Revisiting BMI Standards for Filipinos: A Critical Analysis of Applicability and Health Implications
Abstract:
The Body Mass Index (BMI) has long been a seemingly simple, universal tool for assessing weight and health risk. However, for a population as distinct as Filipinos, this one-size-fits-all approach is deeply flawed, failing to capture a complex physiological reality. This report critically examines how the universal application of BMI can lead to dangerous oversights, as many Filipinos, both at home and in the diaspora, face significant health risks at BMI values that are considered "normal" by Western standards. Their tendency for higher central and visceral adiposity for a given BMI makes them uniquely vulnerable to conditions such as type 2 diabetes and hypertension, often without the visible cues of overweight or obesity. The evidence presented necessitates a paradigm shift in health assessment. It reveals that a nuanced, multi-faceted approach is required, one that moves beyond a single number to incorporate ethnicity-specific BMI cut-offs, alternative anthropometric measures like waist circumference, and a deep understanding of socio-cultural and environmental factors like dietary acculturation. The failure to adopt these tailored guidelines is not merely a scientific inaccuracy; it is a clinical and public health failure that perpetuates health disparities and results in missed diagnoses, delayed interventions, and a misallocation of resources. By adopting a forward-thinking, evidence-based approach that acknowledges the unique realities of the Filipino population, healthcare systems can move toward a more equitable and effective model of care.
KeyWords:
Obesity, Ethnicity-Specific BMI, Visceral Adiposity, Type 2 Diabetes
References:
- Adair, L. S., Kuzawa, C. W., McDade, T., Carba, D. B., & Borja, J. B. (2018). Seventeen-year changes in body mass index, waist circumference, elevated blood pressure, and diabetes phenotypes in a cohort of Filipino women. Asia-Pacific Journal of Public Health, 30(6), 561–571. https://doi.org/10.1177/1010539518800366
- Araneta, M. R. G., Kanaya, A. M., Hsu, W. C., Grandinetti, A., Lim-Abrahan, M. A., Fujimoto, W. Y., & Barrett-Connor, E. (2015). Optimum BMI cut points to screen Asian Americans for type 2 diabetes. Diabetes Care, 38(5), 814–820. https://doi.org/10.2337/dc14-2071
- FNRI - DOST. (2022). Philippine Nutrition Facts and Figures: 2018-2019 ENNS. https://enutrition.fnri.dost.gov.ph/
- Lee, N., White, L. V., Marin, F. P., Saludar, N. R., Edwards, T., & Cox, S. E. (2019). Low mid-upper arm circumference predicts higher inpatient mortality in acutely unwell adult patients hospitalized in a TB ward in the Philippines: A prospective cohort study. PLoS One, 14(5), e0215968. https://doi.org/10.1371/journal.pone.0215968
- Leon Guerrero, R. T., Novotny, R., Wilkens, L. R., Chong, M., White, K. K., Shvetsov, Y. B., Buenconsejo-Lum, L., Badowski, G., & Blas-Laguaña, M. (2017). Risk factors for breast cancer in the Breast Cancer Risk Model Study of Guam and Saipan. Cancer Epidemiology, 50(Pt B), 221–233. https://doi.org/10.1016/j.canep.2017.04.008
- Mui, P., Hill, S. E., & Thorpe, R. J., Jr. (2018). Overweight and obesity differences across ethnically diverse subgroups of Asian American men. American Journal of Men's Health, 12(6), 1958–1965. https://doi.org/10.1177/1557988318793259
- Nazare, J. A., Smith, J. D., Borel, A. L., Haffner, S. M., Balkau, B., Ross, R., & Després, J. P. (2012). Ethnic differences in visceral adiposity and its relation to metabolic risk factors. Obesity, 20(6), 1290–1297. https://doi.org/10.1038/oby.2011.370
- Toledano, A. Y., Adair, L. S., Borja, J. B., & Kuzawa, C. W. (2022). Normal-weight central obesity and cardiometabolic risk in Filipino adults: Findings from the 2018–2019 National Nutrition Survey. Public Health Nutrition, 25(10), 2841–2850. https://doi.org/10.1017/S136898002200085X
- Van Haute, A., De Craemer, M., De Henauw, S., & De Clercq, D. (2020). Body composition and health risks in Filipino young adults: A systematic review. Journal of Health, Population and Nutrition, 39(1), 1–12. https://doi.org/10.1186/s41043-020-00223-y
- Vargas, P., & Jurado, L. F. (2015). Dietary acculturation among Filipino Americans. International Journal of Environmental Research and Public Health, 13(1), 16. https://doi.org/10.3390/ijerph13010016
- White, L. V., Lee, N., Marin, F. P., Saludar, N. R., Edwards, T., & Cox, S. E. (2019). Performance of alternative measures to body mass index in the assessment of moderate and severe under-nutrition among acutely unwell patients hospitalized in a TB ward in the Philippines: A cross-sectional study. PLoS One, 14(5), e0215968. https://doi.org/10.1371/journal.pone.0215968
- World Health Organization. (2020). Body mass index (BMI). https://www.who.int/data/gho/indicator-metadata-registry/imr-details/232
- Wright, M. J., Sotres-Alvarez, D., Mendez, M. A., & Adair, L. S. (2017). The association of trajectories of protein intake and age-specific protein intakes from 2 to 22 years with BMI in early adulthood. British Journal of Nutrition, 117(5), 750–758. https://doi.org/10.1017/S0007114517000502