Weight is made up of bone, muscle, water and fat. With obesity, what matters most is not just BMI, but where the fat sits. Fat under the skin is usually less harmful.
Published Jan 15, 2026 | 7:00 AM ⚊ Updated Jan 15, 2026 | 7:00 AM
Madras Diabetes Research Foundation’s INDIA-IB study shows India has about 101 million people with diabetes and 136 million with pre-diabetes.
Synopsis: Fat stored deep in the abdomen, rather than body weight or BMI alone, poses the greatest risk to metabolic health and is a key driver of diabetes and high blood pressure in India, Dr RM Anjana President of the Madras Diabetes Research Foundation says. In a conversation with South First, she explains how rising obesity, unhealthy diets, low physical activity and stress are fuelling a sharp increase in diabetes and pre-diabetes, particularly among young adults, and why many people remain at risk even when standard tests appear normal.
Obesity is often treated as a cosmetic issue or a BMI problem. But doctors say the real risk lies in body fat, especially the kind that accumulates deep inside the abdomen and surrounds vital organs.
As part of South First’s year-long campaign BOLD, Dr RM Anjana, Managing Director of Dr Mohan’s Diabetes Specialities Centre and President of the Madras Diabetes Research Foundation, discusses in an interview how obesity affects the body, why diabetes and pre-diabetes are rising in India, what is meant by “diabesity”, how blood sugar tests should be read, and the kind of lifestyle changes that are realistically achievable.
Edited excerpts follow.
When we say obesity is dangerous, what is it actually doing inside the body?
Weight is made up of bone, muscle, water and fat. With obesity, what matters most is not just BMI, but where the fat sits. Fat under the skin is usually less harmful.
The bigger risk is fat stored deep in the belly, around organs like the liver and pancreas. That kind of fat upsets metabolism and pushes up the risk of diabetes and high blood pressure. Over time, obesity can also affect joints, lungs and mental health, and in women, periods and fertility.
Are obesity numbers rising, and are you seeing this in your clinic?
This is more than the clinic. This is in the population at large. We have data from the ICMR indices in India, and we are clearly seeing an increase in numbers in urban areas, rural areas, among men, women and even children.
There is a huge increase in obesity everywhere. If you take the metropolitan cities, one in three or four people are obese, and we are showing that in urban areas about 60 percent of people have at least abdominal obesity.
Those are huge and staggering numbers that do not bode well for the metabolic health of the country as a whole.
Top three reasons for the rise in diabetes and pre-diabetes in India?
Research from the Madras Diabetes Research Foundation’s INDIA-IB study shows India has about 101 million people with diabetes and 136 million with pre-diabetes.
For type 2 diabetes, obesity often sits early in the causal pathway. It commonly comes first, followed by pre-diabetes and then diabetes.
Unhealthy diets and low physical activity are major drivers, and our work suggests that improving just these two factors could, in theory, prevent around 50 percent of diabetes in India. The third major factor rising sharply is stress. These are the top three reasons.
Which age group is seeing the sharpest jump?
We are seeing it highest in the youth and young adults. The jump is happening across all ages. It is mainly increasing in young adults—say early 30s and early 40s.
Why is belly fat such a big concern, even when BMI looks normal?
The most metabolically active area is inside your belly because all your main organs are there, and the fat there does the worst damage.
Losing fat everywhere is important, but losing belly fat is especially important, particularly because of the Asian Indian phenotype, thin arms and legs but a pot belly. BMI can look normal, hands and legs can be normal, but the trunk carries fat, and that is the most metabolically active area. So losing that first is best.
One caution: do not lose muscle. Indians already have low muscle mass. Protecting muscle mass will protect you against metabolic disease.
Many people say their weight has not changed, but their waistline keeps increasing. Why does fat tend to accumulate only around the belly, is it food, hormones, or something else?
There are many reasons for this. This is intra-abdominal fat, and it is not a good type of fat to have. In women, as you reach perimenopause, hormonal changes can make you gain weight around the belly, lower abdomen and hips. But you can definitely beat it.
The single most effective thing is exercise. Overall exercise, along with weight training, helps burn belly fat, and that is especially important for women.
Men also tend to gain belly fat as they age. Age-related factors contribute to abdominal fat accumulation, and fat becomes metabolically active faster with age.
Another reason is muscle loss. Arms and legs become thinner with age, while you do not lose as much muscle in the abdomen, so the belly becomes more prominent by comparison.
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Many people dismiss pre-diabetes as “borderline”?
