The Body Mass Index (BMI) is a method used throughout the world to determine whether a person is at a healthy weight for their height. It is calculated by dividing a person’s weight by the square of their height giving a value that is expressed in kg/m². It tends to be used as a measure of a person’s total body fat.

People are assigned to one of four BMI categories (shown below) which helps to identify whether they are overweight or obese.

• Underweight – less than 18.5
• Normal weight – 18.5 to 24.9
• Overweight – 25 to 30
• Obese – 30  and over

It has been a useful, easy method of exploring weight and body fat, but its limitations are well known. Criticisms of it include:

• It doesn’t take into account factors such as age, sex and ethnicity
• It doesn’t look at the type of fat a person has
• It doesn’t differentiate between excess fat, muscle mass or bone mass

This means that the BMI may overestimate the amount of body fat athletes and body builders possess and underestimate harmful body fat in people who have a normal BMI.

Children and BMI

When looking at children, a different scale is used that takes into account the fact that children are constantly growing, and that boys and girls develop differently, so the BMI scale for children takes into account age and sex.

Researchers in the UK have found that the scale for children doesn’t accurately reflect the obesity levels in black and Asian children living in the UK. This is a problem as we can’t accurately identify children who will be at higher risk of health conditions such as diabetes and heart disease later in life.

Research into Children, BMI and Ethnicity

Researchers in St Georges and University College London, funded by the British Heart Foundation started work in this area a few years ago and published their work in March 2017.

Having identified that BMI may not be providing accurate measurements for ethnic minority children they sought to develop a method to adjust BMI values based on ethnicity.

In order to create the BMI adjustments they had to go back to basics and look at the actual body fat measurements of children. They identified 1,728 children aged 4 to 12 years old. They then explored the relationship between  BMI and body fat in each ethnic group (White European, Black African and South Asian). Using this data they were able to calculate the BMI adjustment needed for each ethnic group.

From their work they were able to confirm that BMI underestimated body fat levels in South Asians and overestimated body fat levels in Black Africans.

Based on their findings the research team developed a BMI calculator for children with an adjustment for ethnicity. Parents, teachers and healthcare professionals can use this simple tool to obtain accurate BMI readings for black and Asian children.

The research team followed up this work with research that they published in November 2017. This was a larger piece of work to explore the extent of the problem of using BMI in assessing the body fat of children.

They used data from the National Institute of Health Research’s National Child Measurement Programme.  Every year this programme assesses the weight of children in the UK who are aged 4-5 years old and 10-11, and attend a state-funded primary school.

The research team applied their new BMI adjustment to the weight measurements for children weighed between 2012 and 2013. This included 583,899 children aged 4-5 years old and 485,362 children aged 10-11. Their findings are summarised in the tables below.

Percentage of boys who were overweight or obese

Ethnicity	% Overweight and Obese
	Without Ethnicity Adjustment		With Ethnicity Adjustment
	4-5 years old	10-11 years old	4-5  years old	10-11 years old
Black African	31%	42%	11%	32%
South Asian	19%	42%	39%	52%
White European	23%	33%	–	–

Percentage of girls who were overweight or obese

Ethnicity	% Overweight and Obese
	Without Ethnicity Adjustment		With Ethnicity Adjustment
	4-5 years old	10-11 years old	4-5  years old	10-11 years old
Black African	29%	45%	12%	35%
South Asian	19%	34%	35%	44%
White European	21%	30%	–	–

Their results showed that the BMI overestimated the percentage of black children who were overweight or obese by 10-20% (depending on age and sex) so a significant number of black children are being misclassified in the government’s national weight assessment programme.

They concluded that BMI does not accurately reflect body fat in ethnic minorities and by using adjustments a more accurate measurement of the body fat can be determined.

Our Thoughts

This body of work highlighted the gaps that exist in medical research and the problem of using one ethnic group as a standard for health. This work clearly shows the need to explore ethnicity and health, it demonstrates that by not taking race and ethnicity into account key differences are being masked and we therefore don’t have a true picture of the health of our community.

