Published Aug 06, 2026 | 7:00 AM ⚊ Updated Aug 06, 2026 | 7:00 AM
Representational image. Credit: iStock
Synopsis: A 25-year review finds abdominal obesity has emerged as the fastest-growing metabolic risk in urban India, outpacing diabetes, hypertension and general obesity. The story examines why Indians are uniquely vulnerable to belly fat, how it fuels metabolic disease, why BMI alone falls short, and the lifestyle and policy changes needed to reverse the trend.
For years, India’s conversation around metabolic disease has centred on diabetes, obesity and hypertension. Health camps test blood sugar. Doctors record blood pressure. Weight gets measured almost by reflex, a number on a scale that families track the way they track school marks or cricket scores.
Yet one measurement rarely makes it into routine conversation: the waist, even though it may offer the earliest warning of all.
A systematic review spanning 25 years now puts a number on that risk. The result is striking. Abdominal obesity has grown faster than every other metabolic condition tracked across urban India, climbing from 47 percent in the early 2000s to 72 percent by 2016-2020.
The review, led by researchers at the Madras Diabetes Research Foundation and Deakin University, pooled 57 community-based studies conducted across Indian cities between 2000 and 2025, making it one of the largest syntheses of metabolic disease trends the country has seen. It defines abdominal obesity as a waist circumference of at least 90 centimetres in men and 80 centimetres in women, thresholds developed specifically for Asian Indian populations.
During the same period, diabetes prevalence increased from 13 percent to 21 percent, hypertension from 29 percent to 31 percent, and general obesity from 24 percent to 36 percent. Abdominal obesity, however, rose through every time period analysed without a single decline.
The authors describe it as “the greatest escalating component of India’s urban metabolic burden,” warning that central obesity is emerging as one of the strongest drivers of future diabetes and cardiovascular disease.
For Dr V Mohan, Chairman of Dr Mohan’s Diabetes Specialities Centre and one of India’s leading diabetologists, and co-author of the review, the findings merely confirm what clinicians have been witnessing for years.
“Abdominal obesity is increasing very rapidly in our population,” he said to South First, noting that the trend mirrors findings from both the nationwide ICMR-INDIAB study and the Chennai Urban Rural Epidemiology Study (CURES).
The review answers what is happening. Understanding why, Dr Mohan says, requires looking beneath the skin.
Doctors have traditionally relied on body weight and Body Mass Index (BMI) to judge obesity. Increasingly, however, endocrinologists consider waist circumference a better window into metabolic health because it reflects fat surrounding internal organs rather than fat lying beneath the skin.
A person can appear slim, maintain a normal BMI and still carry enough visceral fat to develop insulin resistance, a phenomenon often described as the “thin-fat Indian.”
Waist circumference can begin changing years before diabetes is diagnosed. By the time blood sugar starts to rise, metabolic damage may already be underway, making waist size one of the earliest visible clues that something inside the body has changed.
Dr Mohan says the explanation begins with a biological difference between South Asians and Europeans. “We as Indians, and in fact South Asians in general, have less of what are called the small adipocytes, or small fat cells, on the abdominal wall,” Dr Mohan said.
Those fat cells act as the body’s first storage space for excess calories. “For the white European, they have a lot of these small adipocytes on the abdominal wall. They will first fill that up. It’s not going inside. It’s more like wearing an extra suit on your body,” he said.
Indians, however, reach that storage limit much sooner. “For us, it gets saturated very quickly and then gets into the abdomen.”
That fat does not simply settle beneath the skin. It surrounds the liver, pancreas, intestines and heart, where doctors call it visceral fat.
“First it goes to the liver,” Dr Mohan explained. “You get fatty liver. Then the liver becomes insulin resistant. The pancreas has to produce more insulin. Ultimately, the pancreas gets exhausted and diabetes develops.”
Nor does the damage stop there. “Fat should never be around the heart, around the blood vessels or in the liver. That’s ectopic fat,” he said. “It’s like having COVID all the time. There is constant inflammation.”
