National, 15th January 2025: A landmark analysis conducted by National Diabetes Obesity and Cholesterol Foundation (N-DOC), Fortis C-DOC Hospital for Diabetes and Allied Sciences, and All India Institute of Medical Sciences (AIIMS) has redefined obesity for the Indian population. This new classification marks a significant step forward in addressing the unique health challenges posed by obesity in Asian Indians.
Background
The need for updated obesity guidelines stems from several critical factors:
Outdated BMI Criteria: The previous guidelines for obesity in Asian Indians, established in 2009 (lead author Prof. Anoop Misra), relied exclusively on Body Mass Index (BMI, a ratio of weight in kg/height in meter square) for diagnosis. Newer research highlights the shortcomings of using BMI alone to accurately diagnose obesity or related conditions, especially for the Asian Indians.
Emerging Health Data: Studies have shown a strong correlation between abdominal obesity in Asian Indians, resulting inflammation and the early onset of comorbid diseases, further emphasizing the need for a refined definition.
Separation of ‘Innocuous Obesity” from “Obesity with Consequences”
Key Components of the New Guidelines
Focus on Abdominal Obesity: Abdominal fat, which is closely linked to insulin resistance and prevalent in Asian Indians, is now recognized as a key factor in the diagnosis.
Inclusion of Comorbid Diseases: The new definition 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.
Inclusion of Mechanical Problems Associated with Obesity: For example, knee and hip osteoarthritis etc, or shortness of breath during daily activities, which produce poor quality of life.
New Two-Stage Obesity Classification
The revised guidelines introduce a two-stage classification system, addressing both generalized and abdominal obesity:
The study introduces a two-stage classification of obesity. Initiation starting point for both is BMI more than 23 kg/m2:
- Stage 1 Obesity: Increased adiposity (BMI > 23 kg/m²) without apparent effects on organ functions or routine daily activities. This stage of obesity, currently not causing any pathological problems (“Innocuous obesity”), could progress to Stage 2 obesity, which has association with mechanical and disease related problems.
- Stage 2 Obesity: Advanced state of obesity with increased BMI more than 23 kg/2, and
Abdominal adiposity; excess Waist Circumference (WC) or Waist-to-Height Ratio (W-HtR). - One of the following impacting physical and organ functions
- Mechanical conditions (e.g. knee arthritis due to excess weight) OR
- Presence of diseases associated with obesity (e.g. type 2 diabetes)
The above stage (“Obesity with consequences”) reflects that obesity is hindering functions of organs of the body and making individual more symptomatic requiring more intensive management.
Tailored Weight Reduction Strategies, based on above classification, could be used in an effective and personalized manner by use of new guidelines.
Study Methodology
The study was conducted using the Delphi process, a structured communication technique, and involved experts in obesity and metabolic disorders:
- A steering committee of five members oversaw the consensus-building process.
- Five rounds of surveys were completed between October 2022 and June 2023.
- Participants included a diverse group of physicians, surgeons, physiotherapists, and nutritionists.
- The surveys utilized a 5-point Likert scale, with a 67% agreement threshold for consensus on key parameters such as obesity classification, diagnostic methods, and intervention guidelines.
Dr. Anoop Misra, Padma Shri awardee and Executive Chairman & Director of Diabetes and Endocrinology at Fortis C-DOC Hospital, emphasized the importance of the findings:
“Obesity rates in India are rising at an alarming pace, extending beyond urban areas. These guidelines are groundbreaking and easy to implement, providing stage-specific strategies for managing obesity-related conditions across India. These also allow application of weight loss therapies to be applied early and optimally”
Dr. Naval Vikram, Professor of Medicine, AIIMS, New Delhi, added:
“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.”