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Sources

1. Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children (22^nd March 2017)
2. Patterns of childhood body mass index (BMI), overweight and obesity in South Asian and black participants in the English National child measurement programme: Effect of applying BMI adjustments standardizing for ethnic differences in BMI-body fatness associations (2^nd November 2017)
3. New BMI readings for children of different ethnicities (March 2017)
4. BMI Adjust (March 2017)
5. Body Mass Index Considerations for Practitioners
6. Body Mass Index Advantages and Disadvantages (July 2017)
7. BMI failing to reflect childhood obesity levels in ethnic minorities (Nov 2017)
8. Children from ethnic minorities may have been wrongly labelled obese, according to new research (Nov 2017)

The black community has a higher risk of developing type 2 diabetes and this increased risk was thought to be due to a combination of factors with genetics playing a significant role.

 In a study recently published in JAMA it has been shown that there is no genetic reason linking black people to an increased risk of diabetes. The increase in risk is due to lifestyle factors like obesity.

This study looked at 4,251 black and white men and women, aged 18 to 30 without diabetes.  Forty-nine per cent were black (2,066 participants) and 54% were women (2,304 participants). Participants were followed for an average of 25 years and over time 504 cases of diabetes were identified – 189 white participants and 315 black partcipants developed type 2 diabetes.

The study found that overall black men and women were more likely to develop diabetes but when they took into account factors like biology, neighbourhood, psycho-social, socioeconomic and behavioural, both black and white people had the same risk of developing type 2 diabetes.  If there was an underlying genetic reason then when all those factors were taken into account then there would have still been an increased risk seen in black men and women.

When exploring what specific factors increased black people’s risk of type 2 diabetes they found that factors that were modifiable were the main culprits – body weight, waist size, blood sugar level, blood pressure and others.

Researcher Prof Mercedes Carnethon said:

“Obesity is driving these differences. The findings surprised us, because for the past 20 years there was a narrative that there must be something we haven’t found that was causing this higher rate. Blacks gained more weight over time. It was the accumulation of this and other risk factors that eliminated the so-called mysterious cause of the disparity.”

The findings for this study are empowering, in a way, as it means that clear steps can be taken to reduce the high risk seen in the black community by promoting a healthy lifestyle with lead study author Michael Bancks stating:

“To eliminate the higher rate of diabetes, everybody needs to have access to healthy foods, safe spaces for physical activity and equal economic opportunity to have enough money to afford these things and live in communities that offer this.”

The focus now has to be on ensuring that more black people live a healthy lifestyle so that health inequalities like this can be addressed. This means delving into the social and economic inequalities which may act as barriers to living a healthy lifestyle.

In the past it has been felt that fibroids may increase a woman’s risk of having a miscarriage, but two recent pieces of research should reassure women affected by fibroids who may be thinking of starting a family. Their work has shown that there is no link between fibroids and an increase in the risk of having a miscarriage.

Study on Fibroids and Miscarriage Risk by Women’s Health Research at Vanderbilt

Researchers at Women’s Health Research at Vanderbilt published their first piece of research in November 2017, although the data was made available in June. Their research was part of the Right from the Start study which explored how a women’s diet, health behaviours, medical history, fibroids and other factors may affect her pregnancy. It included 5, 512 women from eight cities in the US from 2000-2012 who were 18 or over and were either trying to get pregnant or were less than 12 weeks into their pregnancy.  During the course of  the study participants had an initial interview, an ultrasound scan, a telephone interview and a follow-up assessment.

They found that of the 5,512 women who took part in the study, 10.4% of them had at least one fibroid and 89.6% didn’t have fibroids. When they compared the rate of miscarriages in the group who had fibroids to the group of women who didn’t have fibroids, their rate was the same – 11%.

The researchers explained that other studies have reported a link between fibroids and miscarriages but this was because previous studies hadn’t taken into account other reasons for miscarriages.

To learn more about this work you can view their videos below.

