Diversity in health outcomes

There are important differences in health outcomes and risk levels between ethnic groups, which is why BMI thresholds need to take ethnicity into account. Several studies have shown that people from specific ethnic backgrounds experience higher risks of hypertension and cardiovascular disease at lower BMI levels than White populations because of increased levels of abdominal visceral fat.

Unlike subcutaneous fat, which sits beneath the skin and serves as an energy reserve, visceral fat surrounds the organs and increases the risk of insulin resistance and inflammation. It is linked to a higher risk of metabolic diseases such as type 2 diabetes and hypertension.

This contributes to what has been described as a ‘thin outside, fat inside’ (TOFI) or ‘skinny fat’ phenotype, which is commonly seen in South Asian populations – even in people with a normal BMI. The reasons for this fat distribution pattern are unclear, but it may reflect shared genomic factors.

Targeting dietary weight management and physical activity advice to people from ethnic minority groups is therefore an important priority, given that adverse health risks occur at lower BMI thresholds.

However, weight management approaches need to be tailored for patients from diverse ethnic backgrounds because cultural, dietary and socioeconomic factors all vary and significantly influence health behaviours.

Pharmacy teams should develop the skills needed to support patients from diverse cultural backgrounds and demonstrate cultural sensitivity, which helps build trust and improve the effectiveness of weight management support.