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South Asians accumulate fat around the abdomen and inside organs at weights that look entirely normal on a BMI chart. Waist circumference tells you far more about your risk than your weight does.
The thin-fat phenotype
South Asians develop insulin resistance, fatty liver and type 2 diabetes at substantially lower body weights than European populations. The reason is where the fat sits: less under the skin, more around the abdominal organs and inside the liver and muscle, where it directly interferes with insulin action.
This is why Indian BMI thresholds are lower than international ones. Overweight begins at 23 rather than 25, and obesity at 27.5 rather than 30. A person at BMI 24 who considers themselves slim may already have metabolic disease under way.
Measure your waist
- Measure at the midpoint between the lowest rib and the top of the hip bone, after breathing out normally
- Increased risk: above 90 cm (35 inches) in men, above 80 cm (31.5 inches) in women
- A waist-to-height ratio above 0.5 — waist more than half your height — indicates central obesity regardless of BMI
Worth knowing
If your waist is expanding while your weight is stable, you are losing muscle and gaining visceral fat. That is a worse trajectory than gaining a couple of kilograms.
What central obesity does
Visceral fat is not inert storage — it is metabolically active tissue that releases inflammatory signals and free fatty acids directly into the portal circulation supplying the liver. The results are fatty liver, insulin resistance, higher triglycerides, lower protective HDL cholesterol, raised blood pressure and a higher risk of certain cancers.
The encouraging part is how responsive it is. Visceral fat is lost earlier and faster than subcutaneous fat when weight reduction begins, which is why blood sugar, liver enzymes and triglycerides often improve after only five to seven percent weight loss — long before the change is visible.
A realistic approach
- Target 5–10% of body weight over six months, not a dramatic figure
- Cut liquid calories first — sugary tea, soft drinks, juices and flavoured milk
- Reduce refined carbohydrate portions rather than eliminating any food group
- Increase protein at every meal; it preserves muscle while weight falls
- Walk 7,000–10,000 steps daily, and add two sessions of resistance work weekly
- Prioritise sleep — under six hours a night increases hunger hormones and undermines every other effort
When to seek medical help
Consult a physician if you have BMI above 27.5 with any of diabetes, prediabetes, high blood pressure, fatty liver, PCOS or obstructive sleep apnoea; if weight has risen steadily despite genuine effort; or if you snore heavily and wake unrefreshed, which suggests sleep apnoea that must be treated before weight loss will succeed.
Weight gain that is rapid and unexplained also deserves assessment for thyroid disease, medication effects — steroids, some antipsychotics and certain diabetes drugs — and hormonal causes.
Key takeaways
- Indian BMI thresholds are lower: overweight from 23, obesity from 27.5.
- Waist above 90 cