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Patients, physicians should take note of ethnicity-specific Body Mass Index (BMI) guidelines

Since BMI originated with the measurements of European men, we know that it leaves a wide range of people out of the equation.

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Photo by Bill Oxford from Unsplash.com

While body mass index (BMI) as a body composition assessment tool has long had its critics, recent research has highlighted a new potential drawback in that it could prevent people of certain ethnicities from having their risk for Type 2 diabetes assessed earlier. A psychologist and weight management specialist at a top American hospital, Cleveland Clinic, stresses the importance of physicians and patients being aware of different cut-off points based on their ethnicity.

Leslie Heinberg, PhD, MA, explains that recently, researchers in the U.K. discovered that the cutoff BMI number associated with a higher risk of Type 2 diabetes varies between different patient populations. For example, a BMI of 30 or above was linked to a higher risk for white people. For Black people, the cutoff number was 28 or above. For South Asian people it was 23.9 or above and for the Middle Eastern population, the BMI cutoff was 26 or above. 

The problem? Some healthcare providers might only be making recommendations for diabetes-related lifestyle changes or treatment options based on the risk level for white people. This means that other populations might not get the medical interventions they need in time. 

Here, Dr. Heinberg, explains why BMI is still used and gives some tips for how people of color can make sure they’re on the right track despite the discrepancies. 

Where did BMI come from?

The formula for calculating body mass was the creation of a Belgian mathematician, astronomer, sociologist and statistician named Lambert Adolphe Jacques Quetelet. Quetelet wasn’t focused on studying obesity when he developed what was first known as the “Quetelet Index” (your weight in kilograms divided by the square of your height in meters, or Kg/M²). He was looking at years of crime data that he compiled to link crime to social conditions. In doing so, he noticed a relationship between an adult’s height and weight. 

In 1972, American physiologist Ancel Keys gave the Quetelet Index a new name as he thought the formula was a good way to identify obesity. He referred to it as the body mass index. 

“It’s a ratio that takes height into account because taller people weigh more than shorter people,” says Dr. Heinberg. “It was developed more for actuarial tables and to determine which people are at a higher risk for mortality. It’s something that makes sense when you look at a very large population.”

Dr. Heinberg adds that today, many organizations and businesses still rely on BMI when it comes to providing things like insurance or medical procedures. 

The drawbacks of BMI

Dr. Heinberg says that BMI can be a pretty blunt instrument for health because it leaves a lot of physical attributes out of the equation. 

“It doesn’t take into account a lot of things about an individual. You can ask somebody for their height and weight and it becomes a very easy assessment in comparison to a full and comprehensive evaluation. When we think about an individual’s health and their health risks, taking their background information into account is helpful. But when you’re looking at a million people, you just can’t do that.”

Other physical signs of health risks

While BMI is one way of measuring risks, Dr. Heinberg says there are other physical clues to watch out for. 

“We do know things like waist circumference, waist-to-hip ratio and where you hold excess weight might play an even more important role when it comes to metabolic diseases,” she says.

For instance, if you have an apple body shape or a pear shape, the excess abdominal weight of an apple shape is associated with more cardiovascular risks and metabolic disease. “Also, with things like obstructive sleep apnea, neck circumference seems to be important. It all goes way beyond just BMI.”

How people can advocate for their health

Since BMI originated with the measurements of European men, we know that it leaves a wide range of people out of the equation. However, since it is just one piece of information, Dr. Heinberg recommends getting the full picture of your health. 

“What’s helpful about this study is that it helps illustrate that BMI should not just be used to determine if someone is healthy, unhealthy, lean or obese. Instead, it should be considered as another vital sign. If a provider sees someone with an elevated BMI, particularly if they are from a population that is at higher risk for Type 2 diabetes, that should suggest doing some lab work and making additional assessments. It would also be good to discuss any factors that can keep a patient out of that pre-diabetic or full diabetic range.” These factors might include sleep habits, stress management, dietary changes and increased physical activity.

If you already know that your family has a history of diabetes, high blood pressure or other health concerns, discuss it with your provider. The more information they have, the better equipped they are to monitor your health and help you manage any conditions. 

The main thing to keep in mind about BMI 

Dr. Heinberg says the other important message when it comes to BMI or weight is that you do not have to lose a large amount of weight to improve your health.

“There’s this unfortunate message that everyone has to be within this little window. But even a small amount of weight loss — around 2.5kg to 4.5kg — is associated with really significant improvements in metabolic risk or cardiovascular risk.”

