Hawaii’s “Screen at 23” Diabetes Prevention Campaign Targets High-Risk, Lower-BMI Populations

by Dr. Suneil Koliwad, senior medical advisor for Yes Health 

In a breakthrough moment earlier this week, the State of Hawaii announced plans to formally identify people who have an elevated risk for diabetes. On March 22, 2016, which coincided with the American Diabetes Associations’ national “Diabetes Alert Day,” Hawaii began a statewide effort to screen people of Asian descent for diabetes at a BMI of 23 or above.

Obesity is generally accepted as a risk factor for diabetes—although, as we discussed in a previous post, BMI is not always the most reliable measurement tool. Some folks who might be considered normal weight or even lean, may have an elevated risk for diabetes that cannot be captured simply by measuring BMI. Notably, Asians, South Asians (from the Indian Subcontinent) and some Middle Eastern populations have been shown to have an increased diabetes risk even at a lower BMI. This is significant, given the large number of people from these ethnic groups living in the United States.

Hawaii’s new “Screen at 23” campaign targets a BMI threshold that is much lower than the traditional BMI guidelines for defining overweight (26-27) or obese (30) individuals. This campaign also sharply diverges from the U.S. Preventive Services Task Force (USPSTF) diabetes screening criteria, which only highlight the need to screen people who have both an elevated BMI and high blood pressure.

The new campaign sends a strong message that screening certain people for diabetes who don’t necessarily have active symptoms, but do possess genetic risk-factors makes good sense, both in terms of public health and economics. The key moving forward will be to determine which populations have an increased risk for diabetes independent of obesity, and to find markers that can be assessed, diagnosed and tracked with inexpensive testing far in advance of them developing diabetes. Knowing these markers could be a huge advancement for people who are prone to getting diabetes, but who are generally not screened because they are not clearly obese.

Currently, diabetes can be diagnosed in one of three ways:

  1. Having a random blood sugar that is over 200 mg/d
  2. Having a fasting blood sugar that is over 126 mg/d
  3. Having a glucose level that tops 200 mg/dL at at any point during the two hours following the consumption of a standardized sugary beverage (as party of an oral glucose tolerance test) and a hemoglobin A1C (HgbA1C) value over 6.5%

Together with the help of new research, the efforts of the ADA and companies like Yes Health along with visionary policymakers and elected officials, more and more cities and states will join Hawaii and commit themselves to illuminating the number of people who are unaware of their own diabetes.


Yes Health is a low-cost, weight loss and diabetes-prevention program committed to helping everyone live healthier, happier lives.