metaboliq
What obesity means, and why India draws the line at 25
Obesity means carrying enough body fat to harm your health. Worldwide, an adult BMI of 30 marks it.
Sources: [1], [2], [3], [4], [5]
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Indian doctors use 25, and call 23 to 24.9 overweight, because at the same weight an Indian body tends to hold more fat and less muscle than a European one.
The global cut-offs belong to the World Health Organization: 25 for overweight, 30 for obesity. When a WHO expert group went through the Asian studies in 2004, it found diabetes and heart disease climbing at lower BMIs in many Asian populations, from somewhere between 22 and 25 upwards. It left the international lines in place and offered extra action points, 23 and 27.5 among them, for countries that wanted to use them.
India took them up. In 2009 a group led by Dr Anoop Misra, writing for the Association of Physicians of India, fixed the adult bands that most Indian clinics and labs still print: 18 to 22.9 normal, 23 to 24.9 overweight, 25 and above obesity. The reasoning has a well-known illustration. In a 2004 letter to The Lancet, Chittaranjan Yajnik of KEM Hospital in Pune and John Yudkin compared two men with identical BMIs, one Indian and one British. The Indian man had far more fat on him and much less lean tissue.
In practice a BMI of 26, which an app built for Americans will happily call overweight, counts as obesity on an Indian report. If that is your number, the sensible next move is a tape measure and a blood test. You may also meet the code E66 on a discharge summary or an insurance form; it is where the WHO's disease classification files obesity.
| Overweight from | Obesity from | |
|---|---|---|
| 155 cm tall | 55.3 kg | 60.1 kg |
| 165 cm tall | 62.6 kg | 68.1 kg |
| 175 cm tall | 70.4 kg | 76.6 kg |
- 25Obesity line for Indian adults
- 30Obesity line, WHO worldwide
How common is obesity in India?
Common enough that most Indian families have someone with it.
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The ICMR-INDIAB study, which measured 113,043 adults in 31 states and union territories, found obesity by BMI in 28.6% of adults and obesity around the waist in 39.5%.
Its teams spent twelve years collecting that data, from 2008 to 2020, and published it in The Lancet Diabetes & Endocrinology in 2023. Because they used the Asian cut-offs, the figures run higher than older surveys that put the line at 30. The same adults were checked for what usually comes along with weight, and 11.4% had diabetes, 15.3% prediabetes and 35.5% high blood pressure, each of them more often in towns and cities than in villages, prediabetes apart.
Worldwide, the WHO counted 1.1 billion people living with obesity in 2024, about one in seven, and adult obesity has more than doubled since 1990. The World Obesity Federation uses World Obesity Day, every 4 March, to keep that curve in front of governments.
The waist number deserves a second look. More Indian adults carry abdominal obesity than obesity by BMI, so a good share of people whose weight seems unremarkable still carry the fat that drives insulin resistance and fatty liver.
- 1 in 7People worldwide, 2024
Belly fat: why your waist says more than the scale
Abdominal obesity, also called central or truncal obesity, is fat packed around the organs rather than under the skin of the hips and thighs.
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Measure your waist at the navel. For an Indian man, 90 cm or more is the warning line; for a woman, 80 cm or more.
Fat inside the abdomen sits beside the liver and empties into it, so a large waist tends to arrive with fatty liver, high triglycerides and creeping blood sugar. That is why the 2009 Indian consensus drew its waist lines lower than the Western ones.
If you would rather remember one number than two, use a ratio. A 2012 review pooling studies of more than 300,000 adults found that waist-to-height ratio did better than BMI at picking out diabetes, high blood pressure and heart risk. Keep your waist under half your height: at 165 cm tall, that is under 82.5 cm, measured at the navel after a normal breath out.
Families in India often know this shape without a name for it: thin arms and legs, a soft middle, and a prediabetes result at 35 that surprised everyone because weight was never a problem. The scale can sit still for years while the waist grows.
| Keep the waist under | |
|---|---|
| 155 cm tall | 77.5 cm |
| 165 cm tall | 82.5 cm |
| 175 cm tall | 87.5 cm |
Symptoms of obesity, and the signs to take seriously
Early obesity rarely announces itself.
