American Diabetes Association Releases Position Statement on New BMI Screening Cut Points for Diabetes in Asian Americans

Originally Posted on AsiaAmericana.com

The American Diabetes Association is lowering the Body Mass Index (BMI) cut point at which it recommends screening Asian Americans for type 2 diabetes, aligning its guidelines with evidence that many Asian Americans develop the disease at lower BMI levels than the population at large, according to a position statement being published in the January issue of Diabetes Care.

“The position statement highlights, for the first time, the physiologic differences seen between Asian Americans and other populations affected by diabetes,” said Jane Chiang, the Association’s Senior Vice President for Medical Affairs and Community Information. “Asian Americans are a heterogeneous group and have historically been underrepresented in studies, so it is important to keep in mind that this is just the beginning. Clearly, we need more research to better understand why these distinctions exist.”

For members of the general population, the Association recommends testing for diabetes when BMI reaches 25 kg/m2 or higher. Based upon an exhaustive review of the literature, for Asian Americans, it is now recommending that screening be done at 23 kg/m2 or higher. It is believed that Asian Americans – the nation’s fastest growing ethnic group – develop diabetes at lower BMI levels because of differences in their body composition: weight gain tends to accumulate around the waist in Asian Americans, the area in which adiposity is considered most harmful from a disease standpoint, rather than in the thighs and other parts of the body.

“Clinicians have known this intuitively for quite some time,” said William C. Hsu, M.D., Vice President, International Programs, Joslin Diabetes Center and Assistant Professor, Harvard Medical School, who was lead author of the position paper. “They can see that Asian Americans are being diagnosed with diabetes when they do not appear to be overweight or obese according to general standards. But if you use the previous Association standard for diabetes screening of being age 45 or older with a BMI of 25 kg/m2 or above, you will miss many Asian Americans who are at risk.”

“Given that established BMI cut points indicating elevated diabetes risk are inappropriate for Asian Americans, establishing a specific BMI cut point to identify Asian Americans with or at risk for future diabetes would be beneficial to the potential health of millions of Asian American individuals,” the position statement concludes.

The Asian Americans Native Hawaiian and Pacific Islander (AANHPI) Diabetes Coalition began drawing attention to the need for changes in clinical management guidelines for Asian Americans, who experience twice the prevalence of type 2 diabetes than Caucasian Americans despite having lower rates of obesity under current federal BMI standards, following a 2011 State of the Science Scientific Symposium on Diabetes in Hawaii.

“‘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.  This paper is a significant step in the right direction of widely recognizing the diabetes disparity that exists in our populations and communities,” said Ho Luong Tran, M.D., President of the National Council of Asian Pacific Islander Physicians, and lead coordinator of the AANHPI Diabetes Coalition. “The next steps are to increase the amount of clinical research and data on this diverse population, while simultaneously pushing for policy change that will positively impact health outcomes.”

The Association’s position statement does not redefine overweight or obesity for Asian Americans, only the BMI cut point for screening for type 2 diabetes.

“What this does is to help us, as a society, identify those who are at risk for type 2 diabetes who might otherwise not have been identified because of their lack of appearance of obesity,” said Hsu, adding that the growing prevalence of diabetes and its economic impact in the United States heighten the need for early detection and prevention.

For a copy of the Association’s position statement, or to obtain a copy, please visit http://dx.doi.org/10.2337/dc14-2391.

The American Diabetes Association is leading the fight to Stop Diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. For the past 75 years, our mission has been to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

For more information please call the American Diabetes Association at 1-800-DIABETES (800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish.

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Diabetes in Asian Americans

A Dose of Perspective: On Failure and Asking for Help

What is it about failure that makes life complicated? Is it the fear of failing? Is it letting others, or yourself, down? Is it feeling like you're wasting time or talent? Is it going 100 mph down a specific career path, only to realize you've been going in the wrong direction? Is it watching individuals whom you love go down paths you do not approve of? Is it feeling like you don't have all the answers? Is it experiencing depression* and not being able to get out of bed everyday? Perhaps it is a combination of several actions. Or perhaps it is just a reminder that we need to keep what we experience in perspective.

