close_game
close_game

Obesity norms for India updated after 15 years

By, New Delhi
Jan 16, 2025 06:08 AM IST

The term overweight is no more a part of the India-specific obesity guidelines that were revised after nearly 15 years and published on Wednesday.

The term overweight is no more a part of the India-specific obesity guidelines that were revised after nearly 15 years and published on Wednesday.

Obesity norms for India updated after 15 years
Obesity norms for India updated after 15 years

The term overweight has been replaced with Obesity — grades I and II — instead.

The India guidelines, published in a paper in the journal Diabetes and Metabolic Syndrome, Clinical Research and Reviews are in step with the recently-released Lancet report that overhauled obesity diagnosis and emphasised on abdominal fat distribution, which has particularly adverse effects in Asian Indian populations.

“The prevailing guidelines for obesity in Asian Indians, published in 2009, relied solely on body mass index (BMI) criteria. Recognizing the limitations of BMI in accurately diagnosing obesity and the emergence of new research revealing the association between generalized and abdominal adiposity in Asian Indians and early-onset co-morbid diseases, a comprehensive redefinition was needed,” said the authors, researchers from All India Institute of Medical Sciences (AIIMS) and Fortis- C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, in the paper.

They added that recent research has demonstrated that Asian Indians experience more severe metabolic consequences from excess fat accumulation. “Studies show that excess fat in Indian populations generates higher levels of inflammation and metabolic disturbance at lower BMI thresholds compared to Western populations,” the researchers said.

As part of new classification system for India, the researchers suggest two stages: grade 1 — innocuous obesity; and grade II — obesity with consequence, in the paper.

Innocuous obesity is characterised by increased body fat without organ or metabolic dysfunction; and obesity with consequence is marked by impact on physical functions and presence of obesity-related diseases.

According to the authors, this evolution in obesity definition and classification carries significant implications as India has seen the prevalence of obesity double over the past two decades, with abdominal obesity becoming particularly prevalent; childhood obesity rates are rising significantly across India; and concurrent increases are seen in related conditions including diabetes, lipid disorders, fatty liver disease, and cardiovascular disease.

“The obesity diagnosis framework outlined in The Lancet Diabetes and Endocrinology marks a significant advance for India’s health care system, where metabolic disease burden is rapidly rising. South Asian populations present a unique challenge, as they accumulate harmful abdominal fat at BMI levels considered ‘normal’ by traditional standards. The proposed comprehensive assessment approach, incorporating waist circumference, body composition, and associated health conditions, enables more accurate risk stratification. By adopting a two-stage diagnostic model, the new Indian obesity guidelines align with The Lancet framework to deliver more targeted and appropriate treatment intensities,” said Dr Anoop Misra, one of the authors, and chairman, Fortis-C-DOC.

The researchers mention in the paper that abdominal obesity is an important factor in health, even independent of BMI. A meta-analysis of 11 prospective cohort studies including white adults aged 20–83 years from Australia, Sweden, and the USA stated that waist circumference (WC) is positively associated with all-cause mortality. “Coutinho and colleagues carried out a systematic review of cohort studies with adults from the US, Denmark, France, and Korea (n, 14000, suffering from coronary artery disease) and observed that the higher tertiles (second and third) of WC were associated with the higher risk of death even after adjusting for age, gender, smoking, and BMI…”

“Moving beyond BMI-only approaches helps prevent both under- and over-diagnosis of obesity-related health risks. These new frameworks enable more precise, personalized treatment strategies that consider individual metabolic profiles and risk factors..,” said the authors.

Dr Naval Vikram, professor, department of medicine, AIIMS, Delhi, and one of the authors, said, “Focus should be on abdominal fat when looking at treatment options, and obesity with clinical symptoms where organs are affected that is more problematic.”

For management for stage 1 obesity, experts recommend lifestyle-related interventions such as individualized medical nutrition therapy, physical activity, and behavioural intervention. Those diagnosed with stage 2 obesity should aggressively go for lifestyle interventions; along with initiation of pharmacotherapy (drugs and injectables).

The understanding of obesity has evolved significantly over the past decades, with particular attention to ethnic differences. In 1999, the World Health Organization 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.

“These recommendations have been published in the paper and can be seen a reference point for clinicians treating Indians,” added Dr Vikram.

rec-icon Recommended Topics
Share this article
Get Current Updates on India News, Weather Today, Latest News at Hindustan Times.
See More
Get Current Updates on India News, Weather Today, Latest News at Hindustan Times.
SHARE THIS ARTICLE ON
SHARE
Story Saved
Live Score
Saved Articles
Following
My Reads
Sign out
New Delhi 0C
Sunday, February 16, 2025
Start 14 Days Free Trial Subscribe Now
Follow Us On