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It's a classic case of not judging a book by it's cover. Just because you're slim doesn't mean you're out of the risk zone for developing diabetes, and this is especially true for Asian-Americans.

The Body Mass Index correlates height with weight to place individuals into four categories: underweight, normal, overweight, and obese. For most Americans, being on the right side of 25 – the cutoff for the normal weight range - has been enough to prevent weight-related ailments such as diabetes.

Asian-Americans, however, need to aim even lower: a BMI of 23 or less is ideal since they tend to develop diabetes even at a “normal” weight, explains Dr. William Hsu, director of the Asian Clinic at the Joslin Diabetes Center in Boston.

As a result of a difference in body composition, “with any given BMI Asians are going to have more body fat than Caucasians,” Dr. Hsu said.

A higher percentage of body fat regardless of the actual number on the scale, prove dangerous, depending on what type of fat it is and where it’s located on the body, said Northwestern Memorial Hospital physician Mercedes Carnethon.

As Hsu points out, Asian-Americans are prone to having “more central obesity and fatness around the trunk than Caucasian people,” he said. “This apple-shaped body suggests that there’s a lot of fat inside the organs.”

Indeed, Carnethon said, it’s that visceral fat, which is found deeper in the body surrounding the body’s organs, that people need to be mindful of. “Visceral fat is more metabolically active than other [types of fat], which would cause insulin resistance,” she said. Insulin resistance is the chief result of a diabetic condition.

As a result, Asian-Americans need to pull out all the stops when battling the bulge in order to prevent the onset of diabetes, especially those who have become firmly acculturated to a Western lifestyle.

“There is a very clear fact that Western lifestyles, particularly among those not initially exposed to them, tend to be particularly ‘obeseogenic,’” Carnethon said, pointing to the number of processed foods consumed in the typical Western diet and the lack of physical activity. “We have engineered physical activity out of our lifestyles,” she said.

It’s this very adaptation that Hsu believes is highlighting a genetic predisposition to diabetes in the Asian population.

“If you look at…however many thousands of years Asians have been around, diabetes was less than one percent [in Asian countries]. We know that genetics could not have mutated that fast to cause the rise [in diabetes]. It must’ve been environmental factors – diet, physical activity, and weight,” Hsu said.

So, what exactly can Asian-Americans do to counteract some of the negative effects a Western lifestyle has on their health?

For one, says Ann Laetz, a University of Illinois at Chicago nutritionist, start paying attention to portion control.

“The number one thing is monitoring your portions. It doesn’t matter what you’re eating, if you eat too much of anything, you’re going to gain weight. In order to lose weight, you need to take in fewer calories than you’re putting out. Portion control is the key to everything,” Laetz said.

At UIC’s Nutrition and Wellness Center, Laetz instructs diabetes patients on the Plate Method, a technique that emphasizes portion control.

A quarter of the plate should be devoted to a lean protein, she says, about the size of a deck of cards. The other quarter, put a starch on there – something like a potato, or corn, which should be about the size of a fist. The other half of the plate should be filled with vegetables – broccoli, carrots, cauliflower, tomatoes, and the like – because vegetables have tons of nutrients without the caloric wallop.

Hsu said that his team over at the Joslin Diabete’s Center’s Asian clinic hasn’t pinpointed a more traditional Asian diet that Asians could stick to for diabetes prevention, but does agree with Laetz’s methods.

“For now, we don’t know exactly what’s the best diet for them, but we know this: the portion has to be smaller. Because Asian people are so sensitive to weight gain, a little shift puts them at so much more risk than a Caucasian person,” Hsu said.