Pre-diabetes is a stage before diabetes. In India, we have shown that more than 60 percent of people with pre-diabetes will progress to diabetes without intervention, and they progress fast, within a 2 to 5-year period.
It is a wake-up call. Most people with pre-diabetes will have some weight and body fat to lose, so that should be the primary intervention, along with self-discipline. Once diabetes comes, it is harder. In pre-diabetes, it is easier to go back to normal. The goal should be not to progress, but to regress back to normal.
What numbers define pre-diabetes?
It depends on what you are looking at. If it is the HbA1c, or glycated haemoglobin, value, up to 5.6 is normal, 5.7 to 6.4 is pre-diabetes, and 6.5 and above is diabetes. But if you are looking at glucose values, then for fasting glucose, up to 100 to 110 is considered normal, depending on the definition used, and up to 125 is pre-diabetes.
This is called isolated fasting glucose. 126 and above is diabetes. For the two-hour glucose value, less than 140 is normal, 140 to 199 is pre-diabetes, and 200 and above is diabetes.
What if someone’s fasting results show normal within the range but HbA1c 5.7 or 5.8—should they be concerned?
If the HbA1c is high, they should do a GTT, because even if fasting is normal, the two-hour value after glucose may be high. An oral glucose tolerance test includes a fasting value and a two-hour value, and you need both to know where you stand.
If either is high, it needs earlier intervention because it can progress faster. If this has happened, see a specialist. They can guide the next steps. Do not ignore it.
So what are some of the silent signs the body is struggling with sugar even before you know your tests are turning up normal?
The challenge with high blood glucose is that it can stay silent. You may feel perfectly fine and then discover one day that your sugar is very high. If symptoms do appear, it usually means glucose has been elevated for a while.
The classic signs are frequent urination, excessive thirst and increased hunger, along with tiredness, unexplained weight loss, slow-healing wounds, itching, often in the genital area, and blurred vision. Symptoms can vary, but by the time they show up, the disease may already be advanced.
That is why screening matters, especially if you have a family history of diabetes or you are overweight. Start checking in your 20s. You can begin with the Indian Diabetes Risk Score, a simple non-invasive tool that uses four questions and your waist measurement to estimate risk.
If your risk is low, you can recheck in three years. If it is moderate or high, get tested to confirm where you stand and follow up annually.
For pre-diabetes, is walking enough? Is strength training non-negotiable? What works?
You need a combined approach: diet, physical activity and stress management if stress is a factor. The basic diet rule for both pre-diabetes and diabetes is this: keep carbohydrates to about 50 percent of total calories.
Many Asian Indians are closer to 70 percent, so the goal is to bring carbohydrates down and replace those calories with more protein. Protein typically sits around 12 percent but should rise to about 20 percent.
Keep fats around 20 to 25 percent and fibre around 5 to 6 percent. This balance can significantly improve control in both pre-diabetes and diabetes.
For activity, include both aerobic exercise and strength training. Aerobic exercise helps reduce fat, while strength training builds and protects muscle, and both matter for metabolic health. A general target is 60 minutes of walking, or any aerobic activity you enjoy, six days a week, plus strength training on two days.
One more important piece is sedentary time. Sitting for long stretches harms metabolic health, so try to break up every hour of sitting by standing or moving for a couple of minutes.
Does stress or sleep actually affect glucose levels?
Absolutely. Stress is one of the worst factors. It spikes your sugars, does not let them come under control and raises cortisol levels, which affects everything. It is not just glucose. It also affects blood pressure, eating patterns, fat gain and mental health.
Stress is a major killer, and working on it first, before anything else, makes it easier to manage the other factors. Sleep is also linked. When someone is stressed and overthinking, they do not sleep well. They are all connected, and stress requires attention.
What should schools and parents change first?
Lifestyle habits have to start early. Children’s taste and eating patterns are shaped young, so families should make healthy food the default at home. When the whole family eats better, it becomes routine and children carry it forward.
The second priority is physical activity. We need to build a culture where moving is normal, not optional. In schools, PT should not be the first class cut when exams come. Exercise supports both body and mind, and making it non-negotiable early has lasting benefits.
For people looking for realistic change, not quick fixes, what are two or three simple things we can do every day?
There is no one-size-fits-all fix, but a few daily habits make a real difference. Aim for an hour of movement and add 10 minutes of pranayama or breathing to manage stress. Choose whole foods more often than packaged foods.
When cravings hit, pick fruit or something natural. Also, cut down screen time and make space for real human connection every day. It supports both metabolic health and mental wellbeing.
(Edited by Dese Gowda).