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Most people first notice what it does: the stairs to a second-floor flat leave them puffing, a spouse complains about the snoring, or the knees start to ache halfway through the evening walk.
Doctors now count those changes as part of the diagnosis. In 2025 a global commission writing in The Lancet Diabetes & Endocrinology described clinical obesity as the point where body fat is already changing how organs work, or what a person can manage in a day. Its examples would be familiar to most Indian families: getting breathless, a hip or knee that cuts walks short, sleep apnoea, a blood pressure reading the doctor frowns at.
The most serious breathing problem tied to weight has a long name, obesity hypoventilation syndrome. Extra weight on the chest and changes in how the brain drives breathing let carbon dioxide build up, mostly at night. About 0.4% of adults have it, almost all with a BMI over 30 and disturbed breathing during sleep. A blood gas test and a sleep study confirm it, and a CPAP or similar machine at night eases the symptoms.
Other signs are easy to blame on something else. Periods that come later each month, dark velvety skin at the back of the neck, or a tiredness a full night's sleep does not touch can travel with excess weight, and they can just as well come from a thyroid problem or high sugar. A waist reading, a blood pressure check and a blood panel usually settle which.
- Breathless on one flight of stairs
- Loud snoring, sleepy all day
- Dark velvety skin on the neck
- Knee pain that shortens walks
- 0.4%Adults with obesity hypoventilation
Clinical and preclinical obesity: the new way doctors define it
In January 2025 a Lancet commission argued that BMI on its own should no longer be enough to diagnose obesity.
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A doctor should first confirm the extra fat, with a tape measure or a body-fat scan, and then ask whether it is already harming an organ or getting in the way of daily life.
It gave the two situations different names. With preclinical obesity there is extra fat but every organ still works normally, a risk you would want to bring down though not yet an illness. With clinical obesity the fat is already doing damage, through raised sugar, an inflamed liver, joints that limit movement or shortness of breath, and the commission wants it treated as a long-term illness in its own right.
Picture two colleagues in a Bengaluru office. One has a BMI of 24, a 98 cm waist and a fatty liver on his last scan. The other plays kabaddi at weekends, has a BMI of 31 and clean blood results. BMI alone would worry about the second man; the new definition worries about the first.
The World Obesity Federation came to a similar view in 2017 when it called obesity a chronic, relapsing disease process. Swollen fat cells, and fat parked inside organs, release hormones and inflammatory signals that wear down the arteries, heart, liver and pancreas over years.
| Preclinical | Clinical | |
|---|---|---|
| Body fat | Above healthy | Above healthy |
| Organs | Working normally | Already affected |
| Daily life | Unchanged | Limited |
| The plan | Reduce the risk | Treat as an illness |
What causes obesity?
Obesity builds over a long run of taking in more energy than the body uses, shaped by genes, sleep, stress, work hours and the food around you.
Sources: [10], [11], [12], [13], [14]
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A smaller group of people have a medical cause, such as an underactive thyroid, PCOS or too much cortisol.
The World Obesity Federation's 2017 statement names food as the main driver, energy-dense food and sugary drinks above all, working on bodies whose genes make some people store fat much more readily than others. In plenty of Indian homes that looks like maida and white rice at most meals, pakoras with the evening tea, sweet chai four times a day, and portions sized for a day in the fields eaten at a desk.
Once the weight is on, the body defends it. In a 2011 study in the New England Journal, 50 people who lost an average of 13.5 kg on a very-low-energy diet still had less leptin, the hormone that signals fullness, and more ghrelin, a hunger hormone, a full year later, and they said they felt hungrier. Willpower runs out against that, and regain says more about biology than about character.
A few hormone conditions push the same way. An underactive thyroid adds a modest amount. Polycystic ovary syndrome tends to gather weight at the waist. Cushing's syndrome, which is rare, lays fat down on the face, the upper back and the trunk. Each has its own blood test, and finding them is an endocrinologist's job.
Diseases linked to obesity
Obesity raises the risk of a long list of other conditions. The strongest link is with type 2 diabetes.
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High blood pressure, heart disease, gallstones, knee arthritis, back pain, asthma and several cancers are on the list too, and fatty liver travels with fat stored around the organs.
