Why Indian Americans despite lower BMI have Increased Risk of Developing Diabetes Type 2?

Indian Americans—especially people of South Asian ancestry—have a meaningfully higher risk of type 2 diabetes than many other U.S. groups, even at relatively low body weights.

The difference becomes particularly noticeable with age. In one U.S. study, about 31.5% of Asian Indian Americans age 65 or older reported diabetes. Studies specifically examining middle-aged and older South Asians have sometimes found even higher numbers—around 23–29% which is higher compared to other ethnic groups in the U.S.

Why is that?

Reason number 1- Increased visceral fat

One important reason is that South Asians can develop insulin resistance and visceral fat—the fat around internal organs—at lower BMIs than many other populations. Research also suggests reduced pancreatic beta-cell ability to compensate for insulin resistance may contribute. So, an Indian American can look relatively thin and still have significant metabolic risk. In fact, one large health-record study found South Asian adults had substantially more diabetes than White adults even within the "healthy BMI" range. Even among people with BMI below 23, the modeled lifetime risk was about 37% for men and 47% for women.

Reason number 2- History of famine

The older “thrifty genotype” hypothesis says repeated famine could have favored genes that helped people store energy efficiently during times of plenty. If a fetus or young child experiences undernutrition, the body may develop with lower muscle mass, reduced pancreatic beta-cell capacity, and metabolic adaptations suited to a low-food environment. If that person later grows up in an environment with abundant calories and refined carbohydrates, that mismatch can increase the risk of insulin resistance, fatty liver and type 2 diabetes.

Reason number 3- Early screening & detection

The 2026 American Diabetes Association recommends that everyone begin screening by age 35. But for people of Asian ancestry, testing should be considered at any adult age if BMI is at least 23 kg/m² and there is at least one additional risk factor. Asian American ancestry itself is listed among those risk factors, along with family history, physical inactivity, high blood pressure, abnormal cholesterol/triglycerides, PCOS, fatty liver, and other signs of insulin resistance.

How to prevent Diabetes in Indian Americans?

Diet changes

1-Cut refined carbohydrates substantially. Reduce or better avoid maida, white bread, naan made with refined flour, biscuits, bakery products, sweets, sugary cereals, and large portions of white rice.

2-Don't eliminate carbs—replace them. Use smaller portions of brown rice, quinoa, oats, barley, whole-wheat roti, or minimally processed millets. Pair them with protein and vegetables rather than making rice/roti for most of the meal.

3-Aim for roughly ½ vegetables, ¼ protein, ¼ carbohydrate at lunch and dinner. For example: sabzi + dal/paneer/tofu + one or two small rotis.

4-Make dal, beans and legumes major foods. Dal, chana, rajma, moong, black-eyed peas, soy/tofu, etc. provide protein and fiber

5-Keep traditional sweets occasional once a week if prediabetic and once in a month if diabetic rather than daily.

6-Mithai, halwa, laddoo, sweet chai/coffee, jaggery and honey all still contribute substantial sugar. Jaggery is not a diabetes-preventing substitute for table sugar.

7-Use nuts and seeds regularly. Almonds, walnuts, peanuts, pistachios, flax, chia and sesame can replace some refined snacks. Incorporate my high protein laddus daily.

8-Be mindful of saturated fats as well. Large amounts of ghee, cooking oil, coconut fat and fried foods must be in moderation restricting to 2 teaspoon a day.

Exercise Changes

1-Strength Training- Doing at least 150 minutes of moderate activity per week reduces progression to type 2 diabetes by about 58% and this is recommended by the ADA (American Diabetes Association) and its included everyday (Mon to Thurs) as part of The Sahila System in the Diabetes Prevention Program.

2-Kapalabhati Kriya- this breathing technique complements a diabetes-prevention lifestyle” and with my experience of helping numerous people with prediabetes and diabetes I have seen that when this kriya is practiced correctly and consistently, it can reduce or even postpone the development of worsening HbA1c in Indian American population.

This technique is taught in multiple levels in The Sahila System with 3 varying speeds. Certain Kapalabhati techniques create repeated abdominal contractions and may influence autonomic function, insulin sensitivity, and pancreatic beta-cell activity. Some yoga studies show improved insulin and glucose regulation and, in my program The Sahila System, these techniques are taught 1 on 1 with emphasis on doing them correctly and eventually progressing to levels of advanced methods under my guidance.

Focus on increasing insulin sensitivity rather than insulin secretion

Always increasing insulin sensitivity is better than the insulin secretion, why?

Because insulin resistance is usually the underlying problem in early type 2 diabetes particularly in Indian Americans which is where i primarily focus in my programs, while increased insulin secretion is mainly the body's workaround for that problem. Think of insulin as a key and your cells as a lock. With good insulin sensitivity, a small amount of insulin opens the lock easily and lets glucose enter the cell. With insulin resistance, the lock does not respond well, so the pancreas has to make more and more insulin to get the same effect.

What happens when you increase Insulin Sensitivity?

1-You need less insulin to control the same amount of glucose.

2-It reduces the workload on pancreatic beta cells.

3-It addresses the cause rather than the compensation.

4-It helps control post-meal glucose more efficiently.

5-It can reduce chronically elevated insulin levels. Because high insulin is often a sign that the body is struggling to overcome insulin resistance.

How to increase Insulin Sensitivity to overcome Insulin Resistance?

1-Exercise regularly. This is one of the strongest interventions. I conduct daily sessions in morning and evening as well as weekends via various conveneint timings and repeated regularly for diferent time zones in the US.

2-Build muscle. Muscle is a major place where glucose is taken up. Resistance training—weights, using walls to push and climb, yoga blocks and several such others are used in my program.

3-Walk after meals. Even a 10–15-minute walk after eating can help reduce the post-meal glucose rise. I have started the most popular Instgram series called WALK with Sahila movement where I create reels daily while going for my evenig walk motivating my followers to do the same.

4-Avoid long periods of sitting. Get up and move every 30–60 minutes if possible. This problem is very common in IT professionals and desk job workers and my program gives you methods to break those habits.

5-Get enough sleep. Chronic sleep deprivation can worsen insulin sensitivity. In my program you will master Brahmari pranayama which helps in regulating the circadian rhythm and this is praticed regualarly in the program.

6-Manage chronic stress. Persistently elevated stress hormones can interfere with glucose regulation. So think about daily Meditation, yoga, and breathing exercises and I have noticed that this changes your insulin sensitivity dramatically.

7-Intermittent Fasting can help such people mainly because it can improve calorie balance and weight control. It also helps initiate the process of autophagy (body devours toxic cells inside the body). All my enrolled clients learn and practice intermittent fasting from basic to advanced levels in The Sahila System.