compared to other populations. Genetic variations in the way fat is stored, particularly an increased tendency to accumulate visceral fat, contribute to the higher risks seen in this community. Visceral fat, located around organs, can lead to dysfunction and an increased likelihood of developing cardiovascular disease, metabolic syndrome, diabetes, and cholesterol problems.
**The Role of Diet, Exercise, and Cultural Perspectives**
While genetics play a significant role in obesity, lifestyle factors such as diet and physical activity are also crucial. However, it is important to acknowledge that cultural norms and perceptions may impact the adoption of healthy lifestyles. Some Asian Americans may be hesitant to pursue fitness routines that are viewed as too intense or incompatible with their cultural background. Healthcare providers should aim to provide tailored counseling, leveraging culturally appropriate activities such as tai chi or incorporating practical suggestions like carrying groceries as a form of exercise. Encouraging small, sustainable changes to diet, such as substituting refined grains with brown or wild rice, can also make a significant impact.
**Counseling and Awareness among Healthcare Providers**
Healthcare providers have a vital role in addressing the obesity epidemic within the Asian American community. By recognizing the limitations of the BMI standard, they can employ alternative indicators like waist circumference to assess the risk of visceral fat accumulation. It is essential to approach patients in a non-alienating manner, taking into account their cultural perspectives and beliefs. Engaging in open and inclusive discussions about the importance of a healthy diet, regular exercise, and routine check-ups can help mitigate the underdiagnosis and undertreatment of obesity-related conditions among Asian Americans.
**Key Takeaways and Closing Thoughts**
The Asian American community faces unique challenges in addressing obesity and related health risks. Despite lower obesity rates compared to other ethnic groups, Asian Americans cannot afford to be complacent about their health. Genetic predispositions, coupled with the adoption of a Westernized lifestyle, can increase the risk of developing cardiovascular and metabolic diseases. Healthcare providers must adopt culturally sensitive approaches to counseling, recognizing the limitations of standardized criteria, and opting for more tailored assessments. By promoting awareness and empowering individuals to make small, sustainable changes to their diet and physical activity, the Asian American community can take proactive steps towards preventing and managing obesity-related health problems.
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Obesity It is a medical condition that is found everywhere. It is almost three times more common worldwide than in 1975, according to the World Health Organization.
In the US, almost 42% of American adults are obese, CDC data show. But it is less common among Asian Americans. Some experts have suggested that the standard definition of obesity (having a BMI 30 or older, may not be the best option for Asian Americans.
In this interview, Jennifer Ng, MD, a board-certified obesity medicine specialist in New York City and chair of the Obesity Medicine Association Outreach Committee, discusses how obesity affects Asian Americans and what What they need to know about this condition. This interview has been edited for length and clarity.
WebMD: How did you become interested in obesity medicine?
ng: When I started practicing medicine, many of the patients I saw had high BMIs, and this occurred across different socioeconomic classes. I was very surprised. This was not something I was aware of when I was in medical school or residency. Medical school did not train me to handle this or tell me how to counsel patients. It’s frustrating when you’re trained to be the person who gives the answers and you just don’t have the answers. I wanted to learn more.
WebMD: How do obesity rates within the Asian American community compare to other demographic groups?
ng: The obesity rate among Asian Americans is approximately 11%, which is lower compared to many other ethnicities. Under current criteria, a body mass index (BMI) of 25 or higher is considered overweight and 30 or higher is considered obese, and that applies across the board.
But there is concern that we are not capturing the full spectrum of the problem because the BMI and the standard for measuring obesity and overweight are based on people of European descent.
There are some differences between ethnicities that we must take into account. Some guidelines suggest that perhaps we should consider Asian Americans to be overweight and obese with a lower BMI (a BMI of 23 or more for overweight and 25 or more for obesity) because there appears to be a higher prevalence of diseases cardiovascular and metabolic disease with lower body weight among Asian Americans.
WebMD: Do rates of overweight and obesity differ among different subpopulations of Asian Americans?
ng: Different subgroups within the Asian community may have different rates of overweight or obesity. For example, Filipino Americans and South Asians tend to have a higher rate compared to East Asians. I will say that things change depending on how long you have lived in this country. Higher BMI appears to be associated with living longer in the United States.