The Women’s Health Research Centre at Vanderbilt published another study in November exploring the same issue – fibroids and miscarriage risk. They reviewed all research papers on this topic from January 1970 to December 2016 and vetted them, this gave them data from 21,829 pregnancies. Of these women 1,394 had fibroids and 20,435 did not. They carried out statistical analysis on this data and found that there was no difference in the rate of miscarriages in women with fibroids compared to women without fibroids.

Their team have put together a really useful infographic that explains their findings (please click on the image below to see a larger copy of it)

 What Does This Mean for Women with Fibroids?

As Prof Katherine Hartman stated in the above video, this is good news  as this is one less thing that women with fibroids have to worry about. Although she does caution that there may be rare types of fibroids or locations of fibroids that may cause a miscarriage but the risk is lower than previously thought.

Happy New Year everyone and welcome to 2018!

We are seriously looking forward to the new year. For us there will be lots of change which is really exciting, a great opportunity for growth, learning and development.

New Location

In our previous blog we mentioned that throughout 2017 we slowly wound down our projects and activities in the UK as we prepared for our big move. We’re now based in the beautiful island of St Kitts and are exploring how our organisation can make a useful contribution to improving the health and well-being of the citizens of St Kitts and Nevis, and the wider Caribbean community too.

St Kitts and the Caribbean have similar health challenges to the African and African-Caribbean community in the UK – high rates of diabetes, obesity (including very high rates of childhood obesity),  some types of cancer (prostate cancer), heart disease and other non-communicable diseases. In addition, there is the issue of mosquito-borne diseases like dengue fever, Zika and chikungunya. We’re looking forward to seeing how we can support efforts to tackle these health issues by promoting prevention and early detection.

New Name

In just a few weeks’ time we’ll be known as Lake Health and Wellbeing. Whilst we’ll have a new name our mission remains the same: to improve the health and well-being of the black community. We’re almost there, our new logo has been designed, which we love, and we just have a few other logistical issues to iron out with the name change. At this juncture we’d like to say a BIG thank you to FutureSoft for the design of our new logo.

Some of our plans

As well as focusing on the Caribbean we won’t be turning our back on the UK. We’ll continue to support the black community in the UK from afar by providing health information through our blog, social media channels and Learning Zone, as well as teaming up with UK-based organisations like OH Services and Noire Wellness.

We’ll continue offering support  and information to women in the UK (and globally) affected by fibroids through our Fibroids Ask the Expert and fibroids Twitter chats. We’ll also be updating our fibroids booklet and creating a fibroids fact sheet series .  Our first two fact sheets should be launched by the end of January or in early February.  We’re delighted to have teamed up with OH Services to develop one of these fact sheets, Fibroids and your emotional well-being. This fact sheet will aim to help women identify, understand and address the emotions that may be associated with having fibroids. The second fact sheet we’ll be launching will be on exercise and fibroids. In this fact sheet we’ll discuss how exercise can help with improving symptoms and provide readers with simple tips on how to get active without aggravating their current symptoms.

Over the rest of the year our plan is to publish at least three additional fact sheets on:

• Diet and fibroids
• Fibroids and fertility
• Treatment options.

We’re also excited to be exploring the possibility of hosting a fibroids wellness retreat in St Kitts in collaboration with Noire Wellness. We’ll do an assessment and if there is interest, and this is feasible, then look out for an empowering event designed specifically for women with fibroids. If you’ve been affected by fibroids we’d be so grateful if you could complete our survey to help us with our assessment of the need for this type of event. You can complete the survey here.

Have a great year folks

We hope you have a wonderful year and hope you’ll take this journey of transformation with us in 2018. It’s going to be fun and we look forward to working with you, supporting you and serving you in the year ahead.

Researchers from Johns Hopkins University and Meharry Medical College have published the results of their research study exploring the link between Central Centrifugal Cicatricial Alopecia (CCCA) and fibroids. They found that black women with CCCA were nearly five times more likely to develop fibroids compared to those without CCCA.

