Examine exhibits BMI reduce offs for weight problems and diabetes threat don’t work for non-white populations

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New research, presented at this year’s European Obesity Congress (ECO) and simultaneously published in The Lancet Diabetes & Endocrinology, shows that the limits for the Body Mass Index (BMI) are currently set by the World Health Organization (WHO) and the UK National Institute for Health and Care Excellence (NICE) are not suitable for Black Asian and Ethnic Background (BAME) adults in England and could potentially endanger their health.

“This study shows that the one-size-fits-all approach to BMI and type 2 diabetes risk really doesn’t work when we look at the diverse population of the UK,” says lead author Dr. Rishi Caleyachetty, Junior Physician and Epidemiologist at the University of Warwick, UK. “As a doctor, I am extremely concerned that if the current BMI values ​​for BAME patients are not appropriately changed, many BAME patients are unnecessarily slipping through the web, placing them unknowingly at risk for type 2 diabetes.”

Researchers from four leading institutions (Warwick University, Oxford University, London School of Hygiene and Tropical Medicine, and UCL Institute of Health Informatics) have partnered with the Ethnic Health Forum to create this population-based cohort study with linked primary care and electronic secondary care records from England.

The study consisted of people aged 18 and over who were registered with a general practitioner in England between 1990 and 2018. A total of 1,472,819 people with complete BMI and ethnicity data with a follow-up period of at least 1 year (1,333,816 whites, 75,956 South Asian women, 49,349 blacks, 10,934 Chinese, 2,764 Arabs) were included in the analysis. The researchers used statistical models to confirm whether adults from BAME groups had an equivalent risk of type 2 diabetes with a lower BMI than the white European population.

For the equivalent age- and sex-adjusted incidence rate of type 2 diabetes at a BMI of 30.0 kg / m2 in white populations, the BAME BMI limits were much lower: for South Asians, 23.9; Chinese, 27.0; Black 28.2; and Arabs 26.8.

The results of this study come at a critical time as the focus is increasingly on health inequalities that affect millions of people with a BAME background, as well as the link between obesity and COVID-19 (a disease that is also adversely affected British BAME persons).

Co-researcher of the study, Dr. Thomas M Barber (Associate Professor and Honorary Consultant Endocrinologist at the University of Warwick and Coventry and Warwickshire University Hospitals) [UHCW]), UK, and Clinical Director of Obesity Service at UHCW, says: ‘”These data are very important and should provide future clinical guidance and guidelines on obesity management in BAME individuals. Our data also encourage an individualized approach to effectiveness Screening and management of obesity-related diseases (such as type 2 diabetes) in BAME patients. “

Currently, both WHO and NICE recommend a BMI limit of 27.5 kg / m2 to define obesity in both South Asian and Chinese populations and to trigger lifestyle interventions. This new study clearly showed that compared to the risk of developing type 2 diabetes with a BMI of 30.0 kg / m2 in white populations, the equivalent risk in people of South Asian origin with a BMI of 23.9 kg / m2 occurred, a limit that was much lower than the WHO and NICE recommendations.

Dr. Paramjit Gill (Professor of General Practice, General Practitioner and Head of Health Sciences at Warwick Medical School at the University of Warwick), UK, said: “This work underscores that we need evidence for all races as it is based on different BMI Levels are at risk for diabetes. A blanket approach is no longer acceptable. “

With these new findings, the research team believes that general practitioners and other health professionals will feel encouraged to use these ethnically specific BMI limits to trigger measures to prevent type 2 diabetes in England.

An important finding from this study is that BAME people from England will have a better and more personal understanding of the BMI limits. In addition, the results will help to raise awareness within these groups of the increased risk of type 2 diabetes with much lower BMI values ​​than previously recognized.

It is crucial that Dr. Caleyachetty and the research team are now working closely with key organizations to share the findings with policy makers from the UK Government’s Department of Health and Welfare, NHS professionals and BAME staff in England.

The reasons for the different BMI limits for different ethnic groups are said to be: “Whether lower BMI limits for non-white populations are due to differences in body composition, biochemical properties, lifestyle factors (such as physical activity or diet), genetics or lifestyle Gene interactions remain unclear. Future studies examining the relative contributions of these mechanisms to the development of type 2 diabetes may help explain our study results. “

Dr. Caleyachetty explains, “This far-reaching, comprehensive study has revealed a worrying generalization of BMI limits for obesity at the expense of people of different ethnic backgrounds. A complete overhaul of ethnic specificities BMI limits to trigger preventive action Type 2 diabetes is required. This will ensure that healthcare professionals provide BAME patients with appropriate recommendations on lifestyle changes, weight management referrals, and type 2 diabetes screening. “

He added: “We hope that this study will quickly initiate a review of current BMI policies in the UK for BAME patients to both prevent type 2 diabetes and provide early and effective treatment for type 2 – Facilitating diabetes. We all know the NHS was founded on the principles of fairness and that all patients, regardless of their background, should be treated equally, but it is clear right now that for many BAME people these principles may not be a reality. ”

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Provided by the European Association for the Study of Obesity

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