WebMD: When we use a standard like BMI that is based on a population of people like Caucasians or those of European descent and then generalize those findings across populations, what are we potentially missing?
ng: We want to make sure we don’t apply one standard to everyone because people are different. People of different ethnic backgrounds run different risks. When we use only one standard, we sometimes underdiagnose or underscreen certain populations or overdiagnose or overscreen other populations.
WebMD: How does this affect the Asian American population?
ng: There are a lot of misconceptions out there. I have a lot of Asian Americans who come to my office and they don’t believe that overweight and obesity is an Asian problem because there is a trend for Asian Americans to be thinner, they don’t have a family history. , or do not follow a Western diet. They may think they don’t need to exercise or worry about their diet.
Primary care physicians may also be unaware and may underdiagnose or evaluate Asian American patients.
WebMD: Why do Asian Americans experience cardiovascular and metabolic diseases at lower BMI compared to other populations?
ng: You can gain fat in different ways. The size of fat cells may increase or the number of fat cells may increase. There is genetic variation in the way people store fat. It seems that, especially in the South Asian community, there is a tendency to increase the size of fat cells, which seems to be more problematic than increasing the number of fat cells. Fat becomes “ill” and begins to produce inflammatory markers and abnormal hormones, which can lead to many of the problems we see with metabolic diseases.
It is thought that within the East Asian and South Asian community there is an increasing tendency to store fat also as visceral fat. It is the most dangerous fat that is stored in and around the organs. Our organs are not equipped to store fat, so they become dysfunctional. This can lead to an increase in cardiovascular disease, metabolic syndrome, diabetes and cholesterol problems.
For example, if you store more fat in the liver, inflammation occurs because the fat produces inflammatory markers and disrupts the functioning of normal liver cells. This can cause problems metabolizing cholesterol, glucose, and fats. If your glucose control is affected because your liver is not working properly, your pancreas begins to release more and more insulin. That can cause diabetes and insulin itself causes fat cells to grow.
WebMD: Aside from genetics, what else seems to be driving overweight and obesity rates among Asian Americans? Do diet and exercise matter among Asian Americans?
ng: Diet and lifestyle certainly play a role, but so do environmental factors. If people work a lot, live far from work, don’t have the opportunity to eat healthy foods, and aren’t physically active, this becomes problematic. The diet that may have worked for them before moving to the United States, where they were more active and less sedentary, may not work here.
There are misconceptions about exercise among my patients of Asian descent, especially older ones who did not grow up in the United States. They say, “This is not something Asians do. It’s too much. “It’s too intense.”
WebMD: How do you counsel your Asian American patients?
ng: Every patient is different. I’m a primary care doctor, so when they come to me, I evaluate their overall health, their diet, and their exercise and see where they are at. Regardless of BMI or weight, I educate them about healthy diets and exercise.
When I see patients of Asian descent in my office, I am more attentive. I use the lower BMI criteria to counsel my patients and begin monitoring symptoms to consider whether they might be at risk for cardiovascular or metabolic disease. I also use waist circumference to evaluate patients because BMI does not always accurately indicate body composition. Waist circumference may be a better marker for visceral fat, which is a more concerning risk factor for cardiovascular and metabolic diseases.
You don’t want to alienate your patient. You want them to come back. I try to meet them where they are because you cannot destroy them or their culture. I’ll suggest tai chi, which is a gentle exercise that helps develop balance and strengthen muscles, or bodyweight exercises like carrying groceries. I will suggest trying brown rice or wild rice or reducing the portions. Small changes are better than no changes.
WebMD: What do you want Asian Americans to know? What message do you have for them?
ng: My main message is that just because you are thin or in the normal range of standard BMI criteria does not mean you are not at risk. It’s still important to eat healthy, exercise, and see your doctor regularly. Many conditions are reversible if detected early, even if you have a genetic predisposition. There are changes you can make to your diet or lifestyle that can affect obesity and other disease risks.
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