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

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

Emerging Leader: Tina Fischel

Age: 22Hometown: Irvine, CA Future residence: Denver, CO (starting in August) College of William and Mary, 2013 Kinesiology and Health Sciences

Tina Fischel is about to make a big move. At the end of the summer, she will relocate to Colorado to work as a health educator for the Metro Community Provider Network (MCPN), an affiliate of the Health Corps. While there, she will work in a clinical setting among health professionals. Her duties include conducting individual patient consultations on nutrition, diabetes and smoking, and helping to educate a community of historically underserved Spanish-speaking refugees and migrant workers.

Fischel is very excited to see her academic and professional paths converge. For the past eight years, she has been organizing and fundraising for Relay for Life. She is passionate about fulfilling the American Cancer Society’s mission to reduce incidents of cancer, as well as the suffering that comes from cancer.

When she was an EMT, Fischel was exposed to the realities that aren’t necessarily visible to the rest of society.

“[As an EMT] you’re going into people’s homes uninvited and you see things like addiction and poverty. You also see people coming into the ER as a first and last resort,” she explains. The experience shed light on just how complex and inefficient modern healthcare is.

“If I can contribute to a solution or remedy, that’s what I want to do,” Fischel adds. She is motivated to enact change in healthcare, particularly at the community level.

“What inspires me is the people who do it best. When someone does [their job] right, you notice. The patients notice and the people around notice,” Fischel states. Fischel is referring to the 'human connection' that sometimes is lacking in primary and preventative care. This connection includes giving patients the full attention and time that they deserve in order to address their individual diagnoses. She will strive to work in this manner once she’s in her new role in Denver.

When asked about her Fil-Am identity, Fischel looks back on her time before college.

“In my past, my only connection was the fact that I was brown,” she laughs. Fischel’s mom is from the Philippines, while her dad is of Eastern European descent. Growing up, they’d have Adobo once a month, which was always something Fischel and her siblings looked forward to. When she transferred from UCLA  to William and Mary for her sophomore year, she joined the Filipino American Student Association. It was a positive experience, because not only did she learn about Pilipino history and culture, but also saw just how hospitable Pilipinos can be.

“Even though we are not in the Philippines, we are [known for being] welcoming. People around the world notice it, too,” Fischel remarks.

Fischel describes how it’s been a goal of hers to live in Colorado. After casually mentioning it to a friend who worked for AmeriCorps, she was encouraged to apply for the position in Denver. As of a result of what may appear to be a stroke of luck, Fischel offers the following advice to other emerging Fil-Ams and Pilipinos.

“You can’t just give up and settle. Don’t be afraid to look to other people for inspiration. You can gain direction from your peers, and you shouldn’t be afraid of that.”

Behind Closed Doors: A Letter to Gabrielle Molina

On May 22nd, Gabrielle Molina, a 12-year-old Fil-Am from Queens, NY, took her life. She left behind an apologetic note to her family, which explained that she endured relentless bullying, both at school and on the internet.

Gabby's story is not an anomaly. Across the country, and the globe, bullying has become quite commonplace. According to the National Crime Prevention Council, 43% of all teens in America are victims of bullying. This includes cyberbullying, which is done over the internet and through other digital means.

The accessibility and anonymity associated with the internet allows hurtful messages to be sent and seen instantaneously. Thus, the internet incubates open battlegrounds for bickering, name-calling, and downright nasty arguments. These attacks appear on social media sites, comment sections and forums.  Today, kids and teens have technology at their disposal, and can engage in unethical conduct, often without care or knowledge of the consequences. In the wrong hands, this technology becomes dangerous, and in Gabby's case, deadly.

Though we cannot blame Gabby's peers entirely for her passing, they did trigger her decision. As kids, we're taught the following phrase: "Sticks and stones may break my bones,  but words will never hurt me." But what if this isn't the case? Our words certainly have the ability to inflict greater pain than we intend.

In addition to cyberbullying, we must consider the state of Gabby's mental well-being. Kids and teens, like adults, may be living with a mental illness. Often overlooked or unidentified, these illnesses intensify, especially without attention or proper treatment.

As mental health becomes more visible in today's media, I'd like to send out a plea for help. Earlier this month, President Obama held the National Conference on Mental Health. The conference brought various mental health professionals and advocates together, in hopes of addressing the conversation at a national level. While there has been some criticism of the conference, I have faith that we're headed in the right direction. In addition to the conference, the Obama administration launched MentalHealth.gov, a comprehensive site for those seeking mental health services and resources. Furthermore, there are many other organizations out there that have been supporting and advocating for those living with a mental illness. My hope is that this conversation continues, and is not forgotten by the media. I believe it is up to us to equip ourselves with the right attitude and knowledge in order to truly change our culture's perception of mental health. We have to realize that anyone around us could be suffering in silence. By understanding the stereotypes and stigmas against mental health, we can help our friends, family, and even ourselves, during difficult times.

