South Asian Canadians and GLP-1s: why are the BMI cut-offs lower?
What the Canadian research shows about body fat and diabetes risk, which cut-offs the guideline uses, and how they line up with drug labels and plans.
Written for Canada. Other country versions are coming.
South Asian adults tend to carry more body fat, and develop type 2 diabetes, at a lower BMI than white adults. Canada’s obesity guideline starts overweight at a BMI of 23 for South Asian adults and uses smaller waist cut-offs. Drug labels still use BMI 30, or 27 with a weight-related condition, and no public plan pays for weight loss.
Key takeaways
- In an Ontario study of 59,824 adults, South Asian adults had the diabetes risk of a white BMI of 30 at a BMI of 24.1
- Obesity Canada puts the start of overweight at a BMI of 23 for adults of South, Southeast or East Asian ethnicity, and uses a waist cut-off of 85 cm for men and 75 cm for women.2
- South Asians were Canada’s largest racialized group in the 2021 census: 2.57 million people, or 7.1% of the population.3
- Diabetes Canada lists South Asian descent among the risk factors that call for earlier or more frequent diabetes testing.4
- The Wegovy and Zepbound labels in Canada use a BMI of 30, or 27 with a weight-related condition, whatever a person’s ethnicity.5,6
On this page
How many South Asian Canadians are there?
About 2.57 million people reported South Asian origins in the 2021 census, 7.1% of Canada’s population and the largest racialized group.3
- GLP‑1 medicines are prescription-only in Canada.7
- Cut-offs describe groups, not you. A prescriber looks at your own health, not your ethnicity alone.
- Every risk of these medicines is in Guide 5: Side effects and risks.
Statistics Canada says the South Asian population has almost quadrupled since 1996, and could reach 4.7 to 6.5 million by 2041.3 Nearly 3 in 10 were born in Canada. Many others were born in countries such as India, Pakistan, Sri Lanka and Bangladesh, and some trace their roots to East Africa.3 The research below groups these communities together.
Why does the same BMI carry more risk?
Because BMI doesn’t measure fat. Canada’s guideline says BMI over- or underestimates body fat in some groups, including South Asians.2
BMI is weight in kilograms divided by height in metres, squared.2 Two people with the same BMI can carry very different amounts of fat, and in different places.
- Two men, one BMI. A 2004 letter in The Lancet compared an Indian doctor and a British doctor, both with a BMI of 22.3. A body scan found 21.2% body fat in the first and 9.1% in the second.8 It’s one comparison, not a study, and the British doctor ran marathons.8
- A Canadian study. McMaster University researchers sampled 1,078 adults in four Canadian regions. At the same BMI, South Asian, Chinese and Aboriginal adults were more likely to have raised blood sugar and blood fats than European adults.9
In that study, the BMI that marked obesity, judged by blood sugar and blood fats, was about 6 points lower in the non-European groups.9
How much lower is the BMI where diabetes risk rises?
About 6 points lower in Ontario. South Asian adults reached the diabetes rate of a white BMI of 30 at a BMI of 24.1
- Who: 59,824 Ontario adults aged 30 and over without diabetes, from national health surveys, followed for up to 12.8 years.1
- Risk: after allowing for age, sex, social background and BMI, South Asian adults were 3.4 times as likely to develop diabetes as white adults.1
- Age: the median age at diagnosis was 49 in South Asian adults, against 58 in white adults.1
A larger study in England found a similar line: a BMI of 23.9 in South Asian adults matched the diabetes risk of 30 in white adults. That’s a UK study, included here because it points the same way.10
What cut-offs does Canada use for South Asian adults?
