"Screen At 23" Program for Asian Americans

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"Screen At 23" Program for Asian Americans

3 Jan 2021

Disclaimer

In United States, BMI ranges are divided into four categories: Normal (BMI < 18.5), Normal / Healthy Weight (18.5 - 24.9), Overweight (25.0 - 29.9), Obese (30.0 and above). For general US population, diabetes screening is done at 25, which is the lower threshold for Overweight category. However, for Asian Americans, American Diabetes Association (ADA) lowered the threshold for screening from 25 to 23. Why was a threshold that lies in the Normal BMI range chosen as the cut-off? Turns out that a large percentage of Asian Americans with Normal BMI (in range 18.5 to 24.9) actually have diabetes! Moreover, a large percentage of such diabetics and prediabetics remains undiagnosed.

A chart from this research paper explains the situation: Optimum BMI cut points to screen asian americans for type 2 diabetes by Araneta et al, Diabetes Care, 2015 May;38(5):814-20.

"Percent distribution of Asian Americans with newly diagnosed type 2 diabetes by BMI." Source: Optimum BMI cut points to screen asian americans for type 2 diabetes by Araneta et al, Diabetes Care, 2015 May;38(5):814-20.

What is Screen at 23? The lowering of diabetes screening threshold from 25 to 23 for Asian Americans is called Screen at 23. Since 2015, several US states have adopted the program.

(2016) Hawaii Resolution for "Screen at 23".
(2016) California Resolution for "Screen at 23" — another copy.
(2018) Massachusetts Resolution for "Screen at 23".
(2018) Illinois Resolution for "Screen at 23".
(2019) Washington Resolution for "Screen at 23".

Lancet Editorial: Screening thresholds: one size does not fit all, Editorial, The Lancet Diabetes & Endocrinology, Vol 6, Issue 4, p 259, April 1, 2018.

ADA Position Statement: BMI Cut Points to Identify At-Risk Asian Americans for Type 2 Diabetes Screening, by Hsu, Araneta, Kanaya, Chiang and Fujimoto, Diabetes Care 2015 Jan; 38(1): 150-158.

Fat Distribution Matters

How are fats distributed in our body? This makes a big difference! A few videos that explain:

(2017) New ADA Screening Guidelines for Asian Americans

An interesting explanation starts at offset 3:28 — why may a slim looking Filipino female (with BMI 23) have higher risk for diabetes as compared to a heavier looking African American female (with BMI 25)? It has to do where the fats on our bodies are! Under the skin or inside our organs (inside our muscles, pancreas, liver, …)?

(2020) Are BCAA (Branched Chain Amino Acids) Healthy?

(7 mins) Transcript. The first 2-3 minutes of this video explain that fat distribution makes a huge difference to our susceptibility for chronic diseases like diabetes.

(2012) Waist Circumference Less than Half Your Height

(2 mins) Transcript. Excerpts:

"… people with this so-called apple shape tend to live the shortest."

"It’s now accepted that health risks can be determined as much by the relative distribution of the excess fat, as by its total amount. It’s not so much body fat, but visceral body fat, abdominal fat, the fat around our internal organs, that most increases our risk of dying prematurely."

Percentage of Undiagnosed Diabetes

What is the percentage of undiagnosed diabetes among Asian Americans? Over 50%! See this NIH News Release (2015): More than half of Asian Americans with diabetes are undiagnosed

(click to enlarge)

The graph above is from the NIH news release mentioned above. It says:

"The graph shows the percentage of the U.S. adult population — both as a whole and by ethnic/racial subgroup — with diabetes (blue bars) and the percentage who have diabetes that has not been diagnosed (green bars), according to findings from researchers supported by the NIH and the CDC and published in the Sept. 8 issue of JAMA."

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