What is CCCA?

CCCA is a type of hair loss that mostly affects black women. It is characterised by gradual hair loss in the centre of the scalp and it radiates outwards in a circle.  CCCA starts with damage of the hair follicles which leads to scarring and then permanent hair loss.

Historically, CCCA was known as hot comb alopecia as it was initially thought that it was caused by  use of the hot comb as well as relaxers, tight weaves and other practices that may put pressure on our hair and scalp. It is now thought to be caused by a combination of factors as some cases of CCCA are not linked to hair care practices.  Therefore the exact cause of CCCA is unknown but it is thought to be associated with family history (it may run in families) as well as hair care practices.

Exploring the link between CCCA and fibroids

In this current piece of work researchers recognised that women of African descent are more likely to develop disorders such as fibroids, keloids, CCCA and sarcoidosis which all involve abnormal growth of fibrous tissue. Based on these observations they decided to explore whether a link exists between CCCA and fibroids.

To explore whether a link exists they analysed patient data from a four year period (2013-2017).  They extracted data from 487,104 black women who were patients at Johns Hopkins Hospital and  found that 447 of these patients had CCCA (0.09% of patients) and 486,657 didn’t have CCCA.

They then compared the percentage of women with CCCA that had fibroids with that of women who didn’t have CCCA and found that 13.9% of women with CCCA had fibroids ( that is: 62 of the 447 with CCCA) and only 3.3% of women without CCCA had fibroids (that is: 16,212 of the 486,657 without CCCA)

What does this mean?

This means that, in this study, women with CCCA were 4.68 times more likely to have fibroids than women who didn’t have CCCA.

The researchers concluded that there is a strong  association between fibroids and CCCA but:

“The cause of the link between the two conditions remains unclear.”

In their paper they state that:

 “This risk may be due to similar underlying mechanisms in the pathogenesis of both conditions.”

They also cautioned that this data may not reflect the actual association between the two conditions in a real-world setting, so more work will be needed to confirm the association between CCCA and fibroids, and why this association exists.

They do recommend that patients and doctors are made aware of the link so that women with CCCA can be  screened for fibroids and other disorders related to excess fibrous tissue. This will aid early diagnosis and provide the opportunity to control these conditions preventing the development of severe symptoms.

For more information you can download their research summary below

The late Professor Olikoye Ransome-Kuti was a world-renowned paediatrician, health campaigner and a prominent figure in global health for many decades.

Professor Ransome-Kuti was born in Nigeria and studied medicine at Trinity College in Dublin from 1948 – 1954. He returned to Nigeria to practice medicine after his studies and then in 1960 he travelled back to the UK to begin his postgraduate training in paediatrics.  After his postgraduate training he once again returned to the country of his birth becoming professor and head of the Department of Paediatrics at the University of Lagos; in 1978, he became their first professor of primary care.

In 1968 he set up an experimental family health clinic which led to the establishment of the Institute of Child Health and Primary Care at the College of Medicine at the University of Lagos. In 1976 he became the director of the National Basic Health Services Scheme Implementation Agency for Nigeria and was involved in a first attempt to set up a national health system for Nigeria.

While lecturing at the National Institute of Policy and Strategic Studies, Professor Ransome-Kuti impressed Ibrahim Babangida and when Babangida came into power in 1985 he appointed Professor Ransome-Kuti as Nigeria’s health minister.  Professor Ransome-Kuti held this position from 1985 to 1992 and he has been described as the “best Minister of Health Nigeria ever had.”

During his tenure as the Minister of Health he made a significant difference to the healthcare landscape in Nigeria – national health policy was further developed and then implemented, relationships between sectors was strengthened and  healthcare coverage across Nigeria increased significantly. He also made a huge difference in tackling the stigma around HIV/AIDS and his efforts at fighting the emerging epidemic was described as “heroic.” He had a busy period as Health Minister with many other achievements including overseeing a successful anti-smoking campaign which led to manufacturers adding warnings to their products.

