Jonathan Cheng, WSJ’s Korea bureau chief – r/IAmA

Hi, I’m Jonathan Cheng, and I run the Korea bureau for The Wall Street Journal in Seoul. Covering North Korea is a challenge unlike any other in the news business. It’s not just opaque, it’s a country that has made it a deliberate goal to obfuscate, and that makes even reporting the simplest of facts — how old is Kim Jong Un? Is he even really the leader of the country? — a tricky question. One might think going to Pyongyang would help. And it does, to some extent. But going there also raises as many questions as it answers. A delegation of four of us from the Wall Street Journal just returned from North Korea last week, a six-day trip that appears part of a coordinated effort to send a message to Washington about where it thinks it stands and what it wants — and what it will and won’t tolerate. We’ve written one [essay-ish account](https://www.wsj.com/articles/letter-from-north-korea-what-life-looks-like-as-nuclear-crisis-mounts-1506097544) of our week in Pyongyang, but in some ways, it only scratches the surface. So…feel free to ask me whatever you like.

Update: Thanks for the questions! I do need to wrap up now, but feel free to follow me on Twitter for updates. I’ll also circle back and try to answer some of the ones that I’ve left hanging. Thanks everyone!

Proof: https://i.redd.it/zx0qw3jscpoz.jpg

Continue reading “Jonathan Cheng, WSJ’s Korea bureau chief – r/IAmA”

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Worst eating places in Singapore according to Reddit.

/u/kronograf
What’re your personal dining-out nadirs? Maybe we can crowdsource a list of places to stay the fuck away from.

For me:

The Ramen House @ Selegie – truly the mediocre-st ramen I’ve ever had locally. Flaccid noodles, blander soup than Maggi, straggly chashu…

True Blue @ Peranakan Museum – horrendously, horrendously overpriced basic-bitch Peranakan food

Yeo Keng Nam @ Upp Serangoon – taxi-driver disputes aside, hawker centres have better chicken rice than this

https://www.reddit.com//r/singapore/comments/786f6m/the_terrible_singaporean_restaurants_thread/ Continue reading “Worst eating places in Singapore according to Reddit.”

Study: Asians unable to produce enough insulin

Recently the news reported on a study which suggested that one reason why Asians are more prone to diabetes is due to inadequate insulin production.

Study: Asians unable to produce enough insulin

Local researchers from the National University Hospital (NUH), in collaboration with Janssen Pharmaceuticals, have found that the inability to produce enough insulin could be why Asians are more prone to Type 2 diabetes than their Western counterparts.

The breakthrough finding, based on a study of 140 mostly Chinese participants, will pave the way for better diabetes management for people here and in the region. This includes tailoring dietary advice and a better selection of drugs to treat diabetes, doctors believe.

Another interesting finding from a separate study is that Chinese people are more prone to diabetes at lower BMIs than Caucasians.

According to a previous study, 8 per cent of people of Chinese descent with a Body Mass Index (BMI) of 23 (just outside the healthy weight range) have diabetes. This is four times more than their European counterparts. A BMI of 23 is within the normal weight range for Caucasians.

As I have mentioned in my previous blog post, Caucasians tend to have lower body fat than Asians despite having the same BMI.

Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements.

Although Asians had lower BMI, they were fatter than whites of both sexes. The correlations between fat% and BMI varied by BMI and sex and race. Comparisons in anthropometry show that Asians had more subcutaneous fat than did whites and had different fat distributions from whites. Asians had more upper-body subcutaneous fat than did whites. The magnitude of differences between the two races was greater in females than in males.

My theory is that the impaired insulin production is due to the higher body fat percentage that Asians seem to have. A higher body fat percentage translates to a lower fat free mass. Which in turn reduces insulin production. Hence in comparison to Caucasians with the same BMI but lower body fat percentage, Asians will produce less insulin.

This news outlet reported on the same article, but I disagree with something they added.

Most Asians don’t produce enough insulin, more prone to diabetes

In a separate study, it was also discovered that 8 per cent of Chinese participants with a Body Mass Index (BMI) of 23 (this means they’re just outside the healthy range) have diabetes, four times more than those of European descent.

The reason for this? Caucasians generally have more body fat and therefore, a BMI of 23 is considered normal for them.

The part that is in bold is incorrect. The opposite is true, Asians in general have MORE body fat. That is the reason why WHO recommended a LOWER BMI cutoff for Asians.

WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

Conclusions

On the basis of the available data in Asia, the WHO expert consultation concluded that Asians generally have a higher percentage of body fat than white people of the same age, sex, and BMI. Also, the proportion of Asian people with risk factors for type 2 diabetes and cardiovascular disease is substantial even below the existing WHO BMI cut-off point of 25 kg/m2. Thus, current WHO cut-off points do not provide an adequate basis for taking action on risks related to overweight and obesity in many populations in Asia.

Is BMI a good measure of health?

Recently, my government has increased it’s focus on its citizens adopting a healthy lifestyle. Today, I decided to look into one metric that is commonly used to determine a population’s health.

What is BMI?

Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness. BMI can be used to screen for weight categories that may lead to health problems but it is not diagnostic of the body fatness or health of an individual.

What is it used for?

BMI is mainly used to assess weight status of a population. It is a simple screening tool to estimate a person’s body fat, but should be used in conjunction with other body composition tests before a diagnosis is to be made. This is because BMI is unable to discern between body fat percentage and lean mass.

How accurate is it?

This is a tricky question to answer. It’s accuracy differs between populations.

For example, in the USA and Singapore, the use of BMI actually under-diagnoses the prevalence of obesity.

In this study, it was observed that the use of BMI underdiagnosed obesity by 30%!
Accuracy of Body Mass Index to Diagnose Obesity In the US Adult Population

BMI-defined obesity (≥ 30 kg/m2) was present in 21% of men and 31% of women, while BF %-defined obesity was present in 50% and 62%, respectively.

Our findings also suggest that the magnitude of the obesity epidemic may be greatly underestimated by the use of BMI as the marker of obesity 35. In our results, BMI showed an unacceptable low sensitivity for detecting body fatness, with more than half of obese subjects (by body fat measurement) being labeled as normal or overweight by BMI. The true prevalence of obesity might be strikingly higher than that estimated by BMI.

In Singapore, it was observed that the accuracy of BMI differs between ethnic groups.
The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore

RESULTS: Compared with body fat percentage (BF%) obtained using the reference method, BF% for the Singaporean Chinese, Malays and Indians were under-predicted by BMI, sex and age when an equation developed in a Caucasian population was used. The mean prediction error ranged from 2.7% to 5.6% body fat. The BMI/BF% relationship was also different among the three Singaporean groups, with Indians having the highest BF% and Chinese the lowest for the same BMI. These differences could be ascribed to differences in body build. It was also found that for the same amount of body fat as Caucasians who have a body mass index (BMI) of 30 kg/m2 (cut-off for obesity as defined by WHO), the BMI cut-off points for obesity would have to be about 27 kg/m2 for Chinese and Malays and 26 kg/m2 for Indians.

If obesity is defined as excess body fat rather than excess weight, the obesity cut-off point for Singaporeans should be 27 kg/m2 instead of 30 kg/m2. The lowering of the cut-off point for obesity would more than double the prevalence figures in Singapore.

In addition, the study authors also noted that the use of BMI underdiagnosed the prevalence of obesity in Singapore by at least 10%.

Generally, if the cut-off point for obesity in Singapore were lowered to 27 kg/m2, this would have immense impact on the prevalence of obesity among the adult Singapore population. Compared to a BMI cut-off point of 30 kg/m2 the prevalence would increase in females from 6.5% to 15.4% and in males from 5.2% to 17.3%.

Interestingly, it is the opposite for Korea. The use of BMI actually over-diagnosed obesity.

Diagnostic Performance of Body Mass Index Using the Western Pacific Regional Office of World Health Organization Reference Standards for Body Fat Percentage

In the present study, obesity was identified in 38.7% of men and 28.1% of women using body mass index (≥25 kg/m2) and in 25.2% of men and 31.1% of women using body fat percentage. A body mass index cut-off ≥25 kg/m2 had high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72%, women).

On the basis of BF%, 25.2% of men and 31.1% of women were classified as obese in the present study compared to 50% of men and 62% of women in American populations (10). Thus, BF% better reflects the current status than population-specific cut-off points for BMI for international comparisons of the prevalence of obesity. The prevalence of BF%-defined obesity was higher in women than in men in Korea, which suggests that Korean women have less lean mass than do Korean men.

What is the significance of BMI?

As mentioned earlier it is mainly used a health indicator of a population but not an individual.

High and low BMI have been correlated with increased mortality rates. However, the increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. i.e. It’s a reverse causation, people are underweight due to their pre-existing conditions (eg. cancer).

An increase in BMI has been correlated with an increased risk for a myriad of diseases such as heart disease and diabetes.