Fat lurks behind slim Asian frames
ALISA TANG
Associated Press
BANGKOK, Thailand - Prapai Lertphiphat is an average Thai woman: short and slender, a picture of perfect health.
But in Asia, appearances can be deceptive. The 44-year-old hospital clerk is suffering from the classic disease of overweight people: hypertension, or high blood pressure.
Prapai is not alone in her plight.
After a series of independent surveys in 10 Asian countries, researchers have come up with an alarming conclusion: There are millions of people like Prapai in the region, showing symptoms of obesity despite their small frames and apparent lack of excess fat.
It is not that Asians have suddenly become unhealthy. It’s just that health experts had all along been applying a global standard, known as body mass index, to measure obesity that was unsuited to Asians.
To help doctors prevent obesity-related ailments, the World Health Organization established in 1997 a body mass index standard, calculated by dividing a person’s weight in pounds by height in inches, dividing again by height in inches and multiplying by 703. A normal weight is a BMI of less than 25; overweight is under 30 and obesity is over 30.
But the 10-country research showed that Asians had more fat content compared to Caucasians, which meant that a BMI of 25 was way above overweight for Asians.
In response, a group of WHO experts in July recommended an Asian optimal BMI of 23. Anything over it should be considered overweight and a health risk, they said.
In other words, an Asian and Caucasian may be the same weight and height, but the Asian is at greater risk for fat-related illnesses such as heart disease and diabetes. The countries surveyed were Hong Kong, India, Thailand, Malaysia, Fiji, Indonesia, Singapore, mainland China, Korea, and the Philippines.
Researchers in Hong Kong found that as people surpassed a BMI of 23, there was a very sharp rise in the risk of heart disease.
Studies in India found that city dwellers have an average BMI of 24.5, and have diabetes rates four times higher than their rural counterparts, hypertension 2 1/2 times higher, and heart disease twice as high.
Prapai has a BMI of 23.5 because she weighs 121 pounds and is 5 feet tall. Her small frame belies her medical problems, which have forced her into a salt-free diet and a daily regime of antihypertension pills.
“Mornings when I forget to take my medicine, I get headaches and lose my balance while standing,” Prapai said.
In Singapore, 22-year-old Tan Choon Ping, a recent college graduate, was told by his doctor to lose about 4 1/2 pounds from his 181-pound weight.
Standing 6 feet tall, he has a BMI of 24.8 - perfect for a Caucasian but potentially harmful in an Asian.
“I was utterly mortified when my doctor told me I was overweight,” Tan said. “I nearly throttled her.”
Scientists are yet to figure out why Asians have more fat than Caucasians. But they cite a range of theories including evolution, maternal nutrition or simply lack of exercise.
Fat researcher Jeffrey Friedman, a Howard Hughes Medical Institute investigator at Rockefeller University in New York, said populations that store more body fat may have been naturally selected through generations of famine.
In ancient times, people in areas prone to famine - such as China or India - developed a biological mechanism to store more fat to survive. When subsequent generations prospered and had access to food, they accumulated excess fat, Friedman said.
“Having more fat is good in certain environments because … it helps one survive the famine,” he said.
Another reason Asians are fatter might be maternal nutrition, Dr. K.S. Reddy, a WHO expert who studied the data from the 10 countries, said from New Delhi.
He said that if a fetus doesn’t get sufficient nutrition, it adapts its metabolism to consume nutrition conservatively. When the baby is born, its metabolism may not be able to keep up with the greater availability of food, leading to excess fat, he said.
Also, Asians tend to exercise little compared to Westerners, which sets them up for heart diseases later in life.
In China, more than 60 percent of people do not do any physical exercise, according to a survey conducted by a Chinese government sports research organization. It said less than 8 percent of China’s 1.2 billion people exercise with “average intensity” compared to 41 percent of Britons and 20 percent of Americans.
Exercising is also low in priority among people who are more concerned about earning a livelihood. But among wealthier Asians, the treadmill trend is catching on.
“People who are better off tend to do more exercise,” said Yang Xirang, professor of sports physiology at the Beijing Sports University.
In wealthy Hong Kong and other major Chinese cities going through an economic boom, gyms are the latest fad.
Hong Kong’s South China Morning Post newspaper recently reported that Beijingers are spending up to a third of their monthly salary on gym memberships.
But in countries like India and Malaysia, people still wear flab around their waists as a badge of prosperity.
Malaysian Health Minister Chua Jui Meng warned at a conference recently that 25 percent of Malaysia’s 23 million people are overweight.
“We do know there has been a shift towards an overeating population, eating more than the body requires,” he said.
Nothing wrong with that, counter the Asians.
“So what’s wrong with my paunch,” asked Indian businessman Lalit Gupta, patting his belly. “Business is booming … and you might as well eat well and live well,” he said, sitting in his grocery shop in New Delhi’s Yusuf Sarai market.