The idea of failure, as I see it, is a red flag. It's a reminder for us to understand that there are occurrences merely out of our control. That does not mean we, as individuals, are failures, nor are the actions we take. 

A year ago, in June 2014, I had the opportunity to serve as a panelist at the Annual UniPro Summit in New York City. Once I had a microphone in hand, I discussed how each failure I had experienced until that point were actually lessons in disguise. It was the first time I had been so vulnerable in a public space. I had done so candidly - I had not planned to talk about failure - and in front of an audience of over 100 young Filipino professionals and students from around the country. But I wanted to be honest and open. At that point, my "failures" included the fact that I was no longer pursuing a career in the field that I had studied in college, that I had been on the job hunt and underemployed for eight months, and that I had moved back home to live with my family. In reality, there is absolutely nothing wrong and any of these three facts. But really, were these truths my failures? Or were they just my perceived mishaps, existing only in my mind?

Fast forward one year to a warm May evening. Eleven young leaders and myself were gearing up for our graduation ceremony in Wilkinsburg, PA, a community right outside of Pittsburgh. It was in Wilkinsburg that we kicked off our nine-month leadership development training program through Coro, an incredible non-profit dedicated to growing leaders.

The Coro Fellowship in Public Affairs is no joke. It is rigorous and time-consuming. It pushes you out of your comfort zone and demands that you step outside of the box. From individual project placements with various government, business, non-profit and labor organizations, to whole group projects at the local, city, state and national level, we dove into the working world with passion and drive to tackle challenges in society. We were also faced with personality clashes, socioeconomic divides, race and ethnic differences, and conflicting beliefs. To add some imagery, a euphemism we often used to describe ourselves to others was 'twelve different people trying to drive the bus at once.' It took some time, but we eventually figured out a flow to our chaos. But that doesn't mean I was without my share of perceived personal failures.

And there we were, nine months later, at the conclusion of our program. Each of us had prepared reflections from our time in the program. But most importantly, we were there to share glimpses of systemic challenges and personal growth. The key insight that I shared with the fellows, Coro staff, family, friends, project hosts, community members and Coro supporters that evening was this:

While caring for and giving to others is part of the human nature, it is even more important to care and give to oneself. In order to be an effective leader, one must exercise self-compassion. A specific way one can do this is by asking for help.

When someone tells us to not be afraid to "ask for help," is not meant to be demeaning or the end all to any problem. It's not the solution. It's merely a tool for coping and managing stress. It is a step forward toward pure wellness and self-care. Asking for help does not demonstrate weakness. It demonstrates courage and strength. Looking back, I wonder how many of my failures would have changed to experiences of wonder and empowering interdependence had I done just that. Had I asked for help.

Vulnerability can be a scary thing. Telling people of your most inner turmoils and demons without knowing their response can be intimidating. What if they don't understand you?

What if they do?

A reminder to humanity: When someone opens up to you, listen. Whether or not they are a loved one, a colleague, or even a passerby who you just so happens to stumble upon while they weep: do your best to understand. Do not chastise or blame them. Show sympathy, or empathy if you can. Remind them that they are not alone in the pain they face.

And a reminder to those who are conflicted by failure: Be compassionate to yourself. Show yourself love by taking moments to reflect, show gratitude, or do something you enjoy or brings you peace. If you're not at a place to enact self-care, then ask for help. People may not always have a concrete answer or solution. But there is strength in numbers. You're never alone in the struggle you face. Chances are, you're not the only one who has deviated from your college major, been unemployed, or lived at home with family as a twenty-something or older.

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*If you or someone you know is contemplating self harm or suicide, reach out to the National Suicide Prevention Hotline: 1 (800) 273-8255. Additionally, if you or someone you know is living with depression, or displaying symptoms of depression or other mental illnesses, get help. Mental illnesses are medical conditions and should not be overlooked. If you're comfortable, reach out to family, friends, peers and mentors for support. You can also talk to mental health professionals, such as a counselor, therapist, psychologist, psychiatrist or your primary care physician (PCP). If professional medical attention is inaccessible, reach out to community mental health centers. Other mental health resources can be found here.

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The original version of this post appeared on Mama Tanap, a blog that focuses on personal health and wellness.

One Year Later

Imagine a super typhoon with a width that spans the entire US Eastern Seaboard. Now, imagine that storm sweeping through a country, causing flooding, landslides and widespread devastation to homes, infrastructure and the agricultural economy. This was a reality for the Philippines on November 8, 2013.

As a Filipina-American, I've been conflicted with how to give back to my homeland. I was born in the States. I've only been to the Philippines a few times - all visits occurred within the past couple of years. How can I possibly be connected to a country that I have never called home? This identity crisis of mine is not unique to my story. In fact, several Fil-Ams grapple with this, including those who may have moved from the PI to the US at a very young age, and identify more closely as an American. So what have I done to give back? I've donated to charitable causes aiding those affected by Typhoon Haiyan (or Typhoon Yolanda). I've supported and advocated for non-profits that are rebuilding in Central Philippines, such as Advancement for Rural Kids (ARK). But among the most helpful for me has been to both read and write about it, and share stories with others. Talking about how the typhoon as affected me has been the first step.

It's been over a year since Haiyan devastated the Philippines. Like other natural disasters - since it's no longer covered by the media - it can be difficult for others around the world to truly understand just how distressed these communities still are. It wasn't until a friend of mine shared a story concerning the aftermath of Haiyan that nearly broke my heart.

In a film by Simon Rawles and Vishva Samani, what started out as a search for survivors evolved into the exposed reality of how mental illness is handled in a country like the Philippines. Due to inadequate healthcare services (also inclusive of mental health services) particularly in impoverished regions, relatives of an individual with a mental illness have very limited options. They are faced with the challenge of protecting their loved one and preventing them from harming themselves or others in the community. However, due to cultural taboos and misunderstandings surrounding mental illness, it is something that is kept hidden. As a result, Typhoon Haiyan uncovered a form of "modern day slavery."

Filmed in northern Cebu, the film sheds light on individuals with mental illnesses who have been chained and caged by their families or loved ones. For example, the film includes the story of a 34-year-old man named Joel Becira, who was put in a cage by his mother after he suffered from a breakdown. It's easy to be frustrated with these images. However, there are several factors that contribute to this reality and one cannot simply place blame on poverty alone. Stigma against mental illness is embedded in Filipino culture and societal structure, and so communities' hands are tied when it comes to caring for an individual living with a mental illness.

The stigma against mental health and mental illness is not unique to the Philippines. It's certainly not unique to the US, as I've shared in previous posts. It's a fear that has been created and maintained by society.

This fear is a social construct that cannot be dismantled by a mere blog post, by an anti-stigma campaign, or by newly implemented laws and policies. It requires us as human beings to acknowledge that those living with mental illness are not untouchables or less than human. We need to care for those around us, and it starts with us talking about mental health and illness in a positive way, whether it's in conversation with friends and family or at work. It starts with us getting trained in Mental Health First Aid, not just First Aid. It starts and continues with us educating ourselves on and advocating for an underserved population that is integral to our society.

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The original version of this post appeared on Mama Tanap, a blog that focuses on personal health and wellness.

Love, Family, and Alzheimer’s; Kwentuhan Part 3: Forgetting the Details

This past October, in honor of Filipino American History Month, we began to promote the stories of our community through an initiative called Kwentuhan. But storytelling shouldn’t end once it’s November 1st. Actor and writer Nicole Maxali shares:

“When I first started acting at the age of fifteen, the only Filipino actress I could look up to was Lea Salonga.   And in college, I remember that a college professor wouldn’t let me do my final paper on Asian American actors because, she stated, “There aren’t any to write about!” So much has changed since then. But we still lack positive representation in American TV and Films. Since I began writing and performing as a solo performer/storyteller, my intention is to inspire other Fil-Ams, Filipinos and women of color that our stories are worth writing, performing and watching.

