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India reworks obesity guidelines, BMI lowered

The Health Ministry has reduced the diagnostic cut-offs for body mass index (BMI) to 23 kg/m2 and the standard waist circumference to deal obesity

New Delhi: Alarmed by reports that India will become the global diabetes capital by 2050, the Health Ministry has reduced the diagnostic cut-offs for body mass index (BMI) to 23 kg/m2 and the standard waist circumference to fight the battle against obesity.

The standards have been set for the first time in the Ministry's consensus guidelines for Prevention and Management of Obesity and Metabolic Syndrome for the country, released on Tuesday.

The BMI—considered the individual's fitness and obesity indicator—is the ratio of the body weight in kg versus height in m2.

The country's new diagnostic cut-off for the body mass index is 23 kg/m2 as opposed to 25 kg/m2 globally.

The guidelines were released jointly by the Health Ministry, the Diabetes Foundation of India, the All-India Institute of Medical Science (Aiims), Indian Council of Medical Research, the National Institute of Nutrition and 20 other health organisations.

A person with a body mass index of 23 kg/m2 will now be considered overweight and below that as one with normal BMI—unlike the cut-off limit of 25 kg/m2 earlier. 

Those with BMI of 25 kg/m2 will be clinically termed obese (as opposed to 30 kg/m2 at the international level) and those with BMI of 32.5 kg/m2 will require bariatric surgery to eliminate excess flab. 

According to guidelines, cut-offs for waist circumstances will now be 90 cm for Indian men (as opposed to 102 cm globally) and 80 cm for Indian women (as opposed to 88 cm at the international level).

This is the first time India has officially compiled its weight and flab statistics to step up the fight against obesity and its direct fallout—diabetes. 

Studies say that India will become the global diabetes capital by 2050 if the abdominal and lower limb obesity and metabolic syndrome are not arrested. 

Researches over the last several years have shown that Indian bodies and genetics are different from their western counterparts. Indians suffer from abdominal obesity compared to people in the west whose bodies are uniformly obese.  

"The Indian body composition puts them in high risk for diabetes and hypertension. 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 measurements," Anoop Mishra, director and head, department of diabetes and metabolic diseases, Fortis Hospitals, New Delhi and Noida, said releasing the guidelines.

The guidelines estimate that the absolute mortality due to chronic heart diseases in India will increase to 20.3 million annually by 2010 and by 2020 it will touch 2.58 million. The mortality rate stood at 1.59 million in 2000. 

The current load of diabetes in the country—41 million—is expected to rise by 170 per cent in the next 20 years. Even today, India has the largest population of diabetics in the world, the guidelines said.

According to the report, every second person in Delhi fulfils the criteria of obesity or has excess abdominal fat and nearly one-fourth of the adolescent population in the capital has Syndrome X or metabolic syndrome, that heralds the onset of heart diseases and diabetes.

The study says one in every three Indians has high triglyceride (bad cholesterol) levels and 30-70 per cent has low levels of HDL (good cholesterol). 

One in every three Indians has high blood pressure, which is expected to shoot by 60 per cent in the next 20 years.

"For every 10 extra kilograms above the stipulated body weight (measured according to height), life expectancy of a person reduces by three years," the report said. 

"The situation merits an urgent need to formulate guidelines and protocol applications for the Indian obesity because the clinical presentation of obesity and its associated metabolic dysfunctions are so unique here than in the rest of the world," Sir Gangaram Hospital's Minimal Access and Bariatric Surgery Centre Chairman P Chowbey said.

The need for weight and fitness guidelines, specific to Asian countries, was first stressed in a study by the World Health Organisation's sub-committee set up to look into obesity and metabolic syndromes in the Asia-Pacific region in 2000.


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