There was good news this week in the effort to raise awareness of the diabetes epidemic confronting San Francisco’s Asian community. This past Tuesday during San Francisco’s Public Health Commission meeting, the “Screen at 23” Resolution was passed, and this national campaign has officially kicked off in San Francisco. The Campaign was initiated and endorsed by the American Diabetes Association (ADA), the National Council of Asian and Pacific Islander Physicians (NCAPIP), the AANHPI Diabetes Coalition, and the Joslin Diabetes Center. For the Asian community in the city, this is arguably the second most important public health campaign since the HepBFree campaign.
What is “Screen at 23”?
“Screen at 23” is part of the ADA’s 2015 Guidelines designed to specifically to address the disproportionately heavier disease burden of diabetes experienced by Asians. The initiative recognizes that diabetes occurs in many Asians with a body mass index (BMI) lower than 25. Instead of starting screening for diabetes in those with a BMI of 25 or more as was previously the standard, ADA now recommends a lower BMI of 23 to start screening for diabetes in Asians.
Why is “Screen at 23” so important for Asians?
Currently, over half of the Asians who have diabetes do not know they have the disease. In Tuesday’s Health Commission meeting, Dr. Ben Lui, Medical Director of the Chinatown Public Health Clinic (CPHC), shared some compelling evidence regarding screening patients for diabetes. Throughout the total CPHC patient population of 18,087 (mostly Chinese), 22% (4,015) more patients were screened for diabetes by using a BMI of 23 instead of 25 as the starting point for a screening. Of these additional screenings, 16% (642) of the patients were found to have diabetes and an additional 29% (1,148) were revealed to be at the pre-diabetic level. These patients diagnosed were able to start managing the disease sooner in order to avoid the life-threatening complications that can be caused if the disease goes untreated, including heart disease, stroke, kidney failure, to name a few. Thus, using a BMI of 23 instead of 25 has significantly increased the sensitivity of the screening test for Asian patients with diabetes.
The NCAPIP has released some additional information on the campaign:
The “Screen at 23” campaign seeks to reveal the undiagnosed cases of diabetes (more than half, according to the NIH) among Asian Americans. By screening Asian American patients using a body mass index of 23 as per the 2015 ADA recommended guideline, thousands of cases of diabetes (approx 215,000) and even more of pre-diabetes (approx 430,000) will be unmasked.
An Asian American patient who appears to be at a healthy weight, and is relatively thin, could actually be at risk for developing diabetes. Previously, having a body mass index below 25 would often preclude a patient from being screened – and that’s an assumption this campaign seeks to debunk.
Testing for diabetes at a body mass index of 23 is a recommendation of the American Diabetes Association and has been supported by a growing body of research done at the community level. Institutions in government and non-government sectors have begun to take notice, but we need to continue to engage the providers and patients on the importance of screening at 23 so that guidelines are put into practice and policies change.
Having a body mass index of 23 doesn’t mean that an Asian American is “fat”, “overweight”, or any kind of new definition for obesity. It is a marker to be aware of for both doctors and patients however; one to consider being tested for diabetes and to think about lifestyle changes like nutrition and exercise.
The San Francisco Medical Society also has been in strong support of “Screen at 23.”
TAKE ACTION: You can join the “Screen at 23” campaign
- Calculate your BMI with this tool.
- In your next doctor’s visit, let your doctor know if you have a BMI of 23 or over, and mention the “Screen at 23” campaign for Asians to discuss about your need to screen for diabetes.
- Lend “Screen at 23” your support and endorse the campaign using this link.
- Let your friends and families know about this campaign and urge them to find out their BMI.
With your collaborative efforts, we can work to help focus on the health of our community.