Body Mass Index (BMI), which is a measure of weight proportionate to height, is a standard used around the world to figure out when someone is overweight or obese. BMI is an estimate of body fat and a good gauge of your risk for diseases that are more likely to develop with excessive amounts body fat.

According to the Centers for Disease Control and Prevention (CDC), the higher your BMI, the higher your risk for certain chronic diseases such as heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems and certain cancers.

However, if you are South Asian, you should know that the standard BMI scale may underestimate your disease risk.

South Asians tend to have a high percentage of body fat at a lower BMI. A study published in scientific journal The Lancet showed that for the same BMI of 22.3, an individual of Asian Indian decent had more than 21 percent body fat, compared to a Caucasian (white) individual with 9 percent body fat. This study showed that Asian Indians have more body fat at lower BMIs than Caucasian people.

Since even a little excess body fat can significantly increase one’s risk of developing diabetes and heart disease, the World Health Organization (WHO) in 2004 lowered the BMI limits for South Asians to more accurately reflect risk for this population. According to WHO, Asian Indians with a BMI of greater than 23 kg/m2 are considered overweight and a BMI of greater than 27.5 kg/m2 are considered obese.

Another measure measure used to assess weight status, body fat and disease risk is waist-to-hip ratio. It measures visceral fat and is calculated by taking your waist circumference and dividing it by your hip circumference. A waist-to-hip ratio greater than 0.80 for women and 0.90 for men puts the individual at higher risk for diabetes and heart disease.

Since South Asians have a higher percentage of body fat − which is often times deposited in the abdominal area − they may be at higher risk for diabetes and heart diseases even if their weight is considered normal by the CDC standards. To minimize risk, it is important to eat healthy and lead a physically active lifestyle.

The Palo Alto Medical Foundation’s  South Asian Wellness Task Force offers additional South Asian wellness information and team members contributed to this blog post.

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We’ve all experienced this: your fingers scrape the bottom of the bag of chips/cookies/pick-your-poison and you suddenly realize that you may have reached into the bag for handful-after-handful and yet you haven’t really “registered” or gotten satisfaction from many of the bites. Maybe you’re watching TV, on the computer, driving in the car, or lost in your own thoughts and/or feelings. Maybe what drove you to snack in the first place was not actual physical hunger, but stress, anger or boredom. Unfortunately, when we’re not “mindful” of the bites we are eating, either because we are not paying attention or because we’re eating for “head hunger,” not for a physical need, extra bites become extra calories, become extra pounds.

Clearly, a lot of our eating ends up being “out of whack” with our actual physical hunger or need for nutrition. We also don’t always fully appreciate and savor the bites we take so that it ends up taking more and more – and more – bites to achieve some level of satisfaction. In this blog post, let’s take a look at some “mindful” and “intuitive” eating principles which can help better align our food intake with our physiological needs – and enhance our satisfaction with what we’ve eaten so that we don’t need to take quite so many bites!

Honor your hunger:

Keeping your body fed when you are physiologically hungry may mean you have to start actively listening for – and gauging – your hunger. If you were to start using a hunger scale when you are thinking about eating, where would you say your “state of hunger” typically falls along a continuum of “completely empty” to “so over-full that you feel physically ill?” Take some time to note your own patterns – and how often you are eating for reasons not at all related to physiological hunger. Sometimes we eat beyond fullness just because each bite tastes so darn good (“taste hunger”), or we find ourselves eating to soothe feelings or in response to our emotions, boredom or habit (“head hunger” ). So start listening to and rating your hunger – it’s hard to hear something when we’re not paying attention.

Feel your fullness:

Be mindful of physiological signals that tell you that you are no longer hungry. How often are you really stopping your eating based on completely non-hunger related cues? Probably more often than you even realize. You may have been a lifelong member of the “clean-your-plate-club,” or you can’t stand to see anything go to waste because you paid good money for it! There has been a lot of research which has shown that, as adults, the amount of food we eat is strongly influenced by the size of the container, or how many options are available. For example, if offered a bowl with two M&M colors and one with several M&M colors, guess which bowl empties more quickly? Learning to “feel your fullness” can start by abandoning the idea of “eating to completion.” Instead, pause in the middle of eating for a satiety and a taste check. Are you hungry enough to continue? Do you feel satisfied? Is the food enjoyable enough to merit any more bites or are you just eating because the food is there? When you discover your fullness level, you can also identify your “last bite threshold,” when you know that bite of food in your mouth should be your last one. At that point, do something to make it a conscious act, such as nudging your plate forward or putting your utensils or napkin on your plate.

Discover the satisfaction factor:

How often do we overlook the true pleasure and satisfaction that can be found in the eating experience? It helps to become a “mindful eater.” Ask yourself, “What do I really want to eat?” Maybe that tub of off-brand ice cream that was on sale looks promising, but would a scoop of your favorite premium brand be more satisfying? Once you’ve determined what you really want to eat, be sure then to eat without distraction, in a pleasant environment; eat when you are gently hungry, rather than overly hungry. Don’t settle – if you don’t love it, don’t eat it – and if you love it, be absolutely sure to savor it! When we pay attention to our food, we take much more satisfaction in it and we become more aware of how much we’re putting into our bodies.

