BMI Percentile Cutoffs for Overweight and Obesity Are Set Too High in Terms of Adiposity and Metabolic Markers for Asian Children and Adolescents.

OBJECTIVES

Asian adults develop metabolic complications at lower body mass indices (BMIs) compared with other ethnic groups, leading to lower BMI cutoffs for overweight and obesity. However, it remains unclear whether such adjustments are warranted in Asian children and adolescents. We aimed to determine whether lower BMI percentile cutoffs should be considered for overweight and obesity among Asian children and adolescents in the United States.

METHODS

We analysed nationally representative data from U.S. children and adolescents from NHANES, 2012-2020. Metabolic parameters-including truncal fat percentage, glycemic markers, lipid profiles and liver disease markers-were compared between Asian and non-Asian participants within the 85-95th percentile and ≥ 95th percentile ranges. Metabolic parameter-based matching analyses identified corresponding BMI percentiles between groups.

RESULTS

Asian children had more pronounced metabolic abnormalities than non-Asians in the overweight and obesity groups. After matching for metabolic parameters, Asians had the same levels of metabolic dysfunction at lower BMI percentiles than non-Asians, with averaged differences of approximately 3-9 BMI percentiles across various BMI percentile ranges.

CONCLUSIONS

Asian children and adolescents experience elevated metabolic risks at currently defined BMI percentiles. Lower BMI cutoffs targeting the 80th percentile for overweight and 90th percentile for obesity may improve early detection of metabolic risks in the Asian paediatric population.