Overview#
Obesity is a chronic disease characterised by excessive body fat accumulation that impairs health. India is experiencing a rapid rise in obesity, with NFHS-5 showing that 24 % of women and 22.9 % of men are now overweight or obese. Crucially, Indians develop metabolic complications at lower BMI and waist circumference than Western populations due to higher visceral (abdominal) fat. The WHO Asia-Pacific guidelines therefore use lower cut-offs: BMI ≥ 23 is overweight and ≥ 25 is obese for South Asians, compared to 25 and 30 for Western populations.
Causes & Risk Factors#
- Energy imbalance – consuming more calories than the body expends; driven by increased availability of cheap, calorie-dense processed foods.
- Sedentary lifestyle – desk jobs, screen time, and motorised transport have dramatically reduced physical activity.
- Indian dietary patterns – large portions of white rice, excess refined oil in cooking, frequent consumption of mithai, namkeens, and sugar-sweetened beverages.
- Genetic predisposition – South Asians have higher propensity for abdominal fat deposition and insulin resistance.
- Stress, poor sleep, and hormonal factors – cortisol elevation, PCOS, hypothyroidism, and certain medications (steroids, antidepressants) contribute.
Signs & Symptoms#
- Elevated BMI (≥ 23 overweight, ≥ 25 obese for Indians)
- Increased waist circumference (> 90 cm men, > 80 cm women for Indians)
- Breathlessness on mild exertion
- Joint pain (knees, lower back) from excess weight
- Excessive sweating and heat intolerance
- Snoring and sleep apnea
- Skin changes – stretch marks, acanthosis nigricans (dark skin patches)
- Fatigue and reduced stamina
Diagnosis#
Obesity is diagnosed clinically:
- BMI (Body Mass Index) – weight (kg) / height (m²). For Indians: 18.5-22.9 normal, 23-24.9 overweight, ≥ 25 obese (ICMR criteria).
- Waist circumference – measured at the midpoint between the lowest rib and the iliac crest. > 90 cm (men) and > 80 cm (women) indicates central obesity.
- Waist-to-Hip Ratio – > 0.90 (men) and > 0.85 (women) indicates abdominal obesity.
- Metabolic screening: Fasting glucose, HbA1c, lipid profile, thyroid profile, and liver function test. Book Health Checkup
- Body composition analysis – DEXA scan or bioelectrical impedance for precise fat measurement.
Treatment Options#
Lifestyle modification (cornerstone):
- Caloric deficit – reduce daily intake by 500-750 kcal for sustainable weight loss of 0.5-1 kg/week.
- Indian diet approach: Reduce portion sizes (especially rice and roti), increase vegetables to half the plate, choose protein-rich dal/paneer/eggs, avoid sugary drinks and fruit juices, minimise refined oils and fried items.
- Exercise: 300 minutes/week of moderate-intensity activity for weight loss (vs 150 for maintenance). Include both aerobic (walking, cycling) and resistance training (weight training, bodyweight exercises).
- Behavioural strategies: Mindful eating, regular meal times, adequate sleep (7-8 hours), stress management.
Medications (for BMI ≥ 27 with comorbidities or BMI ≥ 30):
- Orlistat – reduces fat absorption by 30 %.
- GLP-1 receptor agonists (liraglutide, semaglutide) – produce 10-15 % weight loss; increasingly available in India.
- Combination therapies under specialist guidance.
Bariatric surgery (for BMI ≥ 32.5 with comorbidities in Indians):
- Sleeve gastrectomy and Roux-en-Y gastric bypass are the most common procedures in India.
- Produces 20-30 % sustained weight loss and can reverse Type 2 diabetes in many patients.
Prevention#
- Adopt the Indian-plate method at every meal: half plate vegetables, quarter plate whole grain, quarter plate protein.
- Walk at least 10,000 steps daily – use a pedometer or smartphone app to track.
- Limit screen time for children to < 2 hours/day and encourage outdoor play.
- Avoid sugary beverages – one regular soft drink daily adds 6-7 kg of weight per year.
- Cook at home using less oil; choose steaming, grilling, or pressure-cooking over deep frying.
When to See a Doctor#
Consult a doctor or endocrinologist if your BMI is above 25 (Indian cut-off), if you have difficulty losing weight despite lifestyle changes, or if you have obesity-related conditions (diabetes, sleep apnea, joint problems, fatty liver). Seek specialist referral for bariatric surgery evaluation if BMI ≥ 32.5 with comorbidities or BMI ≥ 37.5 without.