There’s been a lot on my plate lately, but I figure any event that is five years running deserves a little attention … and honestly, who doesn’t have room on their plate for a little scoop-or three-of Nutella.

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The need for appropriate BMI cut-off values to define obesity among Asians. (Editorial).

Nutrition & Dietetics: The Journal of the Dieticians Association of Australia December 1, 2002 The issue of definition of obesity among Asians has received considerable attention in recent years. The debate has centred around the question of whether the classifications of overweight and obesity using the WHO’s definitions based on body mass index (BMI, kg/[m.sup.2]) are appropriate for Asians.

The use of the Quetelet’s index or body mass index (BMI, kg/[m.sup.2]) to compare the physique of man was first advocated as far back as in the nineteenth century (1). This index has been found to be the most suitable compared to other weight-height indices as it is minimally correlated with height while being highly correlated with body fat percentage (2,3). In a 1997 consultation, WHO recommended that the BMI cut-off values for overweight and obesity to be 25 kg/[m.sup.2] and 30 kg/[m.sup.2] respectively (4). These recommendations were based on the presence of excessive body fat and adverse effects on health (mortality and morbidity). However studies supporting these cutoff points were those conducted among Caucasian populations.

Indications that the relationship between BMI and body fat percentage differs across population groups surfaced in 1994 with the publication of Norgan (5). This was followed by the work of Wang et al. (6), showing that Asians living in New York have lower BMI but higher body fat percentage compared to age-matched Caucasians. Recently, studies in Indonesia, Singapore, Japan and Hong Kong demonstrated that for the same BMI, Asians living in these countries have higher body fat percentage compared to age- and sex-matched Caucasians with the same BMI (7-10). Reasonable comparisons among these studies are hampered by the varying methods used to assess or estimate body fat percentage and use of non-standardised techniques and non-validated methodologies. Ideally a chemical model using a maximum of body compartments should be employed for cross population comparisons but it is not feasible for many countries. Deuterium oxide dilution might be the most feasible alternative, as it is found to be valid (11,12), the met hod is easy to standardise, application is relatively easy even in field situations and samples can be sent for analyses to a specialised laboratory. web site body fat percentage calculator

More importantly, the populations in many Asian countries such as Singapore, Hong Kong, China, Japan, Korea, Thailand, India and Malaysia (13-20) are also experiencing elevated cardiovascular risk factors (both absolute and relative risks) at levels of BMI considered to be normal by WHO. Various levels of BMI cut-off points for obesity were proposed in these populations, ranging from BMI of 25 kg/[m.sup.2] to 28 kg/[m.sup.2] for the different populations. Some countries, such as Indonesia and Japan, have proceeded to revise their BMI cut-off points for obesity based on their own findings.

Recognising the need to address this pressing issue to define obesity among Asians, WHO convened an expert consultation in July 2002, where Asian and international experts deliberated whether population-specific BMI cut-off points for overweight and obesity are necessary. Data from various Asian countries (China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Philippines, Singapore, Thailand and Taiwan) were analysed and discussed during the consultation. It was acknowledged that Asians generally have higher body fat percentage compared to Caucasians and experience elevated risks at lower levels of BMI. The expert consultation emphasised that risk is a continuum along the BMI scale, and cut-offs merely act as triggers for action at various risk levels. It recommended BMI cut-off points of 23 kg/[m.sup.2] (moderate to high risk) and 27.5 kg/[m.sup.2] (high to very high risk) for Asians instead of 25 kg/[m.sup.2] and 30 kg/[m.sup.2] for Caucasians respectively.