Obesity Canada starts overweight at a BMI of 23 for South, Southeast or East Asian adults, and uses waist cut-offs of 85 cm (33.5 in) for men and 75 cm (29.5 in) for women.2
| Measure | Most adults | South, Southeast or East Asian adults |
|---|---|---|
| BMI: healthy | 18.5–24.9 | 18.5–22.9 |
| BMI: overweight starts | 25 | 23 (“at risk”) |
| Waist, men | 102 cm (40.2 in) or more | 85 cm (33.5 in) or more |
| Waist, women | 88 cm (34.6 in) or more | 75 cm (29.5 in) or more |
Obesity Canada assessment chapter, Table 1 and text, checked 12 Oct 2026. Inch figures are our conversions.2
A worked example. A man 1.70 m (5 ft 7 in) tall who weighs 70 kg (154 lb) has a BMI of 24.2. That’s healthy on the general table but “at risk” on the Asian one. This is our arithmetic.2
Diabetes testing. Diabetes Canada advises testing every 3 years from age 40, and earlier or more often with risk factors, including being from a high-risk population such as South Asian descent.4
See your BMI and waist on both Canadian tables. Nothing is stored. No sign-up.
Where do GLP‑1 medicines fit?
The guideline asks prescribers to use ethnicity-specific BMI cut-offs and waist size when deciding about medicines. The drug labels don’t.11,5
- The guideline: medicines are offered at a BMI of 30, or 27 with weight-related problems, “using sex- and ethnicity-specific cut offs if applicable”, always with changes to eating and activity.11
- The labels: Wegovy and Zepbound are approved in Canada for adults with a BMI of 30 or more, or 27 or more with a weight-related condition.5,6
- The gap: below those label lines, use for weight would be off-label (outside the approved use). The guideline recommends against compounded versions.11
- Type 2 diabetes: Ozempic is approved for blood-sugar control in type 2 diabetes at any BMI.12
Public plans don’t pay for any GLP‑1 for weight loss, whatever the cut-off.13 The guideline explainer covers staging and medicines in more detail.
- Stomach effects are the most common. On the Wegovy label, 44 in 100 people felt sick (nausea), against 16 in 100 on a dummy injection.5
- Dehydration from vomiting or diarrhea can harm the kidneys, the Zepbound label warns.6
- Inflamed pancreas (pancreatitis): severe stomach pain that won’t go away needs medical help straight away.5
- Gallstones: 1.6 in 100 people on Wegovy, against 0.7 in 100 on a dummy injection.5
- Not for everyone: not with a personal or family history of medullary thyroid cancer or MEN 2 (a rare inherited condition), and stopped at least 2 months before a planned pregnancy.5
Questions people ask
What is a healthy BMI for South Asians in Canada?
Obesity Canada’s table gives 18.5 to 22.9 as the normal range for South, Southeast and East Asian adults.2
Can I get Wegovy with a BMI of 25 if I’m South Asian?
Wegovy’s Canadian label uses a BMI of 30, or 27 with a weight-related condition, for everyone.5 Below that, use would be off-label (outside the approved use).
Why do South Asians get diabetes at a lower weight?
Studies find more body fat and more blood-sugar problems at the same BMI.9,8 In Ontario, the diabetes risk of a white BMI of 30 came at 24 in South Asian adults.1
What waist size is a risk for South Asian women?
75 cm (29.5 in) or more, in Obesity Canada’s guideline.2
Should South Asian Canadians be tested for diabetes earlier?
Diabetes Canada lists South Asian descent as a risk factor that calls for earlier or more frequent testing.4
How we researched this
On 12 Oct 2026 we read Obesity Canada’s assessment and medicines chapters, Statistics Canada’s 2025 portrait of South Asian populations, Diabetes Canada’s screening chapter, two Canadian studies (Razak 2007, Chiu 2011) and the Canadian labels for Wegovy, Zepbound and Ozempic.
The Y-Y paradox letter and the English study come from our India research and are labelled as non-Canadian. We use the groupings the studies used; “South Asian” covers many communities.
Before you move on
- At the same BMI, South Asian adults tend to carry more fat and more diabetes risk.
- Canada’s guideline starts overweight at 23 and uses 85 cm and 75 cm waists for Asian adults.
