Contextual factors for prevention and management of obesity in India

When the Prime Minister recently described obesity as a ‘silent crisis’ for India, it elevated the issue from a clinical concern to a matter of national policy priority (1). Obesity is now widely recognized as a formidable public health challenge in India, with prevalence rising rapidly in both urban and rural settings. As of 2025, India is preparing its first national obesity guideline, aiming to shift the focus beyond global standards to a home-grown framework that accounts for prevention, early diagnosis, and culturally appropriate interventions (2). A recurring theme in this discourse is whether lower BMI thresholds—such as ≥23 kg/m² for overweight and ≥25 kg/m² for obesity—should be formally adopted in place of the WHO’s international cut-offs (≥25 and ≥30, respectively). The cut-off debate: While several expert consensus statements and smaller studies support the use of lower thresholds for Asian Indians, the evidence remains fragmented. Some cross-sectional studies suggest that cardiometabolic risk factors, including diabetes and hypertension, cluster at BMI levels well below 30 kg/m² (3). Yet, large-scale cohort data directly linking these lower cut-offs with incident cardiovascular events and mortality in Indian populations are still limited. As such, the question of optimal thresholds remains open and could be a focus of systematic research rather than a settled matter.