Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians

Abstract

Objectives: To assess whether overweight Asians, assessed on the basis of WHO criteria, are at greater mortality risk than overweight Caucasians, and to determine whether alternative cut-off points (BMI = 23·0–24·9 kg/m 2 for overweight and BMI ≥ 25·0 kg/m 2 for obesity) suggested by the WHO Western Pacific Regional Office are appropriate. Design: The cohort was followed prospectively until the end of 2001. All-cause and CVD mortality risks of the overweight and obese group, relative to the reference group (BMI = 18·5–24·9 or 18·5–22·9 kg/m 2), were assessed using Cox regression analysis, adjusting for age, smoking and gender. Excess deaths were estimated with a method proposed by the US Centers for Disease Control and Prevention. Setting: National Health Interview Survey (NHIS 2001) and a middle-aged perspective cohort in Taiwan. Subjects: Subjects comprised 36 386 civil servants and school teachers, aged 40 years and older, who underwent a medical examination during 1989–1992. Results: In the WHO-defined overweight group, Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Asians showed risks equivalent to Caucasians’ at lower BMI (around 5 units). Every unit of BMI increase, at 25·0 kg/m 2 or above, was associated with a 9 % increase in relative mortality risk from all causes. Applying a cut-off point of 25·0 kg/m 2 for obesity would result a prevalence of 27·1 %, while the traditional WHO cut-off point of 30·0 kg/m 2 yielded obesity prevalence of 4·1 %. Excess deaths due to obesity accounted for 8·6 % of all deaths and 21·1 % of CVD deaths, based on the alternative cut-offs. Conclusions: In this Asian population, significant mortality risks started at BMI ≥ 25·0 kg/m 2, rather than at BMI ≥ 30·0 kg/m 2. The study supports the use of BMI ≥ 25·0 kg/m 2 as a new cut-off point for obesity and BMI = 23·0–24·9 kg/m 2 for overweight. The magnitude of obesity-attributable deaths has been hitherto under-appreciated among Asians.