- Drug labels still use BMI 30, or 27 with a weight-related condition.
- Ask about diabetes testing if you’re over 40 or have other risk factors.
More from the Canada blog
The monthly Canada update
An independent guide to GLP‑1 medicines. We don't sell medicines, take drug-company money or earn clinic commissions. Once a month: coverage changes, approvals, safety notices and recalls. How we write
Sources
- Chiu M, Austin PC, Manuel DG, Shah BR, Tu JV. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diabetes Care 2011;34(8):1741–8. Institute for Clinical Evaluative Sciences, Ontario. DOI · PMC3142051
- Rueda-Clausen CF, Poddar M, Lear SA, Poirier P, Sharma AM. Canadian Adult Obesity Clinical Practice Guidelines: Assessment of People Living with Obesity. Obesity Canada, version 1, 4 August 2020 (Table 1, waist cut-offs, Edmonton Obesity Staging System). obesitycanada.ca (PDF)
- Kalhor S, Paez Silva A, Badets J. Portrait of the South Asian populations in Canada: diversity and socioeconomic outcomes. Statistics Canada, 89-657-X2025007, released 8 December 2025. statcan.gc.ca
- Ekoé JM, Goldenberg R, Katz P; Diabetes Canada Clinical Practice Guidelines Expert Committee. Screening for diabetes in adults. Can J Diabetes 2018;42(Suppl 1):S16–S19 (risk factors include membership of a high-risk population, such as South Asian descent). guidelines.diabetes.ca
- Novo Nordisk Canada. Wegovy (semaglutide injection) product monograph, date of authorization 2 October 2026. Sections 1, 2, 4.4, 4.5, 7, 8, 10, 11, 14 and patient information. pdf.hres.ca
- Eli Lilly Canada. Zepbound (tirzepatide injection) product monograph, date of authorization 11 June 2026. Sections 1, 4.4, 4.5, 8, 11, 14. pdf.hres.ca
- Health Canada. Drug Product Database: product records and status for semaglutide, tirzepatide and liraglutide products (all on the prescription schedule; generic semaglutide products from Dr. Reddy’s and Apotex marketed in May 2026; Sevmia, Aspen and Sandoz products approved but not marketed). Searched 12 October 2026. health-products.canada.ca
- Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet 2004;363(9403):163. Reused from our India research (checked 5 October 2026). DOI · PMID 14726172
- Razak F, Anand SS, Shannon H et al. Defining obesity cut points in a multiethnic population. Circulation 2007;115(16):2111–8. McMaster University, Hamilton. DOI · PMID 17420343
- Caleyachetty R, Barber TM, Mohammed NI et al. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol 2021;9(7):419–26. A UK study, reused from our India research. DOI · PMID 33989535
- Pedersen SD, Manjoo P, Dash S, Jain A, Pearce N, Poddar M. Canadian Adult Obesity Clinical Practice Guideline: Pharmacotherapy for Obesity Management in Adults, 2025 update. Obesity Canada, version 3, 11 August 2025 (recommendations 1–13; STEP 1 extension, STEP 4, SURMOUNT-4, SELECT, ESSENCE and SURMOUNT-OSA summaries). obesitycanada.ca (PDF)
- Novo Nordisk Canada. Ozempic (semaglutide injection) product monograph (the Canadian label), date of authorization 13 July 2026. Sections 1, 4.4, 4.5, 11 and patient information. pdf.hres.ca
- BC PharmaCare. Drug coverage decision: semaglutide (Wegovy), “Non-benefit”, 18 December 2025 (pCPA talks ended without agreement on 1 December 2025). gov.bc.ca (PDF)
Last checked 12 Oct 2026 · Next review due 12 Oct 2027 · Report an error
How this post was made. Written by the GLP Guidebook team from the sources above. It's general information, not medical, legal or tax advice. Talk to a qualified doctor, nurse practitioner or pharmacist before starting, stopping or changing any medicine. How we write