The implications of this recommendation are apparent. The prevalences of overweight and obesity would be much higher than official figures. For example, in Singapore alone, the proportion of adults in the overweight category would increase from 24% to 35% while obesity prevalence would be 14% instead of 6%. If this were also true for other Asian countries, it would mean that almost half of the adult population in Asia would be at risk for obesity-related illnesses. This would form an escalating public health problem that cannot be ignored, as predicted by the WHO expert consultation group back in 1997 (4). Commitment, resources and concerted actions would be required at all levels, from national to individual levels to address the risk factors for obesity, chiefly the imbalance between energy intake and expenditure. Strategies and measures need to be instituted for different settings such as schools and workplaces, besides the general community, to reduce the prevalences of obesity and its comorbidities, part icularly among high-risk groups in each country. go to website body fat percentage calculator

Policy makers and program planners would need to be extra vigilant in designing health promotion programs to accompany the changes in BMI cut-off points. It is pertinent to craft public education messages that the priority and focus should not be in losing weight, but rather losing excessive body fat and maintaining optimal BMI level through an active lifestyle and sensible diet that is appropriate for the level of physical activity. Doctors and health professionals need to be alerted that weight loss measures through medication and/or surgery are suitable only for the morbidly obese and not for the majority.

The review and revision of BMI cut-off points for Asians paves the way for future research and collaboration to develop indices of obesity that are appropriate for various population groups in Asia. More studies are needed to validate common anthropometric indices, e.g. waist circumference, waist to hip ratio, bioelectrical impedance analysis, skinfold thicknesses against reference methods to assess their suitability for use as surrogate measures of body composition in the field. These studies need to be accompanied by longitudinal studies for definitive quantification of the risks (morbidity and mortality) associated with these indices.

Mabel Deurenberg-Yap Health Promotion Board, Singapore National University of Singapore References (1.) Quetelet LA. Physique Social. vol 2, P.92. Brussels: C Muquardt; 1869.

(2.) Norgan NG, Ferro-Luzzi A. Weight-height indices as estimators of fatness in men. Clinical Nutrition, 1982;36C:363-72.

(3.) Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chron Dis 1972;25:329-43 (4.) World Health Organization. Obesity: Preventing and managing the global epidemic. Report on a WHO Consultation on Obesity, Geneva, 3-5 June, 1997. Geneva: WHO/NUT/NCD/98.1;1998.

(5.) Norgan NQ Population differences in body composition in relation to BMI. Eur J Clin Nutr 1994;48:10S-27S (6.) Wang J, Thornton JC, Russell M, Burastero S, Heymsfield S, Pierson RN Jr. Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr 1994;60:23-8.

(7.) Guricci S, Hartriyanti Y, Deurenberg P, Hautvast JGAJ. Relationship between body fat and body mass index: differences between Indonesians and Caucasians. Eur J Clin Nutr 1998,52:779-83.

(8.) Deurenberg-Yap M, Schmidt G, van Staveren WA, Deurenberg P. Paradox of low BMI and high body fat percent among Singaporeans. Int J Obes 2000;24:1011-17.

(9.) Gallagher D, Heymsfield SB, Heo M, Jebb S, Murgatroyd PR, Sakamato Y. Healthy percentage fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 2000;72,694-701.

(10.) Ko GTC, Tang J, Chan JCN, Sung R, Wu MMF, Wai HPS, et al. Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance. Brit J Nutr 2001;85:239-42.

(11.) Deurenberg-Yap M, Schmidt G, van Staveren WA, Hautvast JGAJ, Deurenberg P. Body fat measurement among Singaporean Chinese, Malays and Indians:a comparative study using a four-compartment model and different two-compartment models. Brit J Nutr 2001;85:491-98.

(12.) Deurenberg-Yap M, Deurenberg P. Validity of deuterium oxide dilution for the measurement of body fat among Singaporeans. Food and Nutrition Bulletin (Suppl) 2002;23:34-7.

(13.) Deurenberg-Yap M, Chew SK, Lin FP, van Staveren WA, Deurenberg P. Relationships between indices of obesity and its comorbidities among Chinese, Malays and Indians in Singapore. Int J Obes 2001,25:1554-62.

