Updated: Nov 16
Body Mass Index (BMI) is a simple height versus weight formula that allows us to calculate if people are under, normal or over weight. Having a high BMI has implications for the risk of becoming diabetic, as well as increased risk of overall mortality, cardiovascular disease and cancer. In multi-ethnic Singapore, when comparing people's BMI numbers and relative risk of type 2 diabetes there are differences to be found between ethnicities and individuals themselves. Asian populations are also prone to a condition known as skinny fat. In this article we will look at the latest research and how these numbers apply to us all.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to any supporting studies or resources are at the end of page.
In 1993 the World Health Organization (WHO) set a normal weight level at between BMI 18.5 to 24.9. Those above BMI 25 labelled as overweight, those above BMI 30 as obese and above BMI 40 as morbidly obese. This numbers are still used by health authorities around the world.
Some factors can however skew the results. For example, people with a high muscle mass, for example, body builders – can have a high BMI without having a high fat mass. As the WHO’s BMI numbers were based on data obtained primarily from white populations, they did not account for differences in BMI and health between different ethnicities as body fat distribution differs by race-ethnicity, in turn affecting health.
In Singapore, with its mixed Chinese, Malay and South Asian population, the BMI for a normal (healthy) weight is set by the government’s Health Promotion Board at BMI 18.5 to 22.9 - lower than the healthy weight range for Caucasian populations.
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BMI and the Risk for Diabetes
A 2021 study from the UK set out to review the ability of BMI to predict the future occurrence of diabetes within specific ethnic groups. It demonstrated that compared to the risk for development of type 2 diabetes in White populations at BMI 30 (obese), the same risk amongst South Asians occurred at BMI 23.9.
The BMI 25 cut off for being overweight in White adults translated to a BMI of 23.4 for Black adults, BMI 22.2 for Chinese, BMI 22.1 for Arab and a markedly lower BMI of 19.2 for South Asian adults.
Essentially, people who outwardly appear thinner (having a lower BMI) can still have similar risk profiles as their overweight contemporaries. This is sometimes called skinny fat. Why this marked difference for South Asians? Due to smaller body frames, higher levels of belly fat (visceral adiposity) and differences in insulin regulation compared to other ethnicities.
In ethnically mixed Singapore, researchers found similar results within the Chinese population when studying the ratios of body fat to BMI. Body fat percentages were also higher (compared the the WHO standard) at lower levels of BMI.
Similar to ethnic differences in risk of diabetes is the concept of individual variation in body fat that can affect the onset of diabetes. This is known as the personal fat threshold.
Successfully managing one'e weight has profound implications for health, both for the risk of diabetes and other chronic illnesses. Weight loss can be a real challenge in Singapore, for many reasons. Our coaching based programmes support sustainable weight loss and long-term health. Physical activity, sleep, stress, work-life balance, social relationships - the pillars of health – all have a role to play. This requires lifestyle change, where we, at The Whole Health Practice, dedicate our energy and support our clients on their unique journeys to health.
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Caleyachetty R, Barber TM, Mohammed NI, Cappuccio FP, Hardy R, Mathur R, Banerjee A, Gill P. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2021 Jul;9(7):419-426. doi: 10.1016/S2213-8587(21)00088-7. Epub 2021 May 11. Erratum in: Lancet Diabetes Endocrinol. 2021 Jul;9(7):e2. PMID: 33989535; PMCID: PMC8208895.
Chen KK, Wee SL, Pang BWJ, Lau LK, Jabbar KA, Seah WT, Ng TP. Relationship between BMI with percentage body fat and obesity in Singaporean adults - The Yishun Study. BMC Public Health. 2021 Jun 1;21(1):1030. doi: 10.1186/s12889-021-11070-7. PMID: 34074272; PMCID: PMC8170923.
Ow Yong, L., Koe, L.W.P. War on Diabetes in Singapore: a policy analysis. Health Res Policy Sys19, 15 (2021). https://doi.org/10.1186/s12961-021-00678-1
Kanaya AM, Herrington D, Vittinghoff E, Ewing SK, Liu K, Blaha MJ, Dave SS, Qureshi F, Kandula NR. Understanding the high prevalence of diabetes in U.S. south Asians compared with four racial/ethnic groups: the MASALA and MESA studies. Diabetes Care. 2014 Jun;37(6):1621-8. doi: 10.2337/dc13-2656. Epub 2014 Apr 4. PMID: 24705613; PMCID: PMC4030091.