Obesity Epidemic Hits India

Yesterday, the Indian Ministry of Health and Family Welfare proposed new obesity guidelines, which reduce the BMI criteria for the diagnosis of overweight and obesity to 23 and 25 respectively.

Likewise, the abdominal circumference cutoffs for abdominal obesity have been reduced to 90 cm for men and less than 80 cm for women, i.e. 12 cm and 8 cm, respectively, lower than the cutoff for abdominal obesity in the West.

According to these guidelines, people with BMI of 25 and above will be considered for initiating drug therapy, eligibility for bariatric surgery requires a BMI of 32.5.

These lower cutoff levels are fully in line with the greater metabolic risk posed by excess weight in people of South Asian origin – currently already home to the largest number of patients with diabetes anywhere in the world. The current load of diabetes in India (41 million) is expected to increase by 170% in the next 20 years.

This new definition of obesity, means that currently 15% of the Indian population have obesity – not too far behind Canada, where the population prevalence of obesity is only 3% points higher. Remarkable statistics for a country, where a significant proportion of the population still performs hard manual labour and has modest access to nutritious foods.

According to my good friend and colleague Dr. Anoop Misra, director and head, department of diabetes and metabolic diseases, Fortis Hospitals, New Delhi and Noida, “The guidelines – with revised statistics – will benefit the additional 15-20 per cent (60-80 million) of the Indian population who can now be clinically termed obese under the revised measurement.”

How India will cope with the treatment of obesity at a population level is unclear. Knowing that so far no society has succeeded in preventing or managing the obesity epidemic (e.g. it is hard to imagine how we will actually deliver obesity treatments to the 600,000 Albertans who need it), it will be interesting to see how a country like India, with its limited health care resources, will even begin to cope.

It is perhaps most timely that I have been invited to speak and chair sessions at the forthcoming 5th Asia-Oceania Obesity Conference to be held in Mumbai in February 2009 – I certainly look forward to some interesting discussions with my Indian colleagues.

Edmonton, Alberta

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