(14.) Ko GTC, Chan JC, Cockram CS, Woo J. Prediction of hypertension, diabetes, dyslipidaemia or albuminuria using simple anthropometric indexes in Hong Kong Chinese. Int J Obes 1999;23:1136-42.

(15.) Lee ZSK, Critchley JAJH, Ko GTC, Anderson PJ, Thomas GN, Young RP, et al. Obesity and cardiovascular risk factors in Hong Kong Chinese. Obesity Reviews 2002;3:173-82.

(16.) Li G, Chen X, Jang Y, Wang J, Xing X, Yang W, et al. Obesity, coronary heart disease risk factors and diabetes in Chinese: an approach to the criteria of obesity in the Chinese population. Obesity Reviews 2002;3:167-72.

(17.) Zhou B, Wu Y, Yang J, Li Y, Zhang H, Zhao L. Overweight is an independent risk factor for cardiovascular disease in Chinese populations. Obesity Reviews 2002;3:147-56.

(18.) Moon OR, Kim NS, Jang SM, Yoon TH, Kim SO. The relationship between body mass and the prevalence of obesity-related diseases based on the 1995 National Health Interview Survey in Korea. Obesity Reviews 2002;3:192-96.

(19.) Ishikawa-Takata K, Ohta T, Moritake K, Gotou T, Inoue S. Obesity, weight change and risks for hypertension, diabetes and hypercholesterolemia in Japanese men. Eur J Clin Nutr 2002;56:601-7.

(20.) Reddy KS, Prabhakaran D, Shah P, Shah B. Differences in body mass index and waist:hip ratios in North Indian rural and urban populations. Obesity Reviews 2002;3:197-202.

Mary Lou Worster Anderson.

American Fitness March 1, 2000 Mary Lou Worster Anderson, 48, has been afflicted by Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) for nine years. Prior to her collapse from this illness (which had apparently been triggered by gall bladder surgery), she was pastor of a Presbyterian church in Henrietta, New York, for nine years. She is currently also a professional folk musician and a teacher who is certified in music, reading and elementary classroom. website gall bladder surgery

Anderson and her ex-husband met at Middlebury College, where they were both music majors. After several years of work at the University of Rochester, they both left their jobs to pursue parish ministry at Colgate Rochester Divinity School. Their second job out of seminary was as interim co-pastors of the Lyndonville Presbyterian Church in Lyndonville, New York, a small apple-growing town with a population of about 1,100. They lived there for only four months with their eight-month-old son. From there, they went to John Calvin Presbyterian Church in Henrietta, New York, as co-pastors.

James G. Anderson, Mary Lou’s ex-husband, became ill in the fall of 1984. He tried to return to work in 1985 although he never felt well. He then collapsed completely in the fall of 1986, suffering from severe exhaustion, depression and weakness.

Mary Lou took over as pastor of the church until November 15, 1990, when gall bladder surgery changed her life in ways she had never imagined. “Looking back, I can now see that my health was declining over a period of several years prior to the surgery,” she says. “I tried to return to work, but I collapsed physically and emotionally. I suffered fatigue and dizziness so severe that I was confined to bed or the couch for much of the next eight years.” Her symptoms included fevers, continuous infections, joint and muscle pain, episodes of blurred vision, severe memory loss, concentration difficulties, progressive loss of right arm use, periodic loss of right leg use, intermittent numbness on the right side of her face and severe depression. Forty years of age at the time, this mother of two young children felt as if her life had come to an abrupt halt. “There I was–an excellent student with two master’s degrees and a very successful professional life who could not do household tasks for more than 20 minutes without requiring a one- or two-hour nap immediately thereafter,” she says.

