Indian Doctors Introduce Updated Obesity Framework After 15 Years

For decades, body mass index (BMI) has served as a standard tool for measuring obesity, defined as a person's weight in kilograms divided by the square of their height in meters. A BMI over 30 has typically indicated obesity. However, this measurement often fails to capture the complexity of individual health risks, especially in populations with unique genetic and lifestyle factors.

Recognizing these limitations, leading Indian experts have introduced updated obesity guidelines tailored specifically to the Indian population. This landmark study, published in The Lancet Diabetes and Endocrinology on Wednesday, reflects the culmination of 15 years of research and collaboration among specialists in medicine, surgery, physiotherapy, and nutrition.

The guidelines were developed by professionals from institutions including the National Diabetes Obesity and Cholesterol Foundation (N-DOC), Fortis C-DOC Hospital, and the All India Institute of Medical Sciences (AIIMS). Dr. Naval Vikram of AIIMS highlighted the importance of the new framework, stating, “This study provides a targeted approach to address obesity and its associated health risks among Indians.”

Traditional BMI-based classifications often overlook critical factors, such as excess body fat that does not meet the BMI threshold for obesity. This can result in underdiagnosed health risks. The new guidelines shift the focus to abdominal fat and its role in chronic diseases, a key concern for Indians.

The updated framework redefines obesity as a condition that directly impacts organ and tissue function due to excessive fat accumulation. This definition aligns with the understanding of obesity as a chronic disease rather than merely a warning sign for other health issues.

Key elements of the new classification include:

1. Stage 1 Obesity: Defined as a BMI over 23 kg/m² without immediate effects on organ function or daily activities. This stage, referred to as "innocuous obesity," poses a risk of progression to more severe health issues if left unmanaged.

2. Stage 2 Obesity: Characterized by a BMI exceeding 23 kg/m², coupled with abdominal adiposity or elevated waist circumference. This stage is associated with mechanical issues, such as joint pain, and metabolic conditions, including type 2 diabetes.

Several factors prompted the development of these guidelines:

- Limitations of BMI: BMI alone is insufficient to diagnose obesity accurately, especially in populations with diverse body compositions, such as Indians.

- Abdominal Fat: Research highlights a strong link between abdominal fat, inflammation, and early onset of chronic diseases in Indians.

- Clarified Risks: The updated guidelines distinguish between obesity that poses immediate health risks and cases that are less harmful.

The guidelines were created using the Delphi method, a structured process for building expert consensus. Surveys conducted between October 2022 and June 2023 informed the recommendations. Dr. Anoop Misra of Fortis Hospital noted that the new approach simplifies diagnosis and allows for timely interventions to prevent obesity-related complications.

India faces a growing obesity crisis, with rising rates of diabetes, heart disease, and other related conditions. The updated guidelines aim to curb this trend by providing a clear, practical framework for healthcare providers.