Obesity and Metabolic Care of Children of South Asian Ethnicity in Western Society

Abstract

South Asians constitute one-fourth of the world’s population and are distributed significantly in western countries. With exponentially growing numbers, childhood obesity is of global concern. Children of South Asian ancestry have a higher likelihood of developing obesity and associated metabolic risks. The validity of commonly used measures for quantifying adiposity and its impact on metabolic outcomes differ by race and ethnicity. In this review we aim to discuss the validity of body mass index (BMI) and other tools in screening for adiposity in South Asian children. We also discuss the prevalence of overweight and obesity amongst South Asian children in western countries and the differences in body fat percentage, adiposity distribution, and metabolic risks specific to these children compared to Caucasian children. South Asian children have a characteristic phenotype: lower lean mass and higher body fat percentage favoring central fat accumulation. Hence, BMI is a less reliable predictor of metabolic status in these children than it is for Caucasian children. Furthermore, the relatively lower birth weight and rapid growth acceleration in early childhood of South Asian children increase the risk of their developing cardiometabolic disorders at a younger age than that of Caucasians. We emphasize the need to use modified tools for assessment of adiposity, which take into consideration the ethnic differences and provide early and appropriate intervention to prevent obesity and its complications.

Obesity in South and Southeast Asia—A new consensus on care and management

“…These approaches depend on standard growth data for children in a given country and can be skewed by ethnic diversity within the population. As in adults, BMI underestimates body fat percentage in South Asian children, owing to the lower lean body mass at a given bodyweight in this population, relative to European‐based norms 58 . If BMI percentile is used to assess childhood obesity, country‐specific childhood growth chart data should be used, when available.…”

“…As in adults, BMI underestimates body fat percentage in South Asian children, owing to the lower lean body mass at a given bodyweight in this population, relative to European‐based norms. 58 If BMI percentile is used to assess childhood obesity, country‐specific childhood growth chart data should be used, when available. If country‐ or population‐specific data are not available, the International Obesity Task Force charts can be considered.…”

“…When BMI findings are borderline or ambiguous, clinical findings suggesting insulin resistance 63 or hypertension (HTN) will increase the index of suspicion that a child is developing unhealthy excess weight. 58 Further assessment is warranted, along with serial monitoring of weight or BMI.…”

“…When BMI findings are borderline or ambiguous, clinical findings suggesting insulin resistance 63 or hypertension (HTN) will increase the index of suspicion that a child is developing unhealthy excess weight. 58 Further assessment is warranted, along with serial monitoring of weight or BMI. As described below, clinical assessment should include three elements: An extensive history, including personal medical, social (e.g., nutritional, physical, and cultural), and family history; a physical examination; and laboratory and diagnostic tests to identify complications of obesity (Table 2).…”

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“…The first effect of obesity is the mental illness/awareness it can cause due to social obstacles/perceptions (3). The second effect of obesity is the metabolic changes including increased risk of diabetes, insulin resistance, metabolic syndrome, gallbladder disease, hypertension, cardiovascular disease, and cancer (4).…”