Know Your Numbers — Through a South Asian Lens
Standard health ranges were largely developed from data on European populations. For South Asians, metabolic risk frequently begins at lower thresholds. Understanding the adjusted benchmarks could change how you and your doctor interpret your results.
Important Context: Many common health thresholds were developed from data largely based on European populations. South Asians may experience elevated metabolic and cardiovascular risk at the same BMI, blood sugar, or cholesterol levels that might appear less concerning in other groups.⁹ This section is educational — always discuss your personal numbers with a healthcare provider.
Six Key Health Metrics — Explained
Each metric tells a different part of your metabolic story. Together they give a complete picture of your diabetes and cardiovascular risk.
BMI (Body Mass Index)
South Asians develop insulin resistance and type 2 diabetes at significantly lower BMI values than white European populations. The ADA updated its Asian American screening threshold to 23.0 kg/m² specifically because of this population difference.⁵
⚠️ Note: BMI does not distinguish muscle from fat or account for fat distribution. For South Asians, waist circumference is often a more clinically useful indicator.
Fasting Blood Glucose
Fasting blood glucose measures blood sugar after an 8-hour fast. Prediabetes begins at 100 mg/dL. For South Asians who may have impaired fasting glucose earlier in life, annual monitoring from the mid-20s is advisable.²
⚠️ Note: A single reading can be affected by recent illness, stress, or sleep. A1C provides a more stable 3-month average.
A1C (Glycated Hemoglobin)
A1C reflects average blood sugar over the past 2–3 months by measuring what percentage of hemoglobin is coated with glucose. It is the most reliable single indicator of long-term blood sugar control and is used to both diagnose and monitor diabetes.⁵
⚠️ Note: A1C may be less accurate in people with certain anemias or hemoglobin variants. Discuss with your provider.
Waist Circumference
Waist circumference is the most direct, accessible measure of central (visceral) adiposity. Since South Asians accumulate dangerous organ fat at smaller waist sizes, the WHO and IDF both recommend lower cutoff points for South Asian, Southeast Asian, and East Asian populations.
⚠️ Note: Measure at the midpoint between the lowest rib and the top of the hip bone, while exhaling normally.
Blood Pressure
High blood pressure strains blood vessel walls, accelerating atherosclerosis (artery hardening). In South Asians with already elevated cardiovascular risk, even Stage 1 hypertension (130–139/80–89 mmHg) significantly increases heart attack and stroke risk.⁴
⚠️ Note: Home monitoring is more reliable than a single clinic reading. Aim for multiple readings over several days.
Cholesterol (Lipid Panel)
South Asians tend to have more atherogenic (artery-clogging) small, dense LDL particles and lower HDL ("good") cholesterol compared to other populations at similar LDL levels. This pattern significantly raises coronary artery disease risk.⁴
⚠️ Note: A fasting lipid panel includes Total Cholesterol, LDL, HDL, and Triglycerides. Request this test from age 25 onward.
When to Get Tested
Advocate for South Asian-Specific Care
"Given my South Asian background, should we use the 23.0 BMI threshold for my diabetes screening?"
"Can we check my waist circumference using the Asian-specific cutoffs (90cm/80cm)?"
"Should I get an A1C and fasting glucose test this year, even if I feel healthy?"
"Is my LDL cholesterol level appropriate given the higher CV risk in South Asians?"
"Do you have experience managing South Asian patients with prediabetes or early metabolic syndrome?"
"What frequency of screening would you recommend given my family history?"
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