A look at public health and the south asian community
This weekend, as the nation walked for science, U.S. Surgeon General Vivek H. Murthy, the “nation’s doctor” was removed by the Trump administration and replaced temporarily by his deputy, Rear Adm. Sylvia Trent-Adams. Early releases stated that Dr. Murthy resigned and that Adams was Trump’s choice to be the new Surgeon General. None of this is accurate.
Dr. Murthy was fired by the Trump administration, according to Murthy’s former Chief of Staff, Parag Mehta. Adams, was appointed as Deputy by Murthy himself because of her extra-ordinary credentials. According to Mehta, Adams may serve as Acting Surgeon General, but cannot be given the position permanently because, by statute, the Surgeon General must be a physician.
Many lauded Vivek’s appointment as Surgeon General for various reasons. Not only was he extremely qualified for the role, but it was the first time the position was held by a South Asian, which is significant as Asian Physicians comprise the largest non-Caucasian demographic of physician providers in the United States. For me personally – as a South Asian holder of a Master’s in Public Health, it was an honor to witness Dr. Murthy’s inauguration as the nation's highest ranking public health official.
However, I believe Dr. Murthy’s ascent, and subsequent removal, is significant for the South Asian population for a very specific reason. Not because we are increasingly becoming the face of medicine and health care providers in the United States, but rather because we are the face of a disproportionately afflicted population of a preventable health epidemic. Let’s take a closer look at this epidemic, shall we?
South Asians are disproportionately susceptible to what is often referred to as “skinny fat.” What that means is that we may appear to have an outwardly healthy physique, but we are actually medically at risk for diseases associated with obesity. It is also referred to as (MONW) Metabolically Obese Normal Weight.
Visually, this “skinny fat” may present as central obesity, where an individual will appear to have a normal, even skinny upper body and lower body, but has an accumulation of fat around their mid-section. I sometimes refer to this as malnourishment fat since the two situations visually appear to have a similar “spare tire” appearance on a “skinny” frame.
This is a very serious issue because our apparent “normal” physical appearance makes us less vigilant than we should be about our health. As a community, we are disproportionately susceptible to diabetes and cardiovascular disease, which makes our false sense of security that much more dangerous. Here are some shocking stats:
The World Health Organization (WHO) has concluded that South Asians have a higher percentage of body fat than Caucasian people of the same age, sex and BMI.
When compared to white Europeans of the same BMI, South Asians have 3 to 5 percent higher total body fat.
South Asians have higher weight-related disease risks at lower BMI
Even the occurrence of type 2 diabetes is more in lower BMI than the WHO cut-off limit of 25 kg/m2.
Thus, WHO recommended that for many South Asians the limits for public health action should be 23 kg/m2. The categories suggested for Asians are: less than 18.5 kg/m2 (underweight); 18.5–23 kg/m2 (normal); 23–27.5 kg/m2 (overweight) and 27.5 kg/m2 or higher (obesity).
The South Asian cutoffs for overweight and obesity are nearly 10% lower than the BMIs for the same categories for non-South Asians
Almost 90% of people living with type 2 diabetes are overweight or have obesity. Currently 60% of the world's diabetic population is Asian. This higher risk may be because Asians, especially South Asians, are more likely to have less muscle and more abdominal fat, which increases insulin resistance. For example, even though Indian newborns have a lower average body weight compared to white newborns, Indian newborns have higher levels of body fat and insulin. Imaging technology that measures fat in humans has shown that Asians of a healthy BMI have more fat around organs and in the belly area than Europeans with the same BMI. In short, being “skinny fat” makes one more susceptible / at risk of diabetes and all the maladies that come along with it.
Obesity is a major risk factor for cardiovascular disease and has been strongly associated with insulin resistance. South Asians account for nearly 25% of the global population, yet we as a community bear over 60% of the world’s heart disease burden. South Asians in the United States have been found to have a near-50% greater mortality rate from cardiovascular disease in comparison to other ethnic communities. South Asian women have a near one-third greater risk of heart disease related death than their Caucasian counterparts. Studies suggest that nearly one in four incidents of heart attacks among East Indian men occur under the age of 40. Studies suggest that 50% of the incidents of heart attacks among East Indian men occur under the age of 50. Nearly one third of cardiac deaths within the community occur in individuals under the age of 65.
South Asians need to be extra vigilant about their health because we are disproportionately at risk for obesity, diabetes, and cardiovascular disease. Our risk for obesity is very hard to detect as we tend to carry more fat around our internal organs and we have higher weight related health risks as lower BMI’s. We are “skinny fat” and the significance of that cannot be overstated.
On April 21, 2017 Dr. Vivek Murthy was relieved of his duties as the Surgeon General. It was a blow to the nation’s public health policy. It was a blow to the South Asian and physician community from a provider perspective. But an unseen consequence of the removal is that it is also a blow to our best opportunity at shining a spotlight on the silent killers running rampant in the South Asian community. It was perhaps our best chance to educate, activate, and arm the South Asian community on the dangers of being “skinny fat.”