The figures come from a 2009 review of 89 long-term studies in BMC Public Health, which checked 18 conditions and found obesity tied to almost all of them. Women with obesity were about 12 times as likely to develop type 2 diabetes as women of healthy weight, and being overweight, short of obesity, nearly quadrupled the risk. Several cancers, heart disease, asthma, gallbladder disease, osteoarthritis and chronic back pain were on the list as well.
Indian data shows the same thing from another side. In ICMR-INDIAB, 35.5% of adults had high blood pressure, and 81.2% of those whose cholesterol was measured had at least one abnormal value. Most families can name a relative carrying two or three of these at once, usually alongside a waist that grew in their thirties.
- 18Conditions checked in one review
Treatment of obesity: what works, in order
Start by measuring: the waist, the blood pressure and a blood panel.
Sources: [16], [17], [18], [19]
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The rest of the plan follows from those, usually food you can keep eating for years, more protein than most Indian plates carry, movement with some strength work in it, and better sleep. For some people a doctor adds GLP-1 treatment or suggests bariatric surgery.
Even a modest loss shows up on the next report. Look AHEAD followed 5,145 adults with type 2 diabetes, and those who lost 5 to under 10% of their weight in the first year were about three and a half times as likely to bring HbA1c down by half a point as those whose weight did not move. Their blood pressure, triglycerides and good cholesterol improved with it.
It works upstream of diabetes too. The US Diabetes Prevention Program asked people with raised sugar to aim for 7% weight loss and 150 minutes of activity a week, and new cases of diabetes fell by 58% over about three years. Britain's DiRECT trial, run through ordinary family practices, found recently diagnosed type 2 diabetes in remission a year later in 46% of the people on its programme.
Sleep apnoea and an inflamed fatty liver are harder. A 2017 review put the loss they usually need at 10 to 15%, against much smaller amounts for sugar and triglycerides, and that is the range where GLP-1 treatment and bariatric surgery come into the conversation. At Metaboliq that conversation starts with a home blood test and a doctor's review, and the doctor decides whether GLP-1 treatment has a place, alongside food and strength work that protect muscle.
- Step 1Measure
Waist, BP, blood panel.
- Step 2Eat
Protein at every meal.
- Step 3Move
Strength work, twice a week.
- Step 4Review
A doctor adjusts the plan.
| People were asked for | What changed | |
|---|---|---|
| Look AHEAD | 5 to 10% off in year 1 | 3.5x likelier to cut HbA1c |
| DPP | 7% off, 150 min a week | 58% fewer new diabetes cases |
| DiRECT | A GP-run programme | 46% in remission at 1 year |
Why weight comes back, and how to keep your muscle
The second year is where most diets come undone.
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Hunger hormones stay shifted for a year or more after a loss, and a crash diet takes muscle along with the fat, so the body burns less and the weight finds its way back.
Too much fat with too little muscle has a name, sarcopenic obesity, which the European clinical nutrition and obesity societies (ESPEN and EASO) defined in 2022 as excess body fat together with low muscle mass or weak muscles. It leaves people worse off than either problem alone, and years of crash diets followed by regain are one way into it.
Keeping muscle is unglamorous. Protein goes on the plate at every meal, dal, paneer, curd, eggs, soya or chicken, whatever your kitchen cooks. Two or three short strength sessions a week are enough to start, chair squats and a resistance band in front of the evening news included. The pace should be one you could hold for months. And once a month, measure: if the waist is shrinking and you still get up from a low chair without pushing on your knees, the weight coming off is mostly fat.
If a report has ever flagged your kidneys or your sugar, have your blood checked before raising protein or lifting heavier, because both depend on those numbers. Metaboliq builds that check into the start of every plan, a home panel read by a registered doctor, since its aim is to lose up to 20% of your body weight — and keep your muscle.
- Step 1Book
Two minutes, on your phone.
- Step 2Home test
45+ markers, collected at home.
- Step 3Doctor
Reads every marker with you.
- Step 4Your plan
Built from your own results.
Childhood obesity: what parents can do
In children, obesity is judged on BMI-for-age charts rather than adult cut-offs, because a healthy BMI changes as a child grows.
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The Endocrine Society advises treating it as a family project, where the whole household eats and moves differently, rather than putting one child on a diet.