In the meantime, here's a letter I wrote to Gabby. It's signed "The World." I hope you will all join me in being part of that world.

Dear Gabby,

We’ll never know how much you suffered nor will we know the truth. We’ll never know just how hard you tried to live freely in your youth. We know it must have been hard to fight the demons deep within. We know you couldn’t take the pain, nor the hell you were living in. But there are some things that you should know, even if it may be too late. Please know that we are sorry that you endured such cruelty and hate.

We apologize that we did not filter the toxins from our freedom of speech. The jagged grains tossed from our own hands went beyond our reach. For the poisonous words and bullying crept right into your very heart; You were physically and mentally tortured, your peace was ripped apart. We apologize that we’ve progressed to this: crimes can reach us in our homes. Perhaps unwelcomed claims and criticisms are worse than sticks and stones.

We apologize that our society has taught us how to turn a blind eye, For media and pop culture tells us to keep quiet when all else goes awry. We know cultural expectations left you amongst many doubts and fears, And that you were afraid ask for our help, lest a soul witness your tears. We are aware that we did not help you, we may have ignored the signs. We are sorry we did not think to look beyond the curtains nor the blinds.

We hope one day you’ll forgive us, and that you do not blame yourself. Because we’re all responsible for each other’s happiness and health. For now is the time to be courageous for those who have only an ounce of hope. It is us who must speak out, and broaden our conversation and our scope. We should help others out of the darkness, the shadows and the grief. We will stand up for all, friend or foe, who cannot find their own relief.

For each of us have been touched by mental pain, illness, or misdirection. So we have the responsibility to elevate and change our perception. We must encourage those around us to find the solace that they seek. We must be a beacon for those who’ve fought until their body’s left them weak. It is our hearts you have touched, though it’s been a tearful goodbye. We know we might not erase the stigma, but hey, it’s worth a try.

With Love, The World

Photo credit: Classic Soul Radio

#PIHealth: A Call to Action for Improving Health in the Philippines

Note from the editor: Today's story is a guest post by Kathleen Cabangon. A major issue that the Philippines faces is health and healthcare. Around one-quarter of families in the Philippines live below the poverty threshold, reflecting broad social inequity and other social challenges. Cities are becoming more crowded and polluted due to increased migration from rural areas; cost of living has increased due to inflation making food more expensive; and access to clean water supplies is more uncertain compared to a generation ago. Despite the Philippines’ economic and political progress in the new millennia, inequity in the public health sector exacerbate challenges in morbidity and mortality and put at risk the well-being and lives of many Filipinos.

Acknowledging the growing concerns in health, the Philippine government is expected to provide universal health care for its citizens by 2016. An article published earlier this year by the World Bank, “Achieving Universal Health Care in the Philippines,” described the current state of the health care system:

“While the Philippines has made considerable progress in the health sector over the previous decades, several important challenges remain. Poor households’ health outcomes were three to four times worse than middle class families’ and the poor lacked proper financial protection from debt accrued from out-of-pocket health expenses. To alleviate poverty, the government prioritized enrolling poor households in the national health insurance program and ensuring they had adequate access to quality health services and financial protection.”

My interest in health issues began while I was an intern at Advancement for Rural Kids (ARK). ARK developed an amazing feeding program: just $15/day feeds one child for an entire year. This program was backed up by statistical data which showed the shift. With this, I began to draw the conclusion that without proper access to food or health care, success was virtually impossible. For example, imagine all the times you were sick and unable to work. Being ill essentially put a “stop” on your ability to produce and be active. There is a direct correlation between productivity and one’s state of health. We can further push that idea to say that for some in the Philippines, the notion of productivity becomes an obstacle because they do not have the necessary health care to remain healthy. So why? Why should we care? Personally, I feel an inherent need to give back in any way that I can to the Filipino community and one way I fulfill that need is by writing this blog post. My role is to give a voice to the people who are voiceless and to expose the hardships Filipinos face, day in and day out. It is a shame that even for a nation with infinite potential like the United States, that inequities such as poverty and access to health are still unsettled issues for the country. Public hospital facilities should be beyond what they are now and should mirror the city’s aims towards growth. The prices of medicines in the Philippines are among the highest in the world—certainly too high in relation to household incomes of most Filipinos. Given the high prices, most medicines are beyond the paying capacity of most Filipinos. Thus, the state of health in the Philippines calls for attention from the government, but most importantly from its citizens, where citizen awareness of the issues is the primary catalyst for change.

Tell us your thoughts on these issues via Twitter using our hashtag, #PIHealth. And follow @unipronow and @uni_issues for daily updates on issues like these.