After leaving his cabinet position in 1992, he became the chairman of WHO’s Executive Board and in 1994 he was appointed chair of the World Bank’s Better Health for Africa Panel where he championed the idea of primary healthcare to other African countries producing a blueprint for all countries to follow.

Professor Ransome-Kuti received numerous awards including the WHO Leon Bernard Award in 1986, an award that recognises a person for outstanding service in the field of social medicine. In 1990 he won the UNICEF Maurice Pate Award in recognition of his work in improving the health and welfare of children. He published many medical papers and held numerous teaching positions including a visiting professorship  at Johns Hopkins University’s school of hygiene and public health in Baltimore.

He was an effective campaigner speaking out against corruption and defending democracy and the rights of poor Africans. Campaigning and fighting for those who didn’t have a voice was something he was passionate about and seemed to run in his family. His mother, Funmilayo Ransome-Kuti, was a women’s rights campaigner and was part of the team that negotiated Nigeria’s independence with the British. Whilst his brother was Fela Kuti the well-known musician, singer,  father of Afrobeat, human rights campaigner and political activist and his cousin Wole Soyinka is the Nobel Laureate, playwright, poet and political activist. 

Professor Ransome-Kuti was not only a brilliant man, but a nice person with his friends and colleagues describing him as a kind, caring, wise, gentle, humorous  and a direct individual. He was a family man and doting father being married to his wife Sonia Ransome-Kuti for 50 years and having three children – Dr Dotun Ransome-Kuti (Veterinary Doctor) , Dr Gboyega Ransome-Kuti (Medical Doctor) and  Bisoye Ransome-Kuti (Lawyer)

Professor Ransome-Kuti sadly died unexpectedly in 2003 from a pulmonary embolism whilst attending a WHO conference in London. He is greatly missed and his legacy lives on in Nigeria.

Scientists at the Nanjing University Medical School in China have published the results of their study exploring the effect of ginkgo biloba extract on stroke patients.

Their study was a fairly small one with 342 patients taking part. The average age of participants was 64. Participants were given ginkgo biloba extract daily for six months after their stroke along with aspirin.  The participants took a cognitive assessment test at the start of the trial and at regular intervals.

The researchers found that those patients taking the ginkgo biloba extract performed better on the cognitive assessment test showing better memory and reasoning.  Based on these findings the researchers concluded that:

“GBE in combination with aspirin treatment alleviated cognitive and neurological deficits after acute ischaemic stroke without increasing the incidence of vascular events.”

They recommended “ginkgo biloba extract for patients with acute stroke for its ability to improve cognition and quality of life.”

The scientists did caution that more work is needed as their study was a small one. They recognised that a large and longer piece of work is needed, but their results were promising.

Other studies have had conflicting results – some show improved brain function, whilst other don’t.

What is Ginkgo Biloba?

The scientists explained that ginkgo biloba is an ancient Chinese tree and the extract has been used in China for many years for memory, depression, tinnitus and confusion.  It is one of the oldest living tree species in the world and has numerous health benefits.

Ginkgo Biloba is not just used in China but it is available in the UK, Europe, Canada and the US as a food supplement. It does have side effects such as nausea, vomiting, headache and constipation. There can be serious side effects such as bleeding in the eye or brain, bleeding after surgery and severe allergic reactions, and  it shouldn’t be taken if you’re on certain medication.

Take Home Message

The study was promising but further work is needed to fully assess the effects of ginkgo biloba on stroke patients.

More Information

You can download the full research paper below.

This week scientists in the Netherlands published the results of their research exploring social isolation and type 2 diabetes. They assessed whether particular aspects of a person’s social network like the size of their social network, how often they are in contact with friends and family, the types of relationships they are in and whether they live alone are linked to pre-diabetes, a new diagnosis of diabetes or a previous diagnosis of diabetes.

Their research looked at people between the ages of 40 and 75 living in the south Netherlands. The study is still ongoing and the aim is to recruit 10,000 participants by the end of the study period.