That persistent inflammation, he said, raises the risk of diabetes, heart disease, stroke and even some cancers. The progression is slow rather than sudden. Visceral fat accumulates silently over years, eventually leading to insulin resistance, prediabetes and diabetes, often before people realise anything is wrong.
The review echoes that clinical experience. Across all 57 studies, abdominal obesity was the only metabolic condition to rise consistently through every period examined, reinforcing the authors’ conclusion that it has become the defining feature of India’s urban metabolic transition.
Doctors are now seeing that progression begin much earlier in life. “We find even six-year-olds and eight-year-olds coming with the big paunch and abdomen because they are eating so much junk food,” Dr Mohan said.
Children today, he added, consume calorie-dense foods rich in sugar, refined carbohydrates and unhealthy fats while spending far less time outdoors than previous generations. “It’s a double whammy.”
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For Dr Mohan, today’s abdominal obesity epidemic did not begin with fast food chains, food delivery apps or desk jobs. Its origins lie decades earlier, in an India where food itself was scarce.
“The problem started because we had a lot of famine and undernutrition,” he said. Generations grew up with inadequate nutrition, shaping the way their bodies stored energy. Then came the Green Revolution, which transformed India’s food production. Wheat and rice became abundant. Starvation receded. But human biology, Dr Mohan argues, did not adapt as quickly as the country’s economy.
The next turning point arrived in 1991.
“When liberalisation came, suddenly everybody started making money,” Dr Mohan said. “Everybody bought a car. Before that people were walking and cycling. Suddenly nobody was walking.”
Economic growth brought more than higher incomes. Processed foods became widely available, occupations became increasingly sedentary, and later the information technology boom pushed millions into long hours of sitting, irregular sleep and round-the-clock work schedules.
“The IT revolution came. People started working night shifts because of the United States. Sleep became disturbed. Circadian rhythm became disturbed,” he said.
Rather than viewing these as isolated events, Dr Mohan sees them as links in the same chain.
“The price that we pay for affluence, for getting richer, is diabetes, obesity and so on.”
“The pronounced rise after 2010 aligns with India’s nutrition and lifestyle transition following economic liberalisation,” the authors write, arguing that refined cereals, ultra-processed foods and increasingly sedentary occupations have reshaped urban lifestyles. They cite national dietary data linking cereal-heavy, low-protein diets to a 14 percent to 30 percent higher risk of diabetes and obesity.
Dr Mohan believes biology compounds these lifestyle changes.
He points to repeated marriages within extended families, still practised in parts of South India, as one factor that may concentrate metabolic risk genes over generations.
“In the same family, when you marry for generations, what’ll happen?” he said. “Diabetic gene, diabetic gene, multiplied diabetic gene.”
That inherited tendency, he argues, intersects with what researchers describe as the “thin-fat” phenotype. Mothers who experienced chronic undernutrition gave birth to smaller babies that were nevertheless predisposed to storing fat around the abdomen. When those children later grew up in an era of food abundance, the weight they gained accumulated centrally rather than evenly across the body.
Together, Dr Mohan says, genetics, early-life nutrition, urbanisation and economic growth have accelerated India’s diabetes burden.
“That is why we are called the diabetes capital of the world.”
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The review found one group experiencing an even sharper rise than the overall population: women.
Female abdominal obesity increased from 49 percent in the early 2000s to 86 percent by 2016-2020. Among men, the increase was from 28 percent to 52 percent.
“The numbers tell only part of the story,” Dr Mohan said, arguing that biology and social circumstances reinforce one another throughout a woman’s life.
He identifies three turning points.
The first is puberty.
“After puberty, girls are often not allowed to go out and play the way boys do,” he said, reducing opportunities for physical activity during adolescence.
The second is pregnancy.
Families, he said, commonly encourage expectant mothers to “eat for two,” resulting in weight gain well beyond the recommended eight to 12 kilograms. Once the baby arrives, regular exercise becomes difficult.
“The baby takes all the time. Sleep is disturbed. The mother doesn’t have time to look after herself.”
Then comes menopause.
“When oestrogen falls, weight automatically starts increasing,” Dr Mohan said.
