Obesity targets could vary by ethnicity

Experts have warned the government that South Asians need altered QOF and BMI measures. Tom Moberly reports.

Adjustments should be made to QOF, BMI thresholds and vascular screening plans, to tackle the increased risk of cardiovascular disease among South Asians, MPs heard last week.

The government's health equality czar warned that England's vascular checks programme, aimed at 40- to 74-year-olds, may need to target South Asians younger than this.

His warning came as a report from a parliamentary group set up to investigate the issue said that all South Asian patients over 25 should be given BMI, HbA1c, BP, cholesterol and waist measurements.

Checks at younger age
The czar, DoH national director for equality and human rights Surinder Sharma, said: 'The vascular checks programme is aimed at everybody aged 40 to 74 years old. We could think about aiming it at younger Asian communities, because it starts at a much younger age for South Asians.'

The idea has received high-level backing - GP reported last year that England's heart czar Professor Roger Boyle believes that vascular checks should start at the age of 30 for South Asians.

At the launch of the diabetes report, the issue of using different BMI thresholds for diagnoses of being overweight or obese was also discussed.

Dr Wasim Hanif, consultant physician and honorary senior lecturer in diabetes at University Hospital Birmingham, said the UK government should consider methods already adopted by the Indian government.

To take account of South Asians' increased risk of cardiovascular disease, the Indian government uses lower BMI thresholds, so that those with BMIs more than 23 are categorised as overweight and those with BMIs more than 25 as obese.

Dr Hanif is chairman of the diabetes working group of the South Asian Health Foundation, which has set up a consensus group to examine support for the change, due to meet in December.

However, he says that evidence for lowering the thresholds to Indian levels is 'blurred'.

'If you are going to cut it down to 25, it has implications for treatment and a number of other things,' he says.

'If you keep it at 25, it would mean 70-80 per cent of the South Asian community would be obese. That means you would start treating them,' he adds.

This would have implications for treatment and for public health interventions, he points out, and could have a huge impact in terms of additional costs of treatments such as bariatric surgery for the morbidly obese.

Appropriate threshold
Dr Hanif says that the consensus group will review the evidence available and recommend an appropriate threshold.

'Everyone agrees that the cut-off needs to be lower for South Asians, but it is not clear what the cut-off should be,' he says. 'I don't think there is enough evidence for a cut-off at 25. I would go for 27 as a cut-off for diagnosing obesity in South Asians.'

He hopes the new threshold will feed into QOF indicators and NICE guidelines, so that South Asians with a BMI greater than 27 will receive obesity treatment.

Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre (NPCRDC), is leading the review of QOF indicators for NICE.

She says that the review team will decide whether QOF indicators have different thresholds for different populations based on evidence.

'The NPCRDC is looking at the wider issues of threshold-setting as part of its work for NICE,' she says. 'NICE is as keen as the previous expert panel to ensure QOF is an evidence-based framework.'

Bradford GP, Dr Shahid Ali, director of the research and development unit at Bradford South and West PCT, argues that care needs to focus more on the right outcome for individual patients.

'What is important to me is that we have people on our practice list and we should be screening them for long-term conditions,' he says. 'I need to consider patients' risk of diabetes and their family history.'

He also points out that increased risks of cardiovascular disease are not limited to South Asians, but should be applied to other Asian groups and to other communities, such as people from Eastern Europe. He says that it is important for GPs to remain vigilant and to be aware of these increased risks.

tom.moberly@haymarket.com

Risk for South Asians

  • South Asians are five times more likely to have diabetes than the general population.
  • South Asians are at greater risk of developing diabetes early.
  • Around 15 per cent of South Asians have diabetes.
  • South Asians are 50 per cent more likely to die prematurely from CHD than the general population.

Sources: Diabetes UK and NHS

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