National Institute for Health and Clinical Excellence (NICE)
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Consider lower BMI risk thresholds for people from black, Asian and minority groups

Healthcare professionals should consider a lower body mass index (BMI) when identifying the risk of weight-related conditions among people from black, Asian and minority ethnic groups, according to latest guidance from NICE.

Evidence shows that being overweight or obese increases the risk of certain conditions, with excess body fat contributing around 58 per cent of cases of type 2 diabetes, 21 per cent of cases of heart disease, and up to 42 per cent of cancer cases

As a result, healthcare professionals use BMI and a raised waist circumference as indicators that a person might be at risk of these conditions.

Currently an adult of white European origin with a BMI of 30 kg/m2 is considered obese, and a raised waist circumference for men is defined as above 40 inches, and more than 37 inches for women.

However, the World Health Organisation believes that these thresholds are not suitable for people from black, Asian and minority ethnic backgrounds, who are much more likely to suffer from type 2 diabetes for example than their white counterparts.

Latest public health guidance from NICE confirms that people from these groups are at an equivalent risk of diabetes and other health conditions or mortality at a lower BMI than their white counterparts.

NICE recommends that GPs and other healthcare professionals should use lower thresholds for BMI to trigger action to prevent type 2 diabetes among South Asian and Chinese populations, as per NICE's pathway on type 2 diabetes.

In addition, these lower BMI thresholds should now be used to trigger action to prevent type 2 diabetes among black African and African-Caribbean populations.

Healthcare professionals should raise awareness of the need for lifestyle preventions at a lower BMI threshold for these groups to prevent type 2 diabetes.

Clinicians should follow NICE's recommendations on BMI assessment and how to intervene in the pathway on obesity. These include assessing co-morbidities, diet, physical activity and motivation along with referral to specialist care if required.

Furthermore, general awareness should be raised among both practitioners and members of the public that people of black, Asian and other minority ethnic backgrounds are at an increased risk of chronic health conditions at a lower BMI than the white population.

Existing local black and other minority ethnic information networks should be used to disseminate this information on the increased risks these groups face at a lower BMI.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: “Excess body fat contributes to more than half of cases of type 2 diabetes, one in five of heart disease and between 8 and 42 per cent of certain cancers (breast, colon and endometrial).

"The number of people affected by these health conditions is far greater among black, Asian and other minority ethnic groups - despite the fact that rates of obesity among these groups are similar amongst the white population.

"Therefore, the point at which the level of body fat becomes risky to health varies between ethnic groups."

He added: "This new guidance supports previously published NICE recommendations on diabetes prevention and highlights recommendations from NICE and other sources in relation to awareness raising, and will help ensure that people at risk of these conditions could be identified at the earliest opportunity to make sure they receive the right advice or preventative action for them."

Catherine Law Professor of Public Health and Epidemiology, UCL Institute of Child Health and Chair of the group that developed the guidance, said: "There is clear evidence that black Asian and minority (BAME) groups are at a higher risk of diabetes than white populations with the same BMI and waist circumference values - 6 times higher among South Asian groups. It also tends to develop at a younger age and progress is faster.

"Our recommendations should help those assessing BMI and waist circumference to be aware that people from BAME groups are at equivalent risk for diabetes and mortality at a lower BMI than white people and then to act to help reduce those risks.

"We also recommend that health professionals and managers work in partnership with existing BAME community initiatives to raise awareness of this risk."

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