Social expectations often amplify these biological changes, he added. Women frequently have less time for leisure or exercise because of caregiving responsibilities, while household eating patterns may prioritise better portions for the family’s earning members.
Dr Mohan believes routine health check-ups continue to rely too heavily on Body Mass Index, despite its limitations.
“One person may be a boxer or an athlete with a very high BMI because of muscle,” he said. “Another person may have exactly the same BMI but very little muscle and a lot of abdominal fat.”
Although both individuals receive the same BMI score, their metabolic risk can be dramatically different.
Waist circumference avoids that confusion because, unlike body weight, it directly reflects fat accumulating around internal organs rather than muscle.
“If you measure the waist, there’s no muscle there,” Dr Mohan said. “Only fat or fluid can increase it.”
That, he argues, makes a measuring tape one of the simplest tools available for identifying people at risk long before diabetes develops.
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If decades of changing diets, lifestyles and biology helped create India’s abdominal obesity epidemic, can a new generation of weight-loss medicines reverse it?
Dr Mohan believes the answer is yes, but only to a point.
Drugs such as semaglutide and tirzepatide, now approved for treating obesity and type 2 diabetes, have transformed obesity management over the past few years. Unlike older therapies that produced modest weight loss, these medicines directly target appetite regulation and help reduce visceral fat, the type of fat wrapped around internal organs.
“They’re excellent drugs,” Dr Mohan said. “They reduce abdominal obesity, they reduce liver fat, and they reduce complications.”
But he is equally quick to caution against viewing them as a miracle cure.
“The moment you stop the drug, the weight comes back,” he said. “So people have to understand that this is not something you take for three months and then forget about.”
Cost remains another major hurdle. Although generic versions have begun entering the Indian market and prices are gradually falling, long-term treatment continues to remain beyond the reach of many patients.
Dr Mohan also warns against the growing trend of obesity medicines being prescribed outside specialist care.
“These are not drugs that gym trainers or dietitians should be prescribing,” he said. “They should be prescribed only under medical supervision.”
Like every medicine, he added, GLP-1 therapies carry side effects. Most are mild, including nausea, vomiting and digestive discomfort during the first few weeks, but rare complications such as pancreatitis and optic neuropathy have also been reported.
“The benefits are tremendous,” Dr Mohan said. “But they have to be used properly.”
While medicines can help individuals already living with obesity, Dr Mohan argues they cannot solve a problem created by the environments people live in.
“You can’t expect one doctor to solve this problem,” he said.
He believes Indian cities themselves need to become healthier. That begins with something as basic as making walking possible.
“We need proper footpaths. We need parks where people can walk safely. We need public gyms.”
Food policy matters just as much, he argues. For many Indian families, calorie-dense staples remain far cheaper than healthier alternatives.
“If fruits and vegetables are expensive and rice or wheat is cheap, what will people eat?” he asked. “Healthy food has to become affordable.”
Schools also have a role to play.
According to Dr Mohan, physical activity has steadily lost ground to academic pressure.
“Every school should have compulsory physical activity,” he said. “Children cannot just study all day.”
The review reaches much the same conclusion.
The authors argue that “behaviour-focused approaches alone have limited impact” when food systems, urban design and environmental conditions continue to reinforce unhealthy lifestyles.
Instead, they call for coordinated action across healthcare, city planning, nutrition policy and environmental regulation, warning that “without such coordinated efforts, urban areas are likely to remain the focal point of India’s expanding NCD burden.”
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For all the discussion about genetics, urbanisation and new medicines, Dr Mohan’s advice to ordinary people is remarkably simple.
He believes every household should own not only a weighing scale, but also a measuring tape.
“The measuring tape is one of the simplest tests,” he said. “If your waist is above 90 centimetres if you’re a man, or above 80 centimetres if you’re a woman, don’t ignore it.”
For decades, India has measured metabolic health largely through blood sugar, blood pressure and body weight. The evidence from this review, together with what clinicians such as Dr Mohan are seeing every day, suggests another measurement deserves equal attention.
In a country that has spent decades measuring blood sugar, it may finally be time to start measuring waistlines.