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Cannabidiol therapy could reduce symptoms in autistic children and teenagers

The use of cannabidiol (CBD) cannabis extract can lead to meaningful benefits and improve the behaviour of children and adolescents with autism spectrum disorder.

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New research presented at the 2025 European Congress of Psychiatry reveals that the use of cannabidiol (CBD) cannabis extract can lead to meaningful benefits and improve the behaviour of children and adolescents with autism spectrum disorder (ASD). ASD affects approximately 1 in 100 children around the world and symptoms can include difficulty interpreting language, difficulty expressing emotions, and repetitive behaviour and routines.1,2 

The meta-analysis included randomised, placebo-controlled trials on the efficacy or safety of CBD cannabis extracts in children and adolescents with ASD. Three studies were used in total with 276 participants with a mean age of 10.5, ranging in age from 5 to 21. The dosage of CBD cannabis extract started at 1 mg/kg per day and was titrated up to 10 mg/kg.  

Key findings from the study include: 

  • CBD cannabis extract use shows moderate improvements in social responsiveness and small yet notable reductions in disruptive behaviours.
  • CBD cannabis extract significantly enhanced social responsiveness and reduced disruptive behaviour.
  • The use of CBD cannabis extract has a favourable safety profile as it did not increase adverse events compared to placebo  
  • There were no significant differences between adverse events in CBD cannabis extract versus placebo  

Lara Cappelletti Beneti Branco, Lead Investigator, São Camilo University Center, University of São Paulo, said: “The global population prevalence of ASD diagnosis amongst children and adolescents is growing, but many treatment pathways are not effective. It is promising to see the effect of CBD cannabis extract on the study participants. However, there still needs to be considerable focus on further research with larger trials to clarify its efficacy and safety in managing ASD.” 

Professor Geert Dom, EPA President, said: “ASD can be extremely frustrating for all involved; parents of children and adolescents with the disorder, the treating clinicians and of course the children and adolescents themselves. A large part of this frustration is down to finding a viable treatment option that works to reduce symptoms. It is with delight that we see the results of this meta-analysis and we hope to see further research into this so we can move towards a solution to the unmet need within this community”.  

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Relaxation techniques may help lower high blood pressure — at least in the short term

Most relaxation techniques seemed to lower both systolic and diastolic blood pressure for people with high blood pressure after 3 or fewer months. The most commonly included interventions were breath control (13 studies), yoga/tai chi (11), biofeedback (8), progressive muscle relaxation (7), and music (7).

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Relaxation techniques may help lower high blood pressure—at least in the short term—but the longer term effects are unclear, finds a pooled data analysis of the existing research published in the open access journal BMJ Medicine.

And the risk of bias in the existing body of research means that further, more rigorously designed and longer studies are needed to confirm whether these techniques have a constructive role in the treatment of high blood pressure, conclude the researchers.

High blood pressure affects around a third of 30-79 year olds and is one of the leading attributable causes of deaths in both men and women, note the researchers. While drugs are available to treat the condition, adherence to them is poor, generating interest in alternative approaches, such as relaxation techniques, to reduce one of the major risk factors for high blood pressure—high stress levels. But it’s far from clear which of these methods, which can include breath control, mindfulness, yoga, Tai Chi, and biofeedback, among others, might be most effective.

To build on the evidence base, the researchers scoured research databases for studies, published in English up to February 2024 that looked at the potential impact of relaxation techniques on high blood pressure (140/90 mm Hg and above) and elevated blood pressure (120/80 mm Hg and above). They included 182 studies, 166 of which looked at high blood pressure, and 16 of which looked at elevated blood pressure (pre-hypertension).

Where possible, the researchers deployed network meta analysis, a statistical technique used to simultaneously compare the effects of several different ‘treatments’.

The pooled results of 54 studies showed that most relaxation techniques seemed to lower both systolic and diastolic blood pressure for people with high blood pressure after 3 or fewer months. The most commonly included interventions were breath control (13 studies), yoga/tai chi (11), biofeedback (8), progressive muscle relaxation (7), and music (7).

Compared with no intervention, breath control achieved a reduction of 6.65 mm Hg in systolic blood pressure (the first and higher number in a blood pressure reading), meditation a drop of 7.71 mm Hg, meditative movement, such as tai chi and yoga, a drop of 9.58 mm Hg, and mindfulness a drop of 9.90 mm Hg.

Music was also associated with a fall of 6.61 mm Hg, progressive muscle relaxation with a fall of 7.46 mm Hg, and psychotherapy with a reduction of 9.83 mm Hg. Combined techniques were associated with a drop of 6.78 mm Hg in blood pressure. 

