Is the body mass index (BMI) out of Europe and the United States inaccurate?

*It is only for medical professionals to read for reference.
BMI "one size fits all" as an indicator of obesity is still very flawed! This article summarizes the body mass index: an index that is not acceptable everywhere.
European and American experience: different ethnic groups require different standards.
Chinese data: Chinese people really can’t stand fat 1 body mass index: an index that is not acceptable everywhere.
BMI (kg /m2) = weight (kg)/height (m) squared-such a simple formula was born approximately in the nineteenth century
.

The second chapter of the second volume of Sur l'homme (Sur l'homme) published in 1835 by Lambert Adolphe Jacques Quetelet, a Belgian generalist, first proposed the relationship between height and weight gain
.

Since then, people gradually determined the body mass index (BMI) as an indicator to assess whether an individual is overweight
.

However, this most commonly used obesity indicator is constantly being challenged by new evidence
.

Figure 1.
1 Ketterer who "invented" BMI and his book "On the Man" By the 1990s, the World Health Organization (WHO) expert committee proposed that BMI ≥ 25.
0 kg/m2 is overweight, and BMI ≥ 30.
0 kg/ m2 is obesity[1]
.

However, the determination of this threshold is mainly based on the observation results between BMI and death risk among European and American whites
.
It has been doubtful whether it is applicable to other ethnic groups .

After this point of view was put forward, new research has always shown that as long as the BMI of Asian population is slightly higher, the risk of death is greatly increased
.

 In response to these emerging new evidence, WHO recommended in 2004 to lower the obesity threshold for obese people in South Asia to 27.
5 kg/m2 [2]
.

According to this recommendation, the British National Institute of Health and Clinical Optimization (NICE) guidelines have reduced the BMI of the South Asian and Chinese population to trigger life>
.

However, this change may not be enough to take care of everyone
.

In fact, BMI's initial practice of determining the overweight and obesity threshold based on the risk of death for whites largely ignored the needs of other ethnic groups, and naturally it would be inaccurate
.

At present, the evidence in blacks, South Asians, Chinese and Arabs is still insufficient, and it is difficult to provide sufficient support for follow-up treatment and management
.

 2 European and American experience: Different ethnicities require different standards.
A recent study published on Lancet Diabetes Endocrinol [5] tried to find the BMI cut-off point suitable for different ethnic groups, and found that diabetes with a white BMI of 30 kg/m2 The risk is used as a benchmark.
The risk of diabetes is high enough for the South Asian population even before being obese, and the Asian population has to be careful when they first set foot on the "slightly fat"
.

Figure 2.
1 Dr.
Rishi Caleyachetty, the first author of the study.
This study used data from electronic health records across primary healthcare and secondary healthcare records from the England General Practitioner Medical Network, incorporating data from more than 1.
47 million participants Among them, there are more than 1.
33 million whites, 75,000 South Asians, nearly 50,000 blacks, slightly more than 10,000 Chinese, and 2764 Arabs
.

The study used the white obesity value, that is, the risk of diabetes when the BMI reached 30.
0 kg/m2, as a benchmark, and determined the BMI cut-off value when different ethnic groups reached the same risk
.

 It was found that during a median follow-up of 6.
5 years, nearly 100,000 (6.
6%) participants were diagnosed with type 2 diabetes
.

At the diabetes risk level when the white BMI is 30.
0 kg/m2, the South Asian population needs to face the same level of diabetes risk even before being overweight.
The BMI cut-off value is only 23.
9 kg/m2 (95%CI 23.
6).
-24.
0 kg/m2), really lost at the starting line
.

In the Chinese population, the corresponding BMI cut-off value is 26.
9 kg/m2 (95% CI 26.
7-27.
2 kg/m2), which is close to the Arab population’s 26.
6 kg/m2 (95% CI 26.
5-27.
0 kg/m2), while the black The corresponding BMI critical value is 28.
1 kg/m2 (95%CI 28.
0-28.
4 kg/m2)
.

A similar conclusion can be obtained when the risk of diabetes with a BMI of 25.
0 kg/m2 in whites is used as the standard
.

 Figure 2.
2 The risk of South Asians is soaring, and the conclusions of the study of Chinese people in the middle are quite consistent with many previous studies [6-9].
Researchers have found that BMI as an indicator of obesity still has a lot of flaws.
If different ethnic groups have different BMI thresholds for reaching the same diabetes risk level, then the risks of other diseases related to BMI may also be different.
The one-size-fits-all approach does not work for the management of BMI and type 2 diabetes risk.
It needs to be based on different groups of people.
Features provide proper clinical monitoring
.

