BMI Cutoffs for Obesity in India
In India, the BMI cutoff for obesity is between 23-27 kg/m², which is lower than the standard international cutoff of 30 kg/m², due to higher adiposity and comorbidity risks at lower BMI levels in Asian populations. 1
BMI Classification for Indian Population
- The standard World Health Organization BMI classifications define obesity as BMI ≥30 kg/m², but these are not appropriate for the Indian population 1
- For South and Southeast Asian countries including India, overweight is defined as BMI ≥23 kg/m² and obesity at lower thresholds than Western populations 1
- Several studies have demonstrated that BMI cut points between 23 and 27 kg/m² more accurately identify obesity in Asian populations, including Indians 1
- Research specific to Indian males suggests a BMI of 23.85 kg/m² as the cutoff for overweight and 24.38 kg/m² for obesity 2
Rationale for Lower BMI Cutoffs
- Asian populations, including Indians, have greater adiposity and higher comorbidity risks at lower BMI levels compared to Western populations 1
- At similar BMI levels, Asian Indians have higher body fat percentages than Caucasian populations 3
- The conventional BMI cutoff of 25 kg/m² significantly underestimates overweight and obesity in the Indian population when percentage body fat is used as the standard 3
- Studies show that cardiometabolic diseases occur at lower BMI levels in Asian populations, necessitating lower thresholds for clinical intervention 1
Additional Measurements for Risk Assessment
- Waist circumference should be used alongside BMI for more accurate risk assessment in Indians 1
- For Indian adults, waist circumference cutoffs are ≥80 cm for women and ≥90 cm for men to identify abdominal obesity 1
- Waist-to-height ratio ≥0.5 can be used to identify individuals at risk of obesity-related metabolic abnormalities 1
Current Obesity Trends in India
- The prevalence of obesity in India is estimated at 40.3%, with significant regional variations (highest in south India at 46.51% and lowest in east India at 32.96%) 4
- Obesity is higher among women (41.88%) than men (38.67%), and in urban (44.17%) than rural areas (36.08%) 4
- Recent data shows increasing trends in overweight/obesity prevalence, with obesity increasing from 2.9% in 1999 to 6.3% in 2021 for women, and from 2.0% in 2006 to 4.2% in 2021 for men 5
Clinical Implications
- Healthcare providers should recognize and treat obesity as a chronic, progressive, relapsing disease 1
- For Indians approaching but not meeting BMI-based criteria for overweight or obesity, clinicians should assess for obesity-related complications to clarify long-term health risks 1
- A comprehensive clinical assessment is recommended for individuals with BMI ≥23 kg/m² to identify obesity-related complications and potential barriers to treatment 1
Common Pitfalls in BMI Assessment for Indians
- Using standard international BMI cutoffs (≥30 kg/m²) for obesity diagnosis in Indians leads to significant underdiagnosis 3
- BMI alone has poor sensitivity in diagnosing excess body fatness in Indians, with studies showing substantial misclassification, particularly in women 3
- Failing to consider ethnic-specific body composition differences can result in delayed intervention for obesity-related complications 1
The evidence clearly supports using lower BMI thresholds for defining obesity in the Indian population to better identify individuals at risk of obesity-related complications and provide timely interventions.