Rethinking Obesity Paradigms: Ethnic-specific Approaches for Asian Populations in Global Clinical Practice

Abstract

Obesity is a long-term disease that keeps coming back again and again. It is caused by having too much fat and makes you sick by messing up your body’s metabolism. In 2022, more than 1 billion adults around the world were obese. The number of obese adults has nearly tripled since 1975. This has led to noncommunicable diseases (NCDs) such as type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), cancers, and severe Coronavirus disease 2019 outcomes. In Asia, which is home to 60% of the world’s population, the epidemic shows up uniquely: the “thin-fat” phenotype, which means that people have more visceral fat and body fat at lower body mass index (BMI) levels than Caucasians. This leads to comorbidities at BMI levels of 23–27 kg/m ² . This review combines genetic, metabolic, behavioral, and socioenvironmental factors that cause problems, as well as the costs, which are thought to be 2.2% of global gross domestic product. A critical examination of guidelines uncovers Eurocentric biases in the standards set by the World Health Organization (WHO), the American Heart Association/American College of Cardiology, and the European Association for the Study of Obesity (obesity defined as BMI ≥30 kg/m ² ), in contrast to Asian adaptations: WHO. Western Pacific (≥25 kg/m ² ), India (≥25 kg/m ² with waist ≥90/80 cm), Japan/China (overweight 23–24.9 kg/m ² ), and Korea’s 2024 guidelines introducing “clinical obesity” beyond BMI. Meta-analyses corroborate the elevated risk of T2DM among Asians (67% increase per 5 kg/m ² BMI elevation) and CVD mortality at reduced BMI levels, with visceral adiposity contributing to insulin resistance and inflammation. Recent advances in pharmacotherapy (glucagon-like peptide-1 agonists, WHO-endorsed 2025) and lower surgical thresholds (BMI ≥27.5 kg/m ² in Asia) necessitate integration. Sociocultural factors, such as the nutrition transition, worsen Asia’s problems. By 2030, there will be 1.13 billion cases of obesity worldwide. Criteria that take ethnicity into account lower the number of missed diagnoses, which makes it possible to start lifestyle changes, drug therapy, and surgery sooner. This review highlights the importance of precise public health measures, such as culturally appropriate interventions, equal access to medications, and the standardization of guidelines to stop the rise of NCDs in Asia.