3 Chinese data: Chinese people really can’t afford to lose weight.
The 2020 edition of the “Guidelines for the Prevention and Treatment of Type 2 Diabetes in China” [10] pointed out that the increasing prevalence of overweight and obesity is one of the influencing factors of the diabetes epidemic in China, which is related to urbanization and aging.
And genetic susceptibility is tied
.

The prevalence of diabetes in overweight and obese people has increased significantly
.

 However, in order to better reflect the risk of diabetes in the Chinese population, the old cut-off values ​​of 25 kg/m2 and 30 kg/m2 cannot be followed by Europeans and Americans
.

The Chinese Obesity Working Group proposed new schemes of 24 kg/m2 and 28 kg/m2 in 2002, and at the same time set the waist circumference of men ≥ 85 cm and women’s waist circumference of ≥ 80 cm as the standard for abdominal obesity [11]
.

Recent studies have further analyzed the effects of BMI and waist circumference on the risk of death, major chronic diseases, and metabolic abnormalities [12-15]
.

 Figure 3.
1 Prospective Study of Chronic Diseases in China This series of studies are based on the China Kadoorie Biobank project jointly carried out by the Chinese Academy of Medical Sciences and the University of Oxford in the United Kingdom
.

The study recruited more than 500,000 local permanent residents in 5 rural areas and 5 cities in China, conducted a baseline survey from 2004 to 2008, and selected 20,000 living participants from 2013 to 2014 to conduct the second This survey analyzed the impact of BMI and waist circumference on health
.

 The results after 7.
2 years of follow-up mainly focused on the relationship between BMI and death risk, and found that compared with participants with BMI 20.
5-22.
4, BMI<18.
5 kg/m2, BMI 18.
5-20.
4 kg/m2, and BMI ≥35 The risk of all-cause death in kg/m2 participants was increased
.

The BMI ranges with relatively low risk of death from various diseases are 18.
5-23.
9 kg/m2 for ischemic heart disease, <26.
0 kg/m2 for cerebrovascular disease, 26.
0-34.
9 kg/m2 for malignant tumors, and 24.
0-25.
9 kg for respiratory diseases.
/m2
.

However, follow-up studies have found that although the relationship between BMI and death risk is U-shaped, it is true that the thicker the waist, the easier it is to die
.

Figure 3.
2 The relationship between BMI and the risk of death from various diseases is U-shaped.
With the increase of BMI and waist circumference, the prevalence of hypertension, diabetes, and dyslipidemia has been increasing
.

According to the latest results, the critical value of overweight BMI for males and females selected by the study is close to 24.
0 kg/m2, while the critical value of obesity for various diseases is between 27.
0-28.
9 kg/m2, most of which are close to 28.
0 kg/m2, so it is still 28.
0 kg/m2.
kg/m2 is the critical point of obesity
.

The critical value of male waist circumference is close to 85cm, while the critical value of female waist circumference is between 80-85cm
.

 Figure 3.
3 People with fat waist and thick waist, high blood pressure, and diabetes.
To manage obesity, first of all, the Chinese must have their own obesity standards
.

In previous multi-ethnic studies [5-7], the critical value of BMI for overweight Chinese people ranged from 23.
6-26.
0 kg/m2 [5-7], while in a recent Chinese study [16-18], males The critical value of BMI for overweight ranges from 23.
2-26.
3 kg/m2, while for women it ranges from 22.
1-24.
4 kg/m2, which continues to support the original standard of 24.
0 kg/m2
.

 At present, the obesity pandemic in China has become an indisputable fact[19], but the follow-up management measures for obesity have not completely kept up[20], and it has even reached the point where Lancet Diabetes Endocrinol is eager to publish a series of articles to speak out! The Chinese became "the fattest in the world"! What's the reason? "The Lancet" has been published! References: [1] WHO.
Physical status: the use and interpretation of anthropometry.
1995.
Accessed via https://apps.
who.
int/iris/bitstream/handle/10665/37003/WHO_TRS_854.
pdf on 2021-06- 03.
[2] WHO Expert Consultation.
Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
Lancet.
2004 Jan 10;363(9403):157-63.
doi: 10.
1016/S0140-6736(03 )15268-3.
[3] National Institute for Health and Care Excellence.
BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups.
Public health guideline [PH46].
July 3, 2013.
Accessed via https: // on 2021-06-03.
[4] Misra A.
Ethnic-Specific Criteria for Classification of Body Mass Index: