The New Face of Obesity: Revised Definitions for Indians After 15 Years!!

Obesity in India – A Growing Health Crisis

• In recent years, the prevalence of obesity and overweight has more than doubled, particularly in developing countries.¹

• With > 1 billion individuals worldwide projected to be obese by 2030, the escalating number of overweight and obese people in India is a pressing concern that demands immediate attention and action. ²

• National Family Health Survey-5 estimates that one in four Indians is obese today.¹

• By 2040, India is projected to have a significantly larger obese population, with rural residents and the elderly being the most affected, highlighting the potential consequences of the current obesity trend.³

• Furthermore, there is a disturbing surge in various diseases and conditions associated with obesity, such as cardiovascular diseases, obstructive sleep apnoea, non-alcoholic fatty liver disease, and dyslipidemia, underscoring the gravity of the situation.⁴

Body Mass Index (BMI)- A Common Tool for Measuring Obesity

• Obesity has traditionally been diagnosed using BMI because it is easy to measure and compare.⁴

• BMI calculates body fat percentages for men and women of any age based on height and weight.⁵

• BMI is computed by dividing an individual’s weight in kilograms by their height in meters squared (kg/m²). ⁵

• In Asian and South Asian populations, classify a BMI of ≥23 kg/m² and ≥25 kg/m² as overweight and obese.⁶

BMI – An Unreliable Measure for Asian Indians

• BMI fails to distinguish between fat and fat-free mass.⁷

• BMI ignores the variations in body fat distribution among ethnic groups.⁷

• Asian Indians have higher visceral and total abdominal fat and a lower glucose clearance rate, even at lower BMI.⁴

• Asian Indians exhibit comorbidities, particularly type 2 diabetes, at lower BMI levels than other ethnicities.⁴

Redefining Obesity in Indians – Updated Criteria

• The previous standards for Asian Indian obesity published 15 years back were based exclusively on BMI measurements.⁴

• Given the limitations of BMI, diagnosing obesity inaccurately, the updated obesity guidelines for Asian Indians included waist circumference, waist-to-height ratio, comorbid conditions, and symptoms associated with daily activities.⁴

• Based on this, obesity is classified into two stages:

Stage 1

• Criteria:  BMI >23 kg/m2 without appreciable impacts on everyday activities or organ functions.
• Recommendations: Clinicians should focus on counselling regarding nutrition, exercise, and lifestyle changes to prevent obesity-related co-morbid conditions and activity limitation.

Stage 2

• Criteria: An advanced stage of obesity requires a BMI > 23 kg/m2, either with excess waist circumference or waist-to-height ratio. Furthermore, one or more symptoms point to restrictions in day-to-day activities or one or more comorbid diseases associated with obesity.
• Recommendations: Besides implementing drastic lifestyle modifications, clinicians should consider including medication or weight loss surgery.

Further Reading

1. Kalra S, Kapoor N, Verma M, Shaikh S, Das S, Jacob J, Sahay R. Defining and Diagnosing Obesity in India: A Call for Advocacy and Action. J Obes. 2023 Nov 7;2023:4178121.
2. Verma M, Esht V, Alshehri MM, Aljahni M, Chauhan K, Morsy WE, Kapoor N, Kalra S. Factors Contributing to the Change in Overweight/Obesity Prevalence Among Indian Adults: A multivariate decomposition analysis of data from the National Family Health Surveys. Adv Ther. 2023 Dec;40(12):5222-5242.
3. Singh, Geetu; Agrawal, Renu; Tripathi, Neelika; Verma, Arti. Overweight and obesity, the clock ticking in India? A secondary analysis of prevalence trends, patterns, and predictors from 2005 to 2020 using the National Family Health Survey. International Journal of Noncommunicable Diseases 8(1):p 31-45, Jan–Mar 2023. | DOI: 10.4103/jncd.jncd_58_22.
4. Misra A, Vikram NK, Ghosh A, Ranjan P, Gulati S; India Obesity Commission Members. Revised definition of obesity in Asian Indians living in India. Diabetes Metab Syndr. 2024 Nov 20:102989.
5. Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
6. Misra A. Ethnic-Specific Criteria for Classification of Body Mass Index: A Perspective for Asian Indians and American Diabetes Association Position Statement. Diabetes Technol Ther. 2015 Sep;17(9):667-71.
7. Dudeja V, Misra A, Pandey RM, Devina G, Kumar G, Vikram NK. BMI does not accurately predict overweight in Asian Indians in northern India. Br J Nutr. 2001 Jul;86(1):105-12.