This current piece of work includes 2861 people with an average age of 60, 57% were not diabetic and 43% of the participants either had pre-diabetes, a new diagnosis of diabetes or had previously been diagnosed with diabetes.

They found that the more socially isolated a person was (i.e. the smaller their social network was) the more likely they were to have a recent or previous diagnosis of type 2 diabetes.  They found  that for each fewer network member in a social group there was a 12% higher chance of being newly diagnosed with type 2 diabetes and a 8% higher chance of having a previous diagnosis in women; in men it was 10% and 5% respectively.

In women they found that higher percentages of social network members living within walking distance and higher percentages of household members were linked to newly and previously diagnosed diabetes.  Researchers concluded that for women “a more centralised social network was associated with type 2 diabetes.”

In men, living alone was associated with significantly higher odds (59% higher odds) of being newly diagnosed with diabetes or being previously diagnosed. In women there was no association between living alone and diabetes.

They also found that a lack of social participation was associated with a 60% higher chance of being pre-diabetic and a 112% higher chance of being previously diagnosed with type 2 diabetes in women. For men a lack of social participation was associated with a 42% higher chance of having a previous diagnosis of type 2 diabetes.

They also found that having more emotional support, practical support and support during sickness were all associated with lower odds of having type 2 diabetes.

What does all this mean??

Simply put, people who are lonely are more likely to develop diabetes. Therefore if we can focus on addressing loneliness we may be able to prevent type 2 diabetes in some people.

It isn’t clear why specifically there is a link between social isolation and diabetes but the researchers feel that their work suggests that:

 “High risk groups for type 2 diabetes should broaden their network and should be encouraged to make new friends, as well as become members of a club.”

Type 2 diabetes is more common in the black community and if we can identify whether  social isolation is also linked to diabetes in the black community then this could be an effective approach to  reducing the high risk in the black community.

The world’s first lupus prevention study, the SMILE clinical trial, was launched recently in the US.

SMILE will identify people who are at a high risk of developing lupus and treat them with an immune-modifying drug to determine whether this will prevent or delay lupus developing.

The drug being used for this study is hydroxychloroquine, a malaria drug. As well as exploring whether this drug delays or prevents lupus, the research team will determine if it improves disease activity and patient outcomes.

The trial will include people aged between 15 and 45 who are at high risk of developing lupus. They will be treated with either a placebo or hydroxychloroquine and then monitored for a period of time.

This study is taking place across five sites across the US – Penn State Hershey Medical Centre, the University of Texas Southwestern Medical Centre, Oklahoma Medical Research Foundation, Cedars-Sinai Medical Centre and the Medical University of South Carolina. Researchers aim to recruit 240 patients and the trial is likely to be completed in 2022.

This is an important study for the black community as black women are three to four times more likely to develop lupus than their white counterparts. Additionally black women  develop lupus at a younger age, experience more severe symptoms and overall develop more complications. Having a treatment that prevents lupus will significantly reduce the suffering of many black women worldwide and we thus look forward to the trial’s conclusions in a few years’ time.

For more information about the trial you can download the SMILE brochure below or email Virginia-Roberts@omrf.org

In this article we hear from the JustBe Croydon team who tell us about their service and how they can help you become happier and healthier.

JustBe Croydon is a website for all Croydon residents.  It has been designed to help you take positive steps towards becoming a happier and healthier YOU.

Big steps or little steps, we believe everyone can make small changes with a little bit of help and support. We have selected the best tools to help you make a change, from losing weight, getting more active and stopping smoking to drinking less, sleeping better and feeling happier. There are apps, podcasts, expert advice, videos, diet plans and exercise routes to help you get started. This is information on local services and a range of resources that will support you in making changes to your lifestyle.

You can even assess your health right now using our Health MOT. We will help you to identify lifestyle changes and put you in touch with the right tools – or people who can help you make a change.

If you have any problems accessing the website or would just like a chat with one of the Advisors you can find them at one of our health hubs detailed here, where you can pop in without an appointment or you can download the details of the health hubs below.