A person can have a seemingly healthy body weight and still have an increased risk of heart disease, diabetes, or other metabolic conditions.

This is an important consideration for people of South Asian ancestry, including individuals from India, Pakistan, Bangladesh, Sri Lanka, and Nepal.

Research indicates that South Asian populations may develop cardiovascular and metabolic risk factors at lower Body Mass Index (BMI) levels than some other populations. Factors such as abdominal fat distribution, insulin resistance, cholesterol patterns, and family history can contribute to this increased risk.

This is why assessing heart health should involve more than looking at body weight alone.

1. Why BMI Does Not Tell the Complete Story

Body Mass Index (BMI) is calculated using a person's height and weight. It is commonly used to identify possible weight-related health risks.

However, BMI does not directly measure:

Abdominal or visceral fat.
Body fat distribution.
Insulin resistance.
Cholesterol abnormalities.
Overall cardiovascular risk.

Some South Asian adults may develop metabolic complications at lower BMI levels. As a result, a BMI reading that appears normal should not automatically be considered evidence of low cardiovascular risk.

The American Diabetes Association's 2026 obesity standards recognise lower BMI thresholds for identifying excess adiposity in people with Asian backgrounds. These include a BMI threshold of 23 kg/m² for screening purposes, alongside assessments such as waist circumference.

2. Understanding Visceral Fat: The Hidden Risk

Visceral fat is the fat stored deep inside the abdomen, surrounding internal organs such as the liver, kidneys, and intestines.

Unlike the fat directly beneath the skin, excess visceral fat is metabolically active and is associated with several health problems.

Higher visceral fat levels are associated with:

Insulin resistance.
Type 2 diabetes.
Elevated triglycerides.
Unfavourable cholesterol levels.
Increased cardiovascular risk.

South Asian populations may have greater abdominal fat accumulation even when their overall body weight is relatively low.

This is one reason waist circumference and waist-to-height ratio can provide additional information beyond BMI.

3. Why South Asians May Have Different Cardiovascular Risk Profiles

Cardiovascular risk is influenced by multiple factors, and South Asian ancestry is recognised as a risk-enhancing consideration in the 2026 ACC/AHA multisociety dyslipidemia guidelines.

Potential contributing factors include:

Abdominal Fat Distribution: Greater visceral fat accumulation can contribute to metabolic dysfunction.

Insulin Resistance: Changes in how the body responds to insulin can increase the likelihood of developing type 2 diabetes.

Lipid Abnormalities: Some South Asian individuals have elevated lipoprotein(a), known as Lp(a), which is associated with increased cardiovascular risk.

Family History: A history of premature heart disease or diabetes in close relatives can provide important information about personal risk.

These patterns do not apply equally to every South Asian individual. Personal health history and clinical measurements remain essential.

4. Important Health Checks Beyond BMI

A more complete cardiovascular and metabolic assessment may include the following measurements.

Blood Pressure

High blood pressure can increase the risk of heart attack, stroke, kidney disease, and other cardiovascular complications.

Regular monitoring helps identify elevated blood pressure that may otherwise go unnoticed.

Blood Glucose and HbA1c

Fasting blood glucose and HbA1c tests help assess blood sugar levels and identify diabetes or prediabetes.

Early identification can support timely lifestyle changes and appropriate treatment.

Complete Lipid Profile

A lipid profile commonly measures:

Total cholesterol.
LDL cholesterol.
HDL cholesterol.
Triglycerides.

These measurements help evaluate cholesterol-related cardiovascular risk.

Waist Circumference

Waist circumference helps assess abdominal fat distribution.

The 2026 ADA standards identify general Asian-background waist thresholds of 90 cm for men and 80 cm for women within their obesity assessment framework. Individual countries and clinical guidelines may use different thresholds.

Lipoprotein(a) – Lp(a)

Lp(a) is a type of lipoprotein influenced largely by inherited factors.

