Diversity in outcomes  

Several studies have shown that people from some ethnic backgrounds experience higher risks of hypertension and cardiovascular disease at lower BMI levels than Caucasian populations because of increased levels of abdominal visceral fat. 

Unlike subcutaneous fat, which sits beneath the skin and serves as an energy reserve, visceral fat is metabolically active. It can sequester vitamin D, reducing its availability, but more importantly it increases the risk of insulin resistance and inflammation. 

Abdominal visceral fat is also linked to a higher risk of metabolic diseases such as type 2 diabetes and hypertension.

This contributes to what has been described as a ‘thin outside, fat inside’ (TOFI) or ‘skinny fat’ phenotype, which is commonly seen in South Asian populations, even in people with a normal BMI. 

The reasons for this fat distribution pattern are unclear, but it may reflect shared genomic factors. 

Targeting weight management and physical activity advice to people from ethnic minority groups is therefore an important priority.

However, weight management approaches need to be tailored to ethnic backgrounds because cultural, dietary and socio-economic factors influence health behaviours. 

Pharmacy teams should develop the skills needed to support patients from diverse cultural backgrounds and demonstrate cultural sensitivity, which helps to build trust and improve the effectiveness of weight management support.

However, cultural sensitivity can only develop once pharmacy teams have developed sufficient competence in this area.