Making the transition from our typical eating patterns to becoming a mindful or intuitive eater is a process that takes awareness, practice, practice and more practice. We have so many cues to eat (from advertising or even just driving down a thoroughfare full of fast food outlets) and so many distractions from the actual “task at hand” while we are eating that maybe it shouldn’t be so surprising that so many of us over-consume calories on a regular basis. In approaching your food intake in a mindful way, you can take back control of what you eat, when you eat and how much you eat.

This blog post is contributed by Karen Handy, MPH, a behavioral health educator and manager of nutrition and diabetes education at Palo Alto Medical Foundation. She supports patients making health behavior and lifestyle changes, co-facilitates PAMF’s bariatric support group and writes a blog on weight management and health behavior change for Sutter Health’s MyLifeStages website.

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Fat free doesn’t mean “calorie free”. In this new video as seen on Sutter Health’s MyLifeStages television, PAMF Registered Dietitian Tracey Slezak offers healthy eating tips and demonstrates how to make better, healthier food choices when you’re trying to lose weight.

Tracy Slezak is a registered dietitian and health educator with PAMF’s Health Management Resources – (HMR) Weight Management program.  You can learn more about nutrition on the PAMF website.

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Get me up on my weight management soap box and you’ll hear me forcefully proclaim that successful weight management has very little do with willpower, it’s actually much more about something we call skillpower: having enough strategies, tips and strategic planning to develop new skills to support ongoing lifestyle change.

As much as the Nike ads would like us to believe we can “Just Do It” — most of us know from personal experience that knowing what to do, even desperately wanting to do, does not translate into lasting behavior change. How many times have we told ourselves, “Today is the day” – we set out with great intentions only to be waylaid by a temptation too strong to resist (name your poison) or “life” getting in the way of exercise plans. Deflated and guilty, we start the cycle over and over again.

Environments can have an influence

I recently read about some interesting research which suggests that, over and above willpower or even skillpower, our environments can have an influence – either positively or negatively – in significant and profound ways that may well be under our radar. According to Dr. Wendy Wood, a professor of psychology and neuroscience at Duke University, almost half of our behavior takes place every day, in the same environments – home, car, school, work, etc. Dr. Wood explains that even though people think they are making choices all the time, many of our repeated behaviors are cued by our everyday environments. “Most people don’t think that the reason they eat fast food at lunch or snack from the vending machine in late afternoon is because these actions are cued by their daily routines, the sight and smell of the food or the location they’re in. They think they’re doing it because they intended to eat then or because they like the food.”

Dr. Wood’s studies demonstrated that people repeat well-practiced behaviors whether they intend to or not. She has also found that physical locations are some of the most powerful behavioral cues. For example, one of her studies demonstrated that college students who transferred to a new university were able to break their TV habit if the TV was in a new location, whereas those students who found their new dorm TV to be in the same place as their old dorm, did not significantly change their viewing habits.

Think about it this way: If you leave a bowl of apples on your counter, are you more likely to eat them than if they are out of sight in your produce drawer? If you’re like me, you’ve no doubt lost count of the number of times you’ve cleared out that drawer of rotting produce! If you removed the comfy cushions on your couch, would you be as likely to spend time watching TV? Trying to avoid a fast food habit? Dr. Wood suggests driving a different route to avoid the visual cue. Similarly, as we like to say in our weight management program, if it’s there, you’ll eat it – and the corollary, if it’s not there, you can’t eat it.

Focusing on triggers

Early on in my career, I worked with smokers to help them quit their cigarette habits. We focused a lot on “triggers” or cues to smoke; how being in certain environments or with particular people, or practicing an everyday behavior (like reading the newspaper, drinking a cup of coffee, or driving a car) could produce at times an overwhelming craving or urge to smoke. Environmental cues and triggers can also work against us – or for us – when working to develop other new health habits. I’ve been working hard (trying to follow doctor’s orders!) to incorporate more strength training into my exercise routine. What has helped is to tie doing certain exercises to my every day “get-ready-in-the-morning” routines. For example, I started doing “wall sits” while I brush my teeth. I’ve put a stability ball near the TV as a cue to do my core work.

What’s the bottom line?

Bottom-line: The more effort we put into problem-solving setting up our environments and cues to work for us – to support habits we’re trying to put in place, or to reduce the cues or ease of practicing behaviors we’d like to avoid — the less we’ll need to rely on willpower; even better, we’ll provide a boost to that skillpower we’re working to develop. Now, to practice what I preach, I need to find a way to get cued to take – and use — those hand weights which have been way too firmly ensconced underneath the TV!

This blog post is contributed by Karen Handy, MPH, a behavioral health educator and manager of nutrition and diabetes education at Palo Alto Medical Foundation. She supports patients making health behavior and lifestyle changes, co-facilitates PAMF’s bariatric support group and writes a blog on weight management and health behavior change for Sutter Health’s MyLifeStages website.  Ms. Handy enjoys spending time with her three children and is interested in reading, running, healthy cooking, hiking and travel.

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