metaboliq
Ramesh is 46 and keeps the accounts for a hardware wholesaler in Lucknow. Since his daughter's wedding he has lost the same eight kilos three times and regained them each time. His waist now measures 104 cm, the office stairs hurt his knees, and his last fasting sugar was 112. At home they tell him to try harder. Ramesh is a composite of many Indian men, not a real patient.
Yes, obesity is a disease. The WHO has called it a chronic disease since 2000. A 2025 Lancet definition adds a sharper test, useful for someone like Ramesh. It asks whether the extra fat is already harming his body or only raising his risk.
Is obesity a disease or a lifestyle problem?
In most Indian homes weight is still discussed as a matter of willpower. The medical view changed a long time ago. A WHO expert report published in 2000 described obesity as a chronic disease needing lifelong prevention and care. The same report set out the BMI classes still used worldwide, with obesity starting at 30 and the severe range at 40.
The American Medical Association voted to call obesity a disease in 2013, after years of debate among its own members. Researchers who followed the next few years found the public slow to accept the label. Over the same period, access to care widened, people with obesity faced less blame, and more research was funded.
Lifestyle is part of most chronic diseases. Salt affects blood pressure and sugar affects type 2 diabetes, and both are still treated as diseases. With obesity, food, sleep and activity act on appetite, fat storage and genes that differ from person to person, which is why the same diet works so differently in two people.
What are clinical and preclinical obesity?
In January 2025 a Lancet commission of 58 experts, led by Francesco Rubino, offered a sharper way to sort this out. Indian endocrinologist Anoop Misra sat on it, and so did people living with obesity. Their starting point was simple: two people with the same BMI can be in very different health.
So they split obesity in two. Clinical obesity is a chronic illness in which extra fat is already changing how organs or the whole body work, and it can lead to heart attack, stroke and kidney failure. Breathlessness from the weight on the chest, or knee and hip pain that limits walking, are typical signs.
Preclinical obesity is extra fat with the organs still coping. The commission did not call it an illness, but it raises the risk of type 2 diabetes, heart disease, some cancers and, in time, clinical obesity.
Ramesh's knees already stop him taking the stairs at the office, which would put him on the clinical side once a doctor confirms the cause. His neighbour, with the same BMI and normal knees, sugar and liver, would sit on the preclinical side. Both still need a waist measurement, because the commission said BMI alone should not be used to diagnose anyone.
Sources: [3]
Why do doctors call obesity a disease?
Body weight is strongly inherited. A Cambridge review of 88 twin studies put the heritability of BMI at between 58% and 87% in most of them. It is also why siblings in one Indian household can differ by 20 kg on the same rice and dal.
The body also resists losing weight. In a Melbourne study led by Priya Sumithran, 50 adults lost an average of 13.5 kg over ten weeks on a very low calorie plan. A year later, their levels of leptin and other appetite hormones had still not returned to where they began, and they reported more hunger than before the diet. Ramesh's three rounds of loss and regain look a lot like that.
Stored fat causes measurable harm. Fat around the liver and inside the abdomen raises insulin resistance, blood pressure and triglycerides. Extra weight wears down knee cartilage and narrows the airway during sleep. A blood test, an ultrasound or a sleep study can show each of these, which is how doctors usually decide that something counts as a disease.
Is obesity a disease in India?
Indian doctors increasingly say yes, though there is no single government notification declaring it. In 2023 Sanjay Kalra and colleagues, writing for Indian endocrinologists, called for obesity to be recognised as a chronic disease with timely screening and treatment. Citing the National Family Health Survey of 2019–21, they put the figure at about one in four Indians.
India also draws the line lower than the West. A 2009 consensus led by Anoop Misra set overweight for Asian Indians at a BMI of 23 and obesity at 25, against 25 and 30 elsewhere. The reason is that Indians carry more fat, and more of it inside the abdomen, at the same body weight.
Waist size shows the scale of it. Analysing the same family health survey, Chaudhary and Sharma found abdominal obesity in 40% of Indian women and 12% of men. Among women in their thirties and forties, five or six in every ten had a waist above the cut-off.
What changes when obesity is treated as a disease?
The questions at the clinic change. A doctor working from the disease model asks what the weight is doing to the liver, blood sugar, blood pressure, sleep and joints, and records numbers that can be checked again in three months. For Ramesh that means a fasting sugar, a liver panel, a waist reading and a note about his knees. Metaboliq's doctor-led plans start from this kind of home blood test and review. They aim to help people lose up to 20% of body weight while keeping muscle, and the numbers are rechecked as the weight falls.
The way people are spoken to changes too. A 2020 international consensus statement in Nature Medicine found that weight stigma harms health and keeps people away from doctors. Patients who feel judged at the clinic tend to skip follow-up, which is when most of the useful work happens.
The label has a known downside. In 2014, experiments by Crystal Hoyt's team found that reading 'obesity is a disease' left some people with obesity less worried about their weight, and they chose higher-calorie food afterwards. Doctors therefore pair the diagnosis with a concrete plan and a date for the next check.
Does BMI decide whether obesity is a disease?
BMI is a quick screen, not a verdict. It cannot tell muscle from fat, and it says nothing about where the fat sits. A kabaddi player and a bank clerk of the same height and weight get the same BMI, though their bodies are built very differently.
Indians show the other side of the problem. Many people here have a normal BMI and a waist above 80 cm for women or 90 cm for men, the cut-offs in the 2009 Indian consensus. Doctors sometimes call this thin-fat. The fat is inside the abdomen, around the liver and pancreas, where it does the most metabolic harm.
That is why the 2025 commission asked doctors to confirm excess fat with a waist measurement or a body fat reading, and to judge the disease by what it is doing to the body. A tape measure costs almost nothing and takes ten seconds. Measure midway between the lowest rib and the top of the hip bone, after a normal breath out, with the tape snug but not tight.
Which diseases does obesity lead to?
The list is long because fat affects nearly every system. The Lancet commission names type 2 diabetes, heart disease, stroke, kidney failure, some cancers and mental health disorders among the risks. Fatty liver, sleep apnoea, knee osteoarthritis, PCOS and infertility are common in Indian clinics too.
Many of these improve as weight comes down, especially fat around the abdomen. That is one reason doctors now track waist, liver enzymes, sugar and blood pressure alongside the scale. The full list, with how each one is checked, is on the obesity guide under Read next.
Sources: [3]
How is obesity treated as a chronic disease?
Treatment is planned in years, the way diabetes care is. The 2009 Indian consensus led by Anoop Misra set out the usual order. Diet and physical activity come first for everyone, medical treatment follows for those who do not respond, and bariatric surgery is for severe obesity with complications. Indian thresholds for each step sit lower than Western ones, because risk rises at a lower BMI here.
Diet in practice means a modest daily calorie gap built on Indian food, with protein at each meal and fewer refined carbohydrates. Activity means daily walking plus strength work two or three times a week, which helps keep muscle while fat comes off. Sleep and stress get attention too, since both change appetite.
Follow-up is where most programmes succeed or fail. After a loss, appetite hormones keep pushing for regain for a year or more, so a doctor checks weight, waist and blood results every few months. For Ramesh, that schedule is the difference between a fourth round of regain and a loss that holds.