Endocrine Abstracts

Introduction: Obese adults of South Asian origin in the UK are considered to be obese at a BMI of 27.5 kg/M² compared with 30 kg/m² for other groups and are at increased risk of obesity related disorders such as type 2 diabetes. From July 2021, GPs have been offered financial incentives for referral of adults to weight management services. However no provision or adjustments have been made for children and young people especially those of South Asian origin: this contrasts to the stated objectives for obesity management in the NHS Long term Plan. Is this lack of action increasing their lifelong risk of obesity related disorders?

Our Current State of Knowledge

Ideally a BMI centile ‘action line’ should be identified on the UK’s paediatric BMI centile charts so that these children may be referred to specialised services. This ‘action line’ should relate to an outcome as is the case in adults for BMI values above 30 kg/M². The BMI centiles currently available for children were not collected in an ethnicity specific way and it has been argued that they should not be used in such a way. However data from the National Child Measurement Programme, when adjusted from ethnicity specific measurements of body fat using deuterium dilution, provides supporting evidence that BMI underestimates body fat in overweight or obese South Asian children but not in most Black children. In addition there is evidence of reduced physical activity in South Asian London children and evidence of less parental concern about future overweight risk.

Conclusion: Evidence is accumulating that South Asian children are at particularly high risk of becoming overweight and developing obesity related problems in later life. While there is a relative lack of longitudinal obesity related outcome data for obese South Asian children, extrapolation from our knowledge of obesity outcomes in adults strongly support consideration of an action line adjustment to the equivalent of 27.5 mg/M² for South Asian children. This needs to be combined with good quality longitudinal outcome studies and a substantial improvement in obesity services for children and young people which are culturally relevant to that population.