Most people think of obesity as a number on a scale. In India, that number can mislead. A person can have a body-mass index (BMI) in the “normal” range and still carry fat around the abdominal organs that raises the risk of diabetes and heart disease. This is why Indian researchers use lower cut-offs than the global standard, and why a tape measure around the waist has become as important as a weighing scale. This article explains the numbers, the science and the new debate about how obesity should be defined. It is general information, not medical advice.
The scale of the problem
The main source of national data is the ICMR-INDIAB study, run by the Indian Council of Medical Research and the Madras Diabetes Research Foundation. Its 2023 report in The Lancet Diabetes & Endocrinology surveyed 113,043 people aged 20 and over, 79,506 in rural areas and 33,537 in urban areas, across 31 states and union territories.
A 2026 review of obesity in India, drawing on that study, cites estimates for 2021 of 254 million people with generalised obesity, defined as a BMI of 25 or more, and 351 million with abdominal obesity, defined as a waist circumference of 90 cm or more in men and 80 cm or more in women. Note the gap: more people qualify by waist than by BMI. That gap is the heart of the story, because it means that a scale-only view of obesity misses a large group.
More Indians qualify as obese by waist size than by BMI. The scale alone misses them.
Why India uses different cut-offs
The World Health Organization's global standard for obesity is a BMI of 30 or more. India's consensus guidelines, issued in 2009, set the threshold lower: a BMI of 23 to 24.9 counts as overweight and 25 or more as obesity. The reasoning is that South Asians tend to develop metabolic problems, including type 2 diabetes, at lower BMI values than people of European descent, and to carry relatively more fat around the abdominal organs at the same BMI. The waist thresholds of 90 cm for men and 80 cm for women used in ICMR-INDIAB follow the same logic.
On the global measure of BMI of 30 or more, the review, citing worldwide estimates, reports that obesity among Indian women rose from 1.2 per cent in 1990 to 9.8 per cent in 2022, and among men from 0.5 per cent to 5.4 per cent. It notes projections of 17.4 per cent of women and 12.1 per cent of men by 2050. Projections carry uncertainty, but the direction is clear. Among children and adolescents aged 5 to 19, the review cites 12.5 million with obesity in 2022, about 3.1 per cent of girls and 3.7 per cent of boys.
Visceral fat: the fat you cannot pinch
Fat is not all the same. Subcutaneous fat lies under the skin. Visceral fat surrounds the organs inside the abdomen. Waist circumference is widely used as a simple proxy for visceral fat, and it is considered a better window into metabolic health than BMI alone because it reflects where fat is stored, not only how much.
The same review describes a “thin-fat” pattern, in which people have a normal BMI but an unhealthy distribution of body fat, carrying cardiometabolic risk similar to people with obesity. It puts the prevalence of this pattern at roughly 32 per cent of the population, although estimates like this depend on the definitions and the samples used and should be treated as approximate. The practical message is that normal BMI is not a guarantee of metabolic health.
A new way to define obesity
In January 2025, a commission convened by The Lancet Diabetes & Endocrinology proposed changing how obesity is diagnosed. Its framework recommends confirming excess fat using BMI plus at least one body-size measurement, such as waist circumference, waist-to-hip ratio or waist-to-height ratio, or using at least two body-size measurements regardless of BMI, or measuring body fat directly, for example by a DEXA scan. It also separates “clinical obesity”, in which excess fat is accompanied by organ dysfunction or limits on daily activity, from “pre-clinical obesity”, in which the excess fat is present but organs are working normally.
The proposal is influential and contested. Later studies have already compared its criteria with simpler approaches, and at least one 2026 analysis reported that assessing BMI together with waist circumference performed as well as, or better than, the commission's full criteria for diagnosing obesity. For readers, the takeaway is not which side is right but that both point the same way: fat distribution matters, and the tape measure belongs alongside the scale.
The direction of travel in obesity research is clear: measure where the fat is, not just how much there is.
Measuring your own waist
The WHO's standard method for population surveys is to measure at the midpoint between the lowest rib and the top of the hip bone, at the end of a normal breath out, with the tape snug but not compressing the skin. Comparing your reading with the 90 cm and 80 cm thresholds used in ICMR-INDIAB can give a rough sense of where you stand. But these are population screening thresholds, not a diagnosis, and a reading above them is a reason to talk to a doctor, not a reason to panic. A doctor can look at blood pressure, blood sugar, cholesterol and family history alongside the measurement.
What the evidence supports, and what it does not
The sources here show that abdominal obesity is common in India, that it affects more people than BMI-based obesity, and that fat distribution is linked to metabolic risk. They do not tell an individual what to do, and this article does not either. Questions such as whether to change diet, increase activity or start medication depend on a person's health, and belong in a conversation with a doctor.
What is worth taking away is a change of habit. Ask not only “What do I weigh?” but “What is my waist?”, and have it measured at check-ups. For a country in which diabetes and heart disease are already rising, a piece of tape and thirty seconds is one of the cheapest screening tools available.
