As India continues to grapple with rising obesity rates and related health challenges, these updated guidelines provide healthcare professionals with a more nuanced and effective framework for diagnosis and treatment, taking into account the unique characteristics of the Indian population.
Published Jan 19, 2025 | 7:00 AM ⚊ Updated Jan 19, 2025 | 7:00 AM
New guidelines redefine obesity classification in India. (Supplied)
In a significant update to India’s obesity guidelines after 15 years, medical experts have introduced a new two-stage classification system that eliminates the term “overweight” and focuses on abdominal fat distribution, particularly relevant for the Asian Indian population.
The revised guidelines, published in the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews, were developed by experts from the National Diabetes Obesity and Cholesterol Foundation (N-DOC), Fortis C-DOC Hospital, and the All India Institute of Medical Sciences (AIIMS).
This update aligns with recent findings from a Lancet report that emphasizes the importance of abdominal fat distribution in Asian populations.
“Obesity rates in India are rising at an alarming pace, extending beyond urban areas,” says Dr Anoop Misra, Padma Shri awardee and Executive Chairman and Director of Diabetes and Endocrinology at Fortis C-DOC Hospital.
“These guidelines are groundbreaking and easy to implement, providing stage-specific strategies for managing obesity-related conditions across India.”
The new classification system introduces two stages of obesity, both starting at a Body Mass Index (BMI) above 23 kg/m².
Stage 1: Termed “innocuous obesity,” refers to increased body fat without apparent effects on organ functions or daily activities. While this stage doesn’t immediately cause health issues, it can progress to more severe conditions if left unmanaged.
Stage 2: Termed “obesity with consequences,” is characterized by increased BMI above 23 kg/m², combined with abdominal adiposity and either mechanical conditions (such as knee arthritis) or obesity-related diseases (like type 2 diabetes).
Dr Naval Vikram, Professor of Medicine at AIIMS, New Delhi, emphasizes that “focus should be on abdominal fat when looking at treatment options, and obesity with clinical symptoms where organs are affected is more problematic.”
The update was necessary due to several factors, including the limitations of using BMI alone as a diagnostic tool and new research showing that Asian Indians experience more severe metabolic consequences from excess fat accumulation compared to Western populations.
Studies indicate that excess fat in Indian populations generates higher levels of inflammation and metabolic disturbance at lower BMI thresholds.
The guidelines outline specific management strategies for each stage. For Stage 1 obesity, recommendations focus on lifestyle interventions, including personalized nutrition plans, regular physical activity, and behavioural modifications.
Medication might be considered for those at risk of progressing to Stage 2 obesity or individuals with a BMI of 27.5 kg/m² or higher.
Stage 2 obesity requires more aggressive intervention, combining intensive lifestyle changes with pharmacological management. The treatment plan includes:
The study methodology involved a structured Delphi process conducted between October 2022 and June 2023, with five rounds of surveys completed by a diverse group of healthcare professionals, including physicians, surgeons, physiotherapists, and nutritionists.
This evolution in obesity definition and classification is particularly significant as India has seen obesity rates double over the past two decades, with abdominal obesity becoming increasingly prevalent.
Childhood obesity rates are also rising significantly across the country, accompanied by increases in related conditions such as diabetes, lipid disorders, fatty liver disease, and cardiovascular disease.
The new guidelines represent a departure from India’s 2009 standards, which relied solely on BMI criteria. The previous guidelines had defined overweight as BMI 23-24.9 kg/m² and obesity as >25 kg/m², already lower than Western standards of 25 and 30 kg/m² respectively.
“Moving beyond BMI-only approaches helps prevent both under- and over-diagnosis of obesity-related health risks,” the researchers note in their paper. “These new frameworks enable more precise, personalised treatment strategies that consider individual metabolic profiles and risk factors.”
As India continues to grapple with rising obesity rates and related health challenges, these updated guidelines provide healthcare professionals with a more nuanced and effective framework for diagnosis and treatment, taking into account the unique characteristics of the Indian population.
(Edited by Sumavarsha Kandula)
