Dr Hughes is a PhD student, and medical doctor studying at Charles Darwin University, based at Menzies School of Health Research. Dr Hughes is also a Torres Strait Islander. I grew up thinking the body shape of my islander relatives was just normal, and ran in the family. I learnt from medical training that many of these relatives actually exhibited signs of illness- obesity and diabetes. The permissive "normal" of obesity and diabetes (and its consequences) in communities is unacceptable. Young people shouldn't expect to grow up believing these illnesses are normal either.

Dr Hughes grew up in Darwin, and is now a kidney specialist (nephrologist). She is concerned that much oft he kidney damage amongst Aboriginal and Torres Strait Islander people stems from preventable illness like obesity,diabetes and heart attack.

Dr Hughes is studying the body composition of Aboriginal and Torres Strait Islanders in her research.

Let's think about the BMI (body mass index) and Indigenous Australians. BMI was developed an indicator of body fatness, and was first studied amongst European populations. The healthy BMI range for Australians is 18 to less than 25kg/m2. This range BMI was associated withthe least deaths from heart disease.

Weight is an essential ingredient of calculating the BMI, but weight does not discern if due mostly to fat or muscle. Muscle has greater density and weighs more than fat. The healthy BMI range hasn't been proven for Indigenous Australians. The BMI of a healthy fit Tones Strait Islander athlete (for example Wendell Sailor or Sam Thaiday) might be very high, even in the "obesity range"because BMI cant differentiate if body weight is dominated by muscle (rather than fat). On the other hand an Aborigine with a slim build might not fit into the BMI categories very well either. A study in Central Australia showed that over 8 years follow-up, people with a BMI of less than 25kg/ m2 (i.e. in the "healthy" range) developed type 2 diabetes.Daniels suggests that a lower BMI (<22kg/m2) amongst the Central Australian community might be recommended in order to prevent onset of diabetes.

This discussion on body mass index highlights some uncertainties about our knowledge of body composition for Indigenous Australians. Another example is body fat. Everyone has fat, and everyone needs it. Too much fat, especially deep belly fat (visceral fat) is strongly linked to pre-diabetes (metabolic syndrome) diabetes and heart disease. Aboriginal and Tones Strait Islander people are extremely well informed (often from personal or family experience) about diabetes, heart disease and kidney failure.

Dr Hughes PhD study are linking body composition with the health profile of healthy people and people with chronic illness in two projects at Menzies School of Health Research. The first study is called the "eGFR Study: The accurate assessment of kidney function and progression of chronic kidney disease in Indigenous Australians." The "eGFR Study" links the measurement of muscle with the accurate measurement of kidney function. Our current kidney blood test is based on measuring a protein that comes from muscle, yet we don't have a.clear understanding of how much muscle Indigenous Australians have (and we know that Indigenous Australians have very different body builds).

The kidney blood test was developed amongst a group of Americans, mostly of Caucasian background. The eGFR study is testing the kidney blood test for accuracy in Aboriginal and Torres Strait Islander people. So I'd encourage people to contact the Menzies eGFR Team at Thursday Island Hospital (16-27 November) if you want your kidneys and body shape checked out. This includes people with diabetes and heart disease as well as relatives of people with kidney disease, because we have to be confident that our eGFR Study shows accuracy for all people (not just those with kidney damage).

Continued support from the community for the eGFR Study (we've tested 300 people across Northern Australia to date) means we can sort out the accuracy of the kidney blood test for Indigenous Australians.

The eGFR team assesses people in Darwin, and travels away to communities also. Recent trips away have included Bega Health Clinic (Kalgoorlie), Tennant Creek, and will return for a second visit to Thursday Island on November 16 2009.

Dr Hughes is leading a second study in Darwin called Healthy Top-Enders which commenced assessments on 28 October 2009 in Darwin. This study focuses on younger people, who are healthy. We are learning about the body composition (muscle, fat, bones) of healthy Aboriginal people and a healthy Non-Indigenous comparator group, and will test 50 people in total. A key focus of the Healthy Top-Enders Study is learning from healthy people, how their bodies are protecting them from diabetes, heart disease and kidney failure. If we understand health well, we can make a bigger impact on prevention and lifestyle programs and policy for people who are at high risk for chronic illness.

Until Dr Hughes reports on her PhD findings about body composition (in 2011), she encourages people to remember key health messages: Have a regular preventative health check-up. Diabetes, heart attack and kidney damage often don't have symptoms, but are very responsive to treatment, especially if detected early.

• don't smoke cigarettes,
• eat a balanced nutritious diet
• exercise regularly (most days of the week) including exercise that makes you huff and puff, and increase opportunities  to walk (instead of driving)

Consider how you can join in the Menzies research efforts to tackle kidney disease (in the eGFR Study) or assist us to learn about Healthy Top-Enders. Please contact Mary Ward on Thursday Island if you would like to be involved (mobile: 0488590332).

Please contact Suresh Sharma or Sian Graham at Menzies in Darwin on 89228673 or 89228283.