Rishi Caleyachetty is a junior doctor and epidemiologist at Warwick Hospital, Warwick and University of Warwick, UK. He is the lead author on a major study presented here at ECO2021 and published at the same time in The Lancet Diabetes & Endocrinology – which shows that traditional and current ethnicity-specific BMI cut offs for obesity and type 2 diabetes risk do not work for non-white populations.
Q: Hello Rishi and welcome to ECO2021. How are you coping with the world of online meetings and conferences?
A: It is always good to be at ECO2021. I have colleagues from around the world so I am used to having online meetings. But I do miss meeting people at conferences and going for lunch or dinner together.
Q: Your study published today in Lancet Diabetes & Endocrinology comes at a time when Black Asian and Minority Ethnic (BAME) Health is already under the spotlight due to COVID. What made you investigate this different relationship between BMI obesity and diabetes risk in people of different ethnicities?
A: Over the years, I have met many people from minority ethnic communities tell me they were surprised to be diagnosed with type 2 diabetes. A lot of them at the time had BMIs considered normal by WHO or NICE definitions.
Q: You found that BAME people were at an equivalent diabetes risk to white people at a lower BMI. Were the findings a surprise?
A: I was aware of the previous research. But the evidence base on BMI cutoffs to trigger action for type 2 diabetes prevention was not robust enough. For example, studies were small, had relatively few ethnic groups, measured BMI and type 2 diabetes at the same time or used self-reported type 2 diabetes.
Q: What do we need to do at various levels to improve awareness in BAME communities of BMI and related risk – national action from government? What can local communities and GPs do?
A: I think the NHS and charities like Diabetes UK already do a lot of good engagement work with minority ethnic communities. So first, we need to continue to work with those hard-working local social and religious leaders and local groups to raise awareness outside of the traditional healthcare environments. It is also important to deliver health messaging in avenues where women from minority ethnic communities have access to necessary information. Second, we need to make sure that the health messaging for minority ethnic communities is culturally competent. We can address any lack of cultural competence by those involved in health messaging the opportunity to acquire, practice, and hone skills in cultural competence. Finally, it goes without saying, but it has been a difficult time to be a GP or other healthcare professional providing primary care in England. Primary care will need its workforce to remain motivated and continue to listen to minority ethnic communities. Through listening, we will be able to generate solid and innovative ideas that can improve awareness among these communities.
Q: What are the next steps to your research in this area?
A: It is important to translate the findings of epidemiological work and so I will be talking to policy makers, senior clinical leaders and charities. I am also planning to go around the country (when allowed to do so) to talk to diverse communities about obesity and type 2 diabetes.
Q: Tell us a bit about your day to day work, where you are based?
A: I am a practicing doctor at Warwick Hospital in Warwickshire, England. I like seeing patients and supporting them in any way I can. It is important to me. Seeing patients also helps memake sure that I am always doing epidemiological work that serves their interests.
Q: This is not the first time you have attracted attention at ECO. In our 2017 meeting in Porto, you had a study extensively covered by the media on the implications of so called metabolically healthy obesity. How was that experience?
A: I like talking about health problems and how to solve them. Having the opportunity to do that on a much larger scale by talking to the media and being part of the conversation, was important to me.
Q: Which sessions would you like to see at this year’s ECO, if you have time, either live or on catch up?
A: There are so many excellent sessions. It is a hard choice but if I am going to have to make one, I would say I am keen to watch the Novel Anti-Obesity Medications on the 13th May.
Thanks Rishi and congratulations on this excellent study and the publication in Lancet Diabetes & Endocrinology.