16 March 2005
REVISION OF BODY MASS INDEX (BMI) CUT-OFFS IN SINGAPORE
1 The BMI cut-off levels for Singapore will be revised based on the findings from local studies and the recommendations from the WHO Expert Consultation in Singapore.
Revised BMI Cut-Off Points in Singapore
2 Recent studies have shown that many Asian populations, including Singaporeans, have higher proportion of body fat compared to Caucasians of the same age, gender and BMI.
3 These studies also showed that Asians have increased risk for cardiovascular diseases and diabetes mellitus at relatively low BMI levels. In Singapore, about half of adult Singaporeans with BMI of 22 to 24 kg/m2 have at least one cardiovascular risk factor.
4 WHO convened an expert consultation to review the BMI cut offs to define risks in Asian populations and recommended that for some Asians, BMI of 23 kg/m2 or higher marks a moderate increase in risk while a BMI of 27.5 kg/m2 or more represents high risk.
5 In view of this, MOH and HPB have recommended that the BMI cut-off points for public health action and clinical interventions proposed by the WHO expert consultation for adults be adopted. The recommended BMI cut-offs are:
6 For the purposes of public health action, the new BMI cut offs will be used at the national level for planning of programmes to prevent obesity and other obesity-related diseases. For the individual and for clinical intervention, these BMI cut-offs should be triggers and indicators that warrant further clinical investigations for risk factors and follow-up interventions and for the individuals to make changes to their lifestyles to adopt healthy lifestyle practices. For someone with a BMI within the moderate or high risk group, losing 5-15% of one’s body weight can improve one’s general health.
7 With the adoption of the new BMI cut-offs for public health action in Singapore, the distribution of the adult population aged 18 to 69 years, by BMI risk categories are 9% of adults with a BMI less than 18.5kg/m2, 42% of adults with BMI between 18.5kg/m2 and 23kg/m2, 35% of adults with BMI between 23kg/m2 and 27.5kg/m2, and 14% of adults with BMI more than 27.5kg/m2.
Recommendations of the Taskforce for Obesity Prevention and Control
8 With the global rise in obesity and the rising trend of overweight and obesity in Singapore adults from 26% in 1992 to 30% in 1998, HPB convened a Taskforce on Obesity Prevention and Control. Please refer to Annex 1 for the Terms of Reference of the Taskforce.
9 The multi-sectoral Taskforce was formed in February 2004, chaired by Dr Lam Sian Lian, Chief Executive Officer, Health Promotion Board, and comprised representatives from the Ministries of Health, Education, National Development, Community Youth and Sports, as well as the Singapore Armed Forces, Agri-Food & Veterinary Authority, National Parks Board, together with healthcare professionals from the College of Family Physicians, Singapore Nutrition and Dietetics Association, The Children Medical Institute, and other experts in the field of obesity. Please refer to the Annex 1 for the list of the Taskforce members.
10 The Taskforce proposed a co-ordinated framework to address the prevention and control of obesity in Singapore.
11 The framework encompasses multi-disciplinary strategies and programmes in 4 key settings: the Community, Workplaces, Schools and Preschools, and Healthcare. Please refer to the Annex 2 for more information on the programmes.
12 Underpinning the strategic framework are the following recommendations:
a) Consistent messages : Guidelines for BMI cut-offs, regular physical activity and healthy diet should be used consistently across all government and professional agencies in public messages.
b) Emphasis on health risks rather than weight: In communications about obesity and overweight, the health risks associated with obesity and overweight should be stressed rather than weight, to emphasise that overweight and obesity are about health risks rather than looks and aesthetics.
c) Emphasis on the importance of individual responsibility: Achieving and maintaining a healthy weight is a matter of individual responsibility to make the necessary lifestyle choices. Knowledge and skills will continue to be imparted to Singaporeans through the various channels such as the National Healthy Lifestyle Campaign, exhibitions, talks and education curriculum.
d) Provision of an environment supportive of health to enable Singaporeans to adopt a healthy lifestyle: The Taskforce recognised the importance of providing an environment that is supportive of a healthy lifestyle and proposed various strategies and programmes in the 4 key settings. Proposals included:
e) Emphasis on the importance of inculcating healthy lifestyles from young: Emphasis will be placed on parents and educators recognising that preventing excessive weight gain should begin from young and measures in schools and pre-schools should aim to make healthy eating and regular physical activity a way of life.
f) Involvement of healthcare professionals: Healthcare professionals play an important role in supporting the national strategy through the provision of proper weight management measures in clinics and hospitals.
Public Education to communicate new BMI cut-offs
13 To communicate the new BMI cut-offs to the healthcare professionals, a seminar on “Obesity Management – Implications of Asian BMI Cut-Off Points” will be organised on 19 March for healthcare professionals. The seminar, organised by the Health Promotion Board aims to update them on the new BMI cut-offs, risks for co-morbidity diseases, and provide overviews of obesity management, medical and surgical treatment for obesity.
14 In addition to the year-long activities promoting a healthy lifestyle that HPB organises, HPB will also be organising a series of fun, engaging and interactive activities for the family, to communicate the importance of healthy living, incorporating the importance of knowing one’s BMI and attaining and maintaining a healthy BMI. Highlights of these activities are attached at Annex 2.
15 HPB has also worked jointly with Caltex and NTUC to place BMI machines at selected 6 Caltex petrol stations and 10 NTUC Fairprice supermarkets around the island, from 16-31 March 2005, for the public to conveniently check their BMI free of charge. More details are attached at Annex 2.16 Public education materials on the new BMI cut-offs have also been produced and will be distributed at polyclinics, hospitals and GP clinics. The public can also obtain information about the new BMI and calculate their BMI on the HPB website at http://www.hpb.gov.sg