Partly due to genetics, Asians are disproportionately likely to have diabetes, getting the disease at lower weights and younger ages than other groups. And this is what health practitioners are seeing out in the field.
Dr. Ronesh Sinha, seeing patients in his clinic in Redwood City, California, knew from medical school that people typically diagnosed with type 2 diabetes are often middle-aged, sedentary and feasted on fast food and soda. However, those visiting his office for diabetes were usually slender Asian Americans who are in their 30s, ate healthy and regularly exercised.
“Maybe, I thought, this is just an anomaly,” he says in an LA Times report.
Except that it wasn’t, as the trend he is noticing is now backed by research. Asians are at a higher risk of developing type 2 diabetes as they are more likely to have less muscle and more abdominal fat, which increases insulin resistance.
The condition – characterized by blood sugar levels that are higher than normal and can result in blindness, strokes and amputations – is usually undiagnosed until it is too late, particularly in Asians who haven’t been traditionally deemed high-risk.
Certain diet and lifestyle trends are pinpointed for this greater risk among Asians. These include increased urbanization and modernization that curtailed physical activity, smoking, consumption of white rice and other refined grains, unhealthy trans fats, increased fast food intake due to globalization, air pollution and poor maternal nutrition.
Thus, doctors are pushing for better testing and treatment among Asian Americans, including Indians, Chinese and Filipinos.
"We began with ‘diabetes is not a big problem in the Asian community,’" shares internist Dr. Edward Chow, who has served patients in Chinatown in San Francisco since the '70s. Now, he adds, “simply being Asian is a risk factor.”
It’s no longer true that Asians have the lowest diabetes rate despite having the lowest obesity rate of any ethnic group, for instance, in Los Angeles County. Ten percent of them are diabetic, compared with 7 percent in whites. For some experts, the mismatch is due to obesity being a measure of weight and not really fat, which is the main culprit in diabetes.
With the tendency to have less muscle and more fat than Europeans of the same height and weight, an Asian who is not necessarily overweight or obese could be retaining enough fat to be at risk for the disease – something dubbed as “skinny fat.”
Compared to other ethnicities, Asians are also more likely to retain increased fat around the waist versus others. Abdominal fat is a bigger diabetes risk factor than fat found somewhere else, like one’s arms or hips.
Advocates warn, though, that raising awareness of the risks is only half the battle. Scott Chan of the LA-based group Asian and Pacific Islander Obesity Prevention Alliance believes that many Asian Americans refuse to believe they could get diabetes partly due to the prevailing “model minority” myth in health.
“You’re skinny, you’re healthy, there’s nothing wrong,” he explains, adding that dietary modifications – such as eating less rice – are also often met with resistance.
In 2014, the American Diabetes Association lowered the body mass index (BMI) cut point at which the group recommends screening Asian Americans for type 2 diabetes. The move aligned its guidelines with scientific evidence of the increased diabetes risk in the group at lower BMI levels than the rest of the population.
“A thin Asian person may be at risk for developing diabetes. Research has shown that BMI may not be the best marker in this population,” says Dr. Ho Luong Tran of the National Council of Asian Pacific Island Physicians, adding that there should be a push for more clinical data and research on the population and pursuing policy change for better health results.
So, instead of calculating one’s BMI, Asians are encouraged to measure waist circumference to more accurately predict diabetes risk. The target measurement is less than or equal to 35.5 inches for men and 31.5 inches for women.
Photo: A/PA Heritage Festival | Flickr