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Ethnic-specific cutpoints for obesity vs country-specific guidelines for action

International Journal of Obesity volume 27, pages 287–288 (2003)Cite this article

Recently investigators1,2,3 and policy-making organizations4,5 have questioned whether the BMI cutpoints for obesity (30 kg/m2) and overweight (25 kg/m2) currently used in the United States and in European countries are appropriate for use in Asian countries. Concern about rises in levels of cardiovascular risk factors and diabetes in some Asian countries with population prevalences of overweight and obesity that would be very modest by American standards has led to proposals that the BMI cutpoints used to define obesity and overweight be lower in Asian countries than those currently used in Western countries. In considering the dilemmas presented by the global diversity in distributions of BMI and in the accompanying morbidity and mortality, I think it useful to draw attention to the approach advocated in a recent WHO Expert Consultation on appropriate BMI for Asian populations.5 The report makes a distinction between definitions of a disease, such as obesity, and the cutpoint chosen for action by the public health and medical resources within a country.

The WHO has defined obesity as a disease in which excess body fat has accumulated to an extent that health may be adversely affected.6,7 This definition links obesity to both body fat and health. Several authors have singled out the link with body fat as a basis for arguments that the BMI cutoffs defining obesity should differ by ethnic group.3,8,9,10 Deurenberg et al3 have shown that for the same percent body fat, African Americans have 1.3 kg/m2 and Polynesians 4.5 kg/m2 higher BMI compared to Caucasians. In contrast, in Chinese, Ethiopians, Indonesians and Thais BMIs are 1.9, 4.6, 3.2 and 2.9 kg/m2 lower than Caucasians, respectively. Despite these differences, it is my opinion that the BMI cutoffs to define obesity should not be population-specific.

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Acknowledgements

I thank Dr Shiriki Kumanyika for her thoughtful discussion and helpful suggestions during the preparation of this manuscript.

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  1. Departments of Nutrition and Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA

    J Stevens

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EDITOR'S NOTE

The commentary below from Professor June Stevens was invited by the Editors because the topic is of significant importance for the obesity scientific community. Dr. Steven's presented the arguments in this commentary at a symposium of the 2002 International Congress on Obesity in San Paulo, Brazil. There has been a movement among the obesity community and in the public health establishment, including the World Health Organization, to consider developing ethnic-specific cutpoints for obesity. Dr. Steven's comments raise questions if this would be a wise decision, and the Editors hope that publication of her commentary will stimulate further debate on the topic.

Richard L. Atkinson

Editor, IJO

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Stevens, J. Ethnic-specific cutpoints for obesity vs country-specific guidelines for action. Int J Obes 27, 287–288 (2003). https://doi.org/10.1038/sj.ijo.0802255

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