Health Talk | How do the revised obesity guidelines help

India has experienced a doubling of obesity prevalence over the past two decades, with abdominal obesity becoming particularly prevalent.

India-specific guidelines on obesity were published this week after nearly 15 years, doing away with the term ‘overweight’ and replacing it with obesity — grade I and II. This development came a day after The Lancet Diabetes & Endocrinology published global obesity guidelines that moved away from the use of body mass index (BMI) as the sole criterion for diagnosing obesity. The authors instead recommended confirmation of excess fat mass (obesity) and its distribution around the body.

Childhood obesity rates are rising significantly across India.(Unsplash)

The methods recommended included at least one measurement of body size (waist circumference, waist-to-hip ratio or waist-to-height ratio) in addition to BMI; at least two measurements of body size (waist circumference, waist-to-hip ratio or waist-to-height ratio) regardless of BMI; direct body fat measurement (such as by a bone densitometry scan or DEXA) regardless of BMI; and in people with very high BMI (>40 Kg/m2), pragmatically assuming excess body fat.

How do these changes help?

As the authors of the Lancet paper explained, relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their vital organs. There is enough evidence to establish that fat around vital organs such as the liver and the heart makes one prone to developing several serious ailments. Also, lean people (without high BMI) can also have excess body fat and fat people (with high BMI) may not experience impaired organ functions, making BMI as sole criterion to diagnose obesity as irrelevant. Indians, in particular, typically have higher body fat percentages than western populations and develop diabetes at lower BMI levels.

The understanding of obesity has evolved significantly over the past decades, with particular attention to ethnic differences. In 1999, the World Health Organization (WHO) established a global definition of obesity.

India came up with country-specific guidelines first in 2009, wherein experts adjusted Body Mass Index criteria downward, with overweight defined as 23-24.9 kg/m² and obesity as >25 kg/m², compared to the Western standards of 25 and 30 kg/m² respectively; and waist circumference thresholds were established at >90 cm for men and >80 cm for women, lower than Western standards of 102 cm and 88 cm respectively.

The modifications made by Indian clinicians some 15 years ago did help in better diagnosis and treatment, and the changes introduced in the current guidelines will help further as non-communicable diseases associated with excess fat are on the rise in the country. As per widely available data, India has experienced a doubling of obesity prevalence over the past two decades, with abdominal obesity becoming particularly prevalent. Childhood obesity rates are rising significantly across India.

These figures are clear indicators of the fact that if India did not act now, it would be staring at an uncontrollable obesity epidemic in the near future.