Updated Obesity Guidelines for Indians, Moving Beyond BMI: Study
A team of Indian doctors, including from All India Institute of Medical Sciences (AIIMS), Delhi, has in a new study redefined obesity for the Indian population. Findings are published in The Lancet Diabetes and Endocrinology.
Traditionally Body Mass Index (BMI) was used to define obesity, but the new approach focuses on abdominal obesity, comorbid diseases.
This new classification, which comes 15 years after the last definition, marks a significant step forward in addressing the unique health challenges posed by obesity in Asian Indians. The need for updated obesity guidelines stemmed from several critical factors such as the outdated BMI criteria, which relied exclusively on Body Mass Index (BMI, a ratio of weight in kg/height in meter square) for diagnosis; as well as emerging Health Data that showed a correlation between abdominal obesity in Asian Indians and the early onset of comorbid diseases.
According to the study, abdominal fat — closely linked to insulin resistance and prevalent in Asian Indians — is now a key factor in the diagnosis. The new definition also integrates the presence of comorbidities — such as diabetes and cardiovascular disease — into the diagnostic process, ensuring that obesity-related health risks are better accounted for, and taken care of in management. It also includes mechanical problems associated with obesity such as knee and hip osteoarthritis etc, or shortness of breath during daily activities, which produce a poor quality of life.
“A distinct definition of obesity for Indians is crucial for the early detection of related diseases and the development of targeted management strategies. This study fills critical gaps in our understanding and offers a clear, rational approach to tackling obesity in the Indian population,” said Dr. Naval Vikram, Professor of Medicine, at AIIMS, New Delhi.
The revised guidelines introduce a two-stage classification system, addressing both generalised and abdominal obesity. Stage 1 includes increased adiposity (BMI more than 23 kg/m²) without apparent effects on organ functions or routine daily activities. While this stage may not cause any pathological problems, it can progress to Stage 2, leading to other comorbidities.
Stage 2 is an advanced state of obesity with an increased BMI of more than 23 kg/2, and abdominal adiposity with excess waist circumference (WC) or waist-to-height ratio (W-HtR). It includes impact on physical and organ functions — knee arthritis due to excess weight, or presence of type 2 diabetes.
The study called for tailored weight reduction strategies, based on the above classification, to tackle obesity.
Reference: Definition and diagnostic criteria of clinical obesity, Rubino, Francesco et al. The Lancet Diabetes & Endocrinology, Volume 0, Issue 0
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