Its 2017 guideline asks doctors to check children with obesity for problems that can start early: prediabetes, high blood pressure, raised cholesterol, fatty liver and, in girls, signs of PCOS. It also advises against routine hormone tests unless a child is short for their age or growing slowly, because true hormone causes are uncommon in children who are growing well.
At home that tends to mean water and milk in place of cold drinks, fewer packets of namkeen in the cupboard, meals at regular times eaten together, and active play every day. In a lot of Indian homes love arrives as extra ghee and a second laddoo, so the grandparents usually need to be part of the conversation.
- Water and milk, not sugary drinks
- Meals at set times, together
- Active play every day
- Grandparents in on the plan
When to see a doctor, and which one
See a doctor if your BMI is 25 or more with a large waist, if your weight has climbed fast for no clear reason, or if you already have raised sugar, blood pressure or fatty liver.
Sources: [12], [13], [14], [22]
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A physician can start; an endocrinologist is the specialist for hormone causes.
An endocrinologist is worth the trip when the story does not add up: several kilos gained in a few months with no change in eating, purple stretch marks and easy bruising, irregular periods with acne or facial hair, or weight that will not move after months of honest effort. Those can point to Cushing's syndrome, PCOS or thyroid disease, each with its own tests.
Thyroid is the one people ask about most. A survey of 5,360 adults in eight Indian cities found hypothyroidism in about 1 in 9, and roughly a third of them had no idea. An underactive thyroid usually adds only a modest amount of weight, though, and plenty of people with obesity have a perfectly normal TSH, so the search often continues past that result.
If you are unsure where to begin, begin with the blood. A panel covering thyroid, sugar, liver and cholesterol, read by a physician, shows whether you need a specialist at all, and which one.
45+ markers, one home blood test
- HbA1c
- Thyroid test
- Fasting insulin
- HOMA-IR
- Fasting blood sugar
- Lipid profile
- Liver function test
- Kidney function test
Every source, in full (23)
[1] World Health Organization. Obesity and overweight (fact sheet)
World Health Organization, 2025. In 2024, 1 in 7 people in the world (1.1 billion) were living with obesity; adult obesity has more than doubled since 1990. For adults, overweight is a BMI of 25 or more and obesity a BMI of 30 or more; children are judged on BMI-for-age.
Read the source[2] WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies
The Lancet, 2004. Many Asian populations carry a high risk of type 2 diabetes and heart disease below a BMI of 25, with observed risk starting between 22 and 25; it kept the international cut-offs and proposed action points at 23, 27.5, 32.5 and 37.5.
Read the source[3] Misra A, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management
Journal of the Association of Physicians of India, 2009. Set the Indian adult bands: BMI 18.0-22.9 normal, 23.0-24.9 overweight and 25 or more obesity, with abdominal obesity at a waist of 90 cm or more in men and 80 cm or more in women.
Read the source[4] Yajnik CS, Yudkin JS. The Y-Y paradox
The Lancet, 2004. Two men with the same body-mass index, one Indian and one British, had very different body fat: the Indian man carried far more fat and less lean tissue at the same BMI.
Read the source[5] World Health Organization. ICD-10 Version 2019, E66 Obesity
World Health Organization, 2019. Obesity is classified under code E66 in the International Classification of Diseases, 10th revision.
Read the source[6] Anjana RM, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17)
The Lancet Diabetes & Endocrinology, 2023. Across 113,043 adults in 31 states and union territories, generalised obesity was 28.6%, abdominal obesity 39.5%, hypertension 35.5%, diabetes 11.4%, prediabetes 15.3% and dyslipidaemia 81.2% of those tested; all except prediabetes were more frequent in towns and cities than in villages.
Read the source[7] Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis
Obesity Reviews, 2012. Across studies of more than 300,000 adults in several ethnic groups, waist-to-height ratio picked out diabetes, hypertension and cardiovascular risk better than waist alone or BMI.
Read the source[8] Rubino F, et al. Definition and diagnostic criteria of clinical obesity
The Lancet Diabetes & Endocrinology, 2025. Proposes that excess body fat be confirmed by more than BMI, and separates preclinical obesity (excess fat, organs working normally) from clinical obesity (excess fat already causing organ dysfunction or limiting daily activity), a chronic illness in its own right.
