For decades, Body Mass Index (BMI) has been the standard way to assess whether someone is overweight or obese. Calculated using a person’s height and weight, BMI has been widely used by doctors and public
health agencies around the world.
But growing research suggests that BMI alone may not accurately reflect health risks in Indians. Increasingly, experts say waist size — not just body weight — may be a far better indicator of disease risk, especially in South Asian populations.
India is facing a growing abdominal obesity crisis, often hidden behind seemingly normal body weights.
An editorial by Amerta Ghosh and Anoop Misra published in the journal Diabetes and Metabolic Syndrome: Clinical Research and Reviews has emphasised the necessity of measuring waist circumference in all patients.
What Is Abdominal Obesity?
Abdominal obesity refers to excess fat accumulation around the stomach and abdominal organs, often called visceral fat.
Dr Vijay S Pandey, Director – Minimal Access, Robotic & Bariatric Surgery, Max Super Speciality Hospital in Vaishali, says that visceral fat is metabolically active and can disrupt the normal functioning of the body.
“Visceral fat surrounding internal organs such as the liver and pancreas is particularly damaging because it operates differently from subcutaneous fat. It is metabolically active and toxic to overall health,” he explains.
This type of fat is metabolically active and is strongly linked to conditions like Type 2 diabetes, cardiovascular disease, high blood pressure, fatty liver disease and metabolic syndrome.
Because of these risks, doctors increasingly rely on waist circumference as a key indicator of metabolic health.
For Asian Indians, experts recommend lower thresholds than those used in Western countries:
Men: Waist circumference 90 cm or more
Women: Waist circumference 80 cm or more
Crossing these levels significantly increases the likelihood of cardiovascular and metabolic risk factors.
Why BMI Is Not Enough For India?
BMI is a simple formula that divides a person’s weight by the square of their height. While it provides a general estimate of body fat, it has several limitations.
“BMI simply compares weight with height, but it does not differentiate between muscle and fat or tell us where fat is located,” says Dr Saurav Shishir Agrawal, a Senior Consultant- Endocrinology & Diabetes, Medanta Hospital in Noida.
BMI does not show where fat is stored in the body. Two people may have the same BMI but very different fat distribution — one may carry more fat around the abdomen, while the other stores it around the hips or thighs.
Dr Agrawal explains that because Indians are more likely to develop metabolic complications at a lower BMI because they are accumulating fat primarily in the central portion of their bodies, it is possible for someone who has a normal BMI, as defined by the WHO to have harmful visceral fat and therefore, a BMI alone does not provide a complete picture of the potential risk for chronic disease.
One reason BMI fails in Indians is a phenomenon researchers often call the “thin-fat Indian phenotype.”
Many Indians may look slim by weight standards but still carry disproportionately high levels of body fat, particularly around the abdomen. This body composition pattern makes them more vulnerable to metabolic diseases even when their weight appears normal.
This partly explains why Indians tend to develop diabetes and heart disease at younger ages and lower body weights compared with Western populations.
A Growing Public Health Concern
Recent national data highlight how widespread abdominal obesity has become in India.
Analysis of the National Family Health Survey (NFHS-5) shows that:
Around 40% of Indian women have abdominal obesity
About 12% of Indian men are affected
The survey measured waist circumference in more than 700,000 adults across the country, making it one of the largest datasets on obesity patterns in India.
Researchers also found that abdominal obesity is no longer limited to urban or affluent populations. It is increasingly seen in rural areas and among lower and middle-socioeconomic groups.
Women appear particularly affected, with five to six out of ten women aged 30–49 showing signs of abdominal obesity in some demographic groups.
Why Abdominal Obesity Is Rising in India
Dr Pandey says that in India, a rise in abdominal Obesity is becoming more common among the urban populations due to a more sedentary lifestyle, consuming more processed carbohydrate-rich foods, and being involved in low levels of physical activity.
Several factors are driving the increase in belly fat across the country:
1. Sedentary lifestyles: Urbanisation and desk-based jobs have reduced daily physical activity.
2. High-carbohydrate diets: Diets dominated by refined grains such as white rice and refined flour can contribute to fat accumulation when combined with low activity levels.
3. Processed foods and sugar: The growing availability of ultra-processed foods and sugary drinks has increased calorie intake.
4. Genetic susceptibility: South Asians appear to be genetically predisposed to storing fat in the abdominal region.
Why Belly Fat Is More Dangerous
The rising prevalence of belly fat is contributing to the country’s increasing burden of diabetes, heart disease and metabolic disorders.
Abdominal fat is closely linked to insulin resistance, a condition in which the body’s cells stop responding properly to insulin. This can lead to higher blood sugar levels and eventually type 2 diabetes.
Visceral fat also releases inflammatory chemicals and fatty acids into the bloodstream, which can damage blood vessels and organs.
This is why waist circumference is often a stronger predictor of cardiometabolic diseases than BMI.
Studies have shown that even small increases in waist size can significantly raise the risk of fatty liver disease, diabetes and heart disease.
Because BMI can miss hidden metabolic risks, many doctors now recommend measuring waist circumference as part of routine health checks.
Waist measurement is simple, inexpensive and can provide a quick indication of metabolic risk.
For individuals, it may offer a more realistic assessment of health than weight alone.
In other words, a normal weight does not always mean a healthy body — especially if excess fat is accumulating around the waist.