There was no statistical evidence of effectiveness for any technique after 3 to 12 months and the certainty of the evidence was very low. The most commonly included techniques at this timepoint were biofeedback (7 studies), yoga/tai chi (4), and progressive muscle relaxation (4).

Very few studies included long term follow up of 12 months or more, and of the 3 included in the network analysis, the results showed that compared with no treatment autogenic (self directed) training might lower both systolic and diastolic blood pressure, but the certainty of the evidence was low. 

There was no statistical evidence of effectiveness for other treatments assessed at this time point, including biofeedback, progressive muscle relaxation, and techniques involving a combined approach.

Limited data were available for elevated blood pressure: only two studies compared relaxation techniques with no treatment/usual care and the effects on systolic blood pressure were small. 

The researchers note that the descriptions of relaxation interventions were sometimes incomplete or sparse, there were few data on costs and cost effectiveness, and most of the included studies didn’t report information on the risk of cardiovascular disease/events/deaths. 

But they suggest: “The results of our systematic review and network meta-analysis indicate that relaxation or stress management techniques might result in meaningful reductions in blood pressure at up to three months of follow-up.” 

But they caution: “Uncertainty exists about this effect, however, because of the risk of bias in the primary studies, the potential for publication bias in this area, and imprecision in the effect estimates, meaning that the observed changes in blood pressure might be too small to affect cardiovascular or cerebrovascular outcomes.” 

And they add: “Hypertension is a chronic condition, likely to require long term drug treatments or behavioural changes. As such, interventions that are used for a brief period, or provide only short term benefits, are unlikely to be clinically useful. 

“Too few studies exist, however, to assess whether the beneficial effects of relaxation are maintained when the techniques are practised for longer than three months. Future studies must clearly report whether participants were still using relaxation methods at the time of the outcome assessment, with details on adherence to the relaxation schedule. These factors might strongly influence the effectiveness of the different relaxation and stress management techniques.” 

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Poor oral health linked with body pain and migraines in women

Findings highlight the importance of good oral health to potentially mitigate pain and improve overall wellbeing, prompting further exploration into the role of oral microbiota in chronic unexplained pain conditions. This includes fibromyalgia, a condition experienced by 67 percent of the study participants.

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New research from the University of Sydney has revealed poor oral health is significantly associated with higher instances of migraines, abdominal and body pain in women. 

Published in Frontiers in Pain Research, the world-first study identified specific oral microbes correlated with certain pain conditions, suggesting a potential relationship between the oral microbiome and the nervous system.   

The findings highlight the importance of good oral health to potentially mitigate pain and improve overall wellbeing, prompting further exploration into the role of oral microbiota in chronic unexplained pain conditions. This includes fibromyalgia, a condition experienced by 67 percent of the study participants. 

“This is the first study to investigate oral health, oral microbiota and pain commonly experienced in women with fibromyalgia, with our study showing a clear and significant association between poor oral health and pain,” said lead investigator Associate Professor Joanna Harnett from the Faculty of Medicine and Health. 

“Our findings are particularly important to fibromyalgia which, despite being a common rheumatological condition, is often underrecognised,” said first author and PhD candidate in the Faculty of Medicine and HealthSharon Erdrich.  

“Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, and headaches including headaches, as well as fatigue, sleep disturbances, and cognitive problems.” 

The research examined associations between self-reported oral health, the oral microbiome, and various pain presentations in a group of New Zealand women with and without fibromyalgia.   

Oral health was assessed using the WHO oral health questionnaire and evaluated against body pain, headaches, migraines, and abdominal pain using validated instruments, including the Short-form 36 (which measures quality of life), the International Headache Society headache survey and the functional bowel disorder severity index. Strong associations were evident between oral health scores and pain and each of these were associated with specific microbes found in the mouth, which were assessed using advanced genomic technology.   

Participants with the poorest oral health were more likely to suffer from higher pain scores: 60 percent were more likely to experience moderate to severe body pain, and 49 percent were more likely to experience migraine headaches. Lower oral health was a statistically significant predictor of frequent and chronic migraine. 

Four oral microbial species from the Dialister, Fusobacterium, Parvimonas and Solobacterium genera were significantly associated with pain after age, BMI and added dietary sugars were considered.   

A weak but significant inverse correlation with diet quality and oral health was also found, though the researchers note this has yet to be investigated in detail. 

The Australian Dental Association recommends regular oral hygiene appointments and dental health checks, in addition to twice daily teeth brushing and flossing. 

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