Read the source[9] Masa JF, et al. Obesity hypoventilation syndrome
European Respiratory Review, 2019. Obesity hypoventilation syndrome combines a BMI of 30 or more, raised daytime carbon dioxide and sleep-disordered breathing; it affects about 0.4% of adults, and CPAP or non-invasive ventilation at night improves symptoms.
Read the source[10] Bray GA, et al. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation
Obesity Reviews, 2017. Describes obesity as a chronic relapsing disease process: energy-dense food and low activity act on genetic susceptibility, and enlarged fat cells and fat inside organs release products that damage the arteries, heart, liver, muscle and pancreas.
Read the source[11] Sumithran P, et al. Long-term persistence of hormonal adaptations to weight loss
New England Journal of Medicine, 2011. Fifty adults who lost an average of 13.5 kg on a very-low-energy diet still had lower leptin, higher ghrelin and a higher appetite one year later than before the weight loss.
Read the source[12] Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: an intriguing link
Indian Journal of Endocrinology and Metabolism, 2016. Overt hypothyroidism is linked with modest weight gain; a raised TSH can follow obesity rather than cause it; treating overt hypothyroidism has at most a modest effect on weight, and thyroid hormone has no supported role when the thyroid is normal.
Read the source[13] Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
Journal of Clinical Endocrinology & Metabolism, 2023. The international PCOS guideline, 254 recommendations and practice points, covering diagnosis, metabolic risk, weight and lifestyle care for women with PCOS.
Read the source[14] Nieman LK, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline
Journal of Clinical Endocrinology & Metabolism, 2008. Advises testing for Cushing's syndrome when several progressive features appear together, starting with one accurate test (late-night saliva cortisol, 24-hour urine cortisol or an overnight suppression test), and sending an abnormal result to an endocrinologist.
Read the source[15] Guh DP, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis
BMC Public Health, 2009. Across 89 studies it assessed 18 co-morbidities and found significant links with obesity for nearly all of them (not oesophageal or prostate cancer); obesity raised the risk of type 2 diabetes in women 12.41-fold, and overweight alone 3.92-fold.
Read the source[16] Wing RR, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes
Diabetes Care, 2011. In 5,145 Look AHEAD participants with type 2 diabetes, losing 5 to under 10% of body weight in a year made a half-point fall in HbA1c about 3.5 times as likely, and improved blood pressure, triglycerides and HDL cholesterol.
Read the source[17] Knowler WC, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
New England Journal of Medicine, 2002. In 3,234 adults with raised blood sugar, a lifestyle programme aiming at 7% weight loss and 150 minutes of activity a week cut new cases of type 2 diabetes by 58% over an average of 2.8 years.
Read the source[18] Lean MEJ, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial
The Lancet, 2018. A structured weight management programme run in family practices put type 2 diabetes of under six years into remission at one year in 46% of participants, against 4% with usual care.
Read the source[19] Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over
Current Obesity Reports, 2017. Blood sugar and triglycerides improve with small amounts of weight loss; obstructive sleep apnoea and fatty liver with inflammation usually need 10 to 15%; more weight loss brings more improvement.
Read the source[20] Donini LM, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement
Obesity Facts, 2022. Defines sarcopenic obesity as excess body fat together with low muscle mass or function, a condition that worsens patient outcomes.
Read the source[21] Styne DM, et al. Pediatric obesity: assessment, treatment, and prevention. An Endocrine Society Clinical Practice Guideline
Journal of Clinical Endocrinology & Metabolism, 2017. Asks doctors to check children with obesity for prediabetes, high blood pressure, cholesterol, fatty liver and PCOS, to involve the whole family, and to skip routine hormone tests unless the child is short for age or growing slowly.
Read the source[22] Unnikrishnan AG, et al. Prevalence of hypothyroidism in adults: an epidemiological study in eight cities of India
Indian Journal of Endocrinology and Metabolism, 2013. Of 5,360 adults tested in eight Indian cities, 10.95% had hypothyroidism (15.86% of women, 5.02% of men), and 3.47% had it undetected until the study's blood test.
Read the source[23] World Obesity Federation. World Obesity Day
World Obesity Federation, 2026. World Obesity Day, led by the World Obesity Federation, is marked every year on 4 March.
Read the source