“As Filipinos, it’s not just important to be nurses but to be artists as well. It’s equally important to write and share our stories! I learned years ago that waiting around for Hollywood to write and cast me in a positive Filipino American narrative film was just as fruitless as waiting around for a winning lotto ticket to fall into my lap.

“If I wanted change, I’d have to create it myself! We Filipinos are a hardworking and resourceful people. Just take a look at the first wave of Manongs that immigrated to Hawaii and Delano, California. For decades we have been making our dreams come true in this country, so performing this show to sold out houses and receiving rave reviews proves that we can continue to do so.”

The show Nicole describes is Forgetting the Details, a critically acclaimed tale of a woman torn between tradition and ambition, struggling between her Filipino roots and the American dream. At a recent encore of this one-woman show, an audience gathered to witness Nicole’s talents and to experience the journey of that woman, her father, and her grandmother as they navigate their strained relationships with one another in contemporary San Francisco. Nicole elaborates, “Forgetting the Details has themes that explore a young woman’s Coming of Age, Change versus tradition, Facing Reality, Loss, and Family. The show tells my story of being raised in San Francisco by my traditional Filipino grandmother, yet influenced by my free-spirited father, and the struggles we face as a family when my grandma is diagnosed with Alzheimer’s. It's a powerful story that reaches beyond the Filipino American context and touches upon powerful elements of the human experience.”

I had the privilege of being part of that live audience at the cozy 13th Street Repertory in downtown New York, entering with few expectations and leaving floored by the show. Contrary to the show’s title, it seems that no detail is forgotten when it comes to describing the play’s unique characters. Manifesting her unique characters’ complexity through their actions and interactions with one another, Nicole develops her characters with such detail that the show seems set apart from others. As the play goes on, the characters reveal more and more while pulling the audience deeper and deeper into Nicole’s memories. For example, not many can sympathize with Nicole’s father, presented initially as a drugged-up dropout, cast aside by the family in favor of his brother, a college graduate and Navy sailor. We learn later that he, like his daughter, is an artist. He is a dreamer with a childlike wonder, lost in his music and painting, and seeking the acceptance from his daughter that he never gained from the rest of his family.

View the Forgetting the Details trailer.

True to life, Nicole’s characters also display a wide range of emotions as they embark on journeys of transformation throughout the course of the play. The characters express depth and complexity during every interaction, each moment strung into a chain of poignant and real memories. For example, while Nicole was once ashamed of her grandmother’s brazen personality, she learns to appreciate her grandmother’s wit and sage advice, adoring her as they grow older.

Similarly, the show itself has come a long way since its inception eight years ago. Nicole explains:

“I started writing this piece in 2006 during a solo performance workshop I was taking taught by W. Kamau Bell (Host of the FX show “Totally Biased”). During that year, my grandma was diagnosed with dementia and Alzheimer’s disease.  It was a difficult time for my family and for me, especially since my grandma provided unconditional love and stability during my formative years.  So I chose to write about it in Kamau’s workshop. Writing was my coping mechanism--a positive outlet for the pain. After our class final, Kamau told me that it was some of the best writing he has ever seen me perform.

“The piece evolved as I performed it in venues around San Francisco. Soon people began approaching me, sharing their own stories about loved ones with Alzheimer’s. They related to this story in a special way due to their experiences with Alzheimer’s. I realized that my show had become something more than just a source of healing for me. It was a way for people to connect to a piece that was both real and funny. And it spoke to their own issues of caregiving, guilt, shame, mental health, and family dynamics. My desire to add to healing and light in an otherwise dark and painful world of Alzheimer’s disease was my source of inspiration.

“The first time I performed the full-length version was November 2011…just four months after a close family member passed away. It was a very challenging time for me but I continued with the West Coast premiere of my show at Bindlestiff Studio in San Francisco and sold out most of my shows and received rave reviews and standing ovations.