Higher levels are associated with increased cardiovascular risk. The 2026 ACC/AHA dyslipidemia guideline recommends measuring Lp(a) at least once in adulthood as part of risk assessment.

Apolipoprotein B – ApoB

ApoB is a protein found on several cholesterol-carrying particles that contribute to plaque formation in arteries.

In selected patients, an ApoB test can provide additional information about cardiovascular risk, particularly when triglycerides are elevated or standard cholesterol measurements do not fully reflect the risk profile.

5. Why Kidney Health Also Matters

Heart health and kidney health are closely connected.

The heart circulates blood throughout the body, while the kidneys filter waste products and regulate fluid, electrolytes, and blood pressure.

Conditions such as diabetes and hypertension can affect both organs.

Depending on individual risk factors, healthcare professionals may recommend:

Serum creatinine and estimated glomerular filtration rate (eGFR).
Urine albumin-to-creatinine ratio (UACR).
Blood pressure monitoring.
Blood glucose testing.

These assessments can help identify kidney problems and related cardiovascular risks.

6. Does Everyone Need Advanced Heart Screening?

Not necessarily.

More detailed investigations are appropriate only when supported by an individual's medical history, examination, and overall risk assessment.

A healthcare professional may consider:

Apolipoprotein B Testing: To provide additional information about cholesterol-related risk in selected patients.

Lipoprotein(a) Testing: To identify an inherited cardiovascular risk factor.

Coronary Artery Calcium (CAC) Scoring: A specialised CT scan that can help assess calcified plaque in coronary arteries when treatment decisions remain uncertain.

Additional Cardiometabolic Assessments: Further testing may be appropriate when diabetes, kidney disease, hypertension, or other risk factors are present.

CT or MRI assessment of visceral fat is not routinely necessary for everyone. Waist measurements and standard clinical assessments are often more practical starting points.

The goal is not to order every available test, but to select appropriate investigations based on individual risk.

7. Practical Ways to Support Long-Term Heart Health

Daily habits play an important role in cardiovascular and metabolic health.

Consider these practical steps:

Choose balanced meals with vegetables, whole grains, legumes, and appropriate protein sources.
Limit excessive sugar, refined carbohydrates, and highly processed foods.
Include regular aerobic and strength-building physical activity.
Monitor blood pressure, glucose, and cholesterol as recommended.
Maintain a healthy waist measurement.
Avoid tobacco.
Discuss family history of early heart disease with your healthcare professional.
Attend routine health assessments.

For South Asian diets, healthier eating can include traditional foods such as lentils, beans, vegetables, whole grains, nuts, and appropriately portioned meals.

8. Who Should Consider a Personalised Heart Risk Assessment?

Discuss a more comprehensive cardiovascular assessment with a healthcare professional if you have:

A family history of premature heart disease.
Type 2 diabetes or prediabetes.
High blood pressure.
Abdominal fat despite a relatively normal BMI.
Elevated cholesterol or triglycerides.
Known kidney disease.
Elevated Lp(a) or other recognised cardiovascular risk factors.

South Asian ancestry can add useful context to cardiovascular risk assessment, but it does not automatically mean someone has heart disease or needs medication.

Treatment decisions should be based on an individual's complete clinical profile.

Final Thoughts

Heart health is about much more than body weight.

For South Asian adults, relying on BMI alone may overlook important metabolic and cardiovascular risk factors. Assessing waist circumference, blood pressure, glucose levels, cholesterol, kidney function, family history, and selected additional biomarkers can provide a more complete picture.

Early identification and personalised preventive care can help people make informed decisions about their long-term health.

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Medical Disclaimer: This article is intended for general educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Screening tests and their frequency should be determined by a qualified healthcare professional based on individual risk factors.

This article explores why BMI alone may not capture cardiometabolic risk in South Asian adults. It highlights visceral fat, metabolic health, and the importance of personalised cardiovascular screening. The information is for educational purposes and does not replace professional medical advice.