During the next few years, Anderson learned she suffered from Chronic Fatigue Immune Dysfunction Syndrome–probably from as far back as the summer of 1989. She was also diagnosed with major depressive disorder, type II diabetes and early stage Hashimoto’s disease (a thyroid disorder). “Needless to say, I couldn’t work,” Anderson says. “My marriage also suffered greatly, leading to a separation in the fall of 1991.” Eight years ago, Anderson’s now-19-year-old son, Jesse, became ill with CFIDS as well. Two years later, his sister, Rebecca, began suffering from the same affliction. “I later learned that during this same period of time, one out of every five people in Lyndonville, New York, fell ill with CFIDS,” she says. “To this day, we do not know why, as the government has never been willing to investigate this epidemic.” Anderson says that her biggest challenge as both a minister and single parent has been to not give up. “There were several years when I was very sick and had both of my children home-schooling because they were too weak to attend school,” she says. “I have been part of a 12-step program during this entire time, which has forced me to take life one day sometimes one hour–at a time. I have pursued any treatment that I thought would help us and, along with the children’s father, have tried to have a household filled with music and love.” Several years ago, Anderson underwent a course of physical therapy followed by the beginning of a regular exercise program. When both of her children became ill, Anderson could not continue the regimen, but she did not forget how much it had begun to help her. “This February, I wanted to start physical therapy again, but I realized that I was a little stronger than I had been six years ago,” she says. “I was also inspired by the stories of three women on Olympic teams who had been stricken by CFIDS, were ill for years, and then retrained using a modified program. All three had made it back to the last Olympics. Hearing that, I started an exercise program at Gold’s Gym in Irondequoit. At first, it was three days a week, but now it’s every day. I structured my program after the one I had learned in physical therapy, starting with very low weights and low [bicycle] speeds. I only moved things up when they became very easy for me.” After 11 months, Anderson says she’s amazed where such a highly disciplined and careful approach has taken her. “I started out with five minutes on the exercise bicycle at the lowest speed,” she says. “I can now do 30 to 60 minutes of cardiovascular work a day at low to moderate speeds. I started out with 10 minutes on the lowest weights on resistance machines. I now work for 30 to 90 minutes, depending on my schedule. My weights on the upper body machines vary from 40 to 80 pounds, while my weights for leg work vary from 80 to 140 pounds.” Anderson testifies that her life has been profoundly changed by her fitness endeavors. She is much stronger, more alert and far more active than she has been in a long time. She’s even begun to sing and write music professionally again, as well as tending to domestic matters. “I can actually clean my house because I no longer get sick from the exertion,” she says. “I have hope for my future and can imagine returning to work again.” Part of this new future includes attending the Rochester, New York, AFAA Personal Trainer/Fitness Counselor Certification program February 18-20, 2000. “My goal is to work with people who have Chronic Fatigue Immune Dysfunction Syndrome and Persian Gulf War Syndrome (which have been thought to be the same or related diseases),” she says. “I want to help other people find hope again. When one is confined to a bed, the world becomes very small. I would like to help others experience a gradual expansion of their world as they regain strength through carefully structured, extremely moderate exercise programs. My long-term goal would be to develop an actual center in Rochester where physicians, physical therapists, counselors, personal trainers and support groups could work together. My son, Jesse, would be especially interested in seeing this happen for children and adolescents, as more and more of them are diagnosed with CFIDS and there is very little support for them.” As is clearly evident, Anderson is very excited about the future and the opportunities her path to recovery and increased wellness has brought her. Since beginning her exercise program, Anderson has lost 28 pounds, dropped 21/2 sizes and ceased three of her medications. Her diabetes is now controlled by diet and exercise alone and although she still deals with memory loss, concentration difficulties and depression, all three are improving. gallbladdersurgerynow.com gall bladder surgery

As 2000 promises further progress, Anderson admits to finding a bit of irony in the entire situation. “I think it is humorous, in a wonderful way, that a woman who has spent much of the last nine years in bed can become trained as a fitness counselor,” she says. “To me, this is a way to take a desperately discouraging experience and turn it around to help other people. It has given me hope, excitement and renewed dreams. It has helped me to believe once again that there are no experiences in life which cannot be used to help someone else.”