“Since 2011, it’s become a tighter and stronger show. Originally 100 minutes, I have since then cut it down to a 75-80 minute show. I’ve also injected more humor to it. My background is also stand-up and improvisational comedy.  So performing this show for the past three years in different cities around America (Boston, Minneapolis, Los Angeles, etc.) has led me to find new jokes within the show. And working with my director, Paul Stein, for the past four years has definitely shaped the show to what it is today.”

Her grandmother’s declining health becomes a focal point in the play, as her sickness becomes a burden for Nicole and her father. Not every father-daughter relationship runs smoothly, and their relationship is no exception. Both characters struggle between their dreams and their responsibilities, often delving too deep into their trade while familial obligations come second. However, the further and further Nicole distances herself from her father as time goes on, the closer and closer her father comes to returning to her life, especially as a result of her grandmother’s illness. The importance of their relationship eventually climaxes during her father’s death, when Nicole discovers just how proud her father was of her from the newspaper clippings he saved about her, even during years of separation.

Forgetting the Details is simply a play I will not forget. Nicole states:

“I want the audience to walk away with a greater appreciation of their lolas, parents, family, and the loved ones around them. Life in general can be stressful and all consuming. But when we take a step back and appreciate the people in our lives that have shaped who we are, it allows us to slow down and take stock of how much we’ve accomplished with their help. Alzheimer ’s disease in general has taught me to stay present and appreciate the people in my life that love and support me. So go call your lola and lolo right now and tell them ‘Mahal kita’!

“Specifically for Fil-Ams, my show touches on the conflict of being a good traditional Filipino granddaughter versus a third generational Fil-Am with her own American dreams. Most Caucasian Americans don’t fully understand the pressure we face in Asian families of being the model daughter/son or granddaughter/grandson. And the pressures we face to take care of our elders as we get older and having our families remain our top priority. It is difficult to find that balance and especially hard to manage the internal guilt we feel if we pick our own happiness or career over our parents’ wishes.”

I, too, had a grandmother who passed away from various complications, a difficult time when my parents also separated. Audience members will feel as if Nicole is telling their stories, and not only hers. Forgetting the Details is more than a tale of a daughter and her grandmother, told with laughter and drama and everything in between; it’s an invitation to Nicole’s dinner table, her heart, her memories, her story as a Filipina American, and her own human experience.

For more Kwentuhan, read our reviews and exclusive interviews for Renee Rises’ Undressing the Fragments and Carlos Celdran’s Livin’ La Vida Imelda. Interested in storytelling within the Filipino American community? Contact us: eboard@unipronow.org

Hoy Tabachoy! Healthier Pilipino Recipes

When I think of my favorite home cooked Pilipino dishes they all have two things in common. One, they make my mouth happy. Two, they are all some devilish combination of fatty, greasy, meaty, salty, or fried. Let’s face it, the very things that make most Pilipino food so deliciously decadent are also the things that are clogging up your arteries. The preference for a savory Pilipino palette has had a profound effect on the health of Pilipino Americans. According to the statistics presented by Dr. Charito Sico:

“1 in 4 Pilipino Americans have hypertension, 1 in 4 have high cholesterol,   and 1 out of 5 Asian Americans with diabetes are Pilipino American.”

Like most Fil-Ams, I believe that savoring an exquisite meal is a cherishable human experience that should be an unalienable right. Since food, quite literally, gives me a reason for a living, I like my meals to meet a certain par of deliciousness and often make unwise choices in which I follow my stomach instead of my heart.

Luckily, the American Heart Association and Kaiser Permanente collaborated to put together a healthy recipe booklet filled with dishes that keep the same Pilipino flavors we love but go easier on our bodies.

You can find a PDF of Mula Sa Puso: Heart Healthy Traditional Filipino Recipes for free online by clicking on the hyperlink. Below are a few examples from the booklet of Pilipino favorites that have been altered to keep your heart pumping strong.

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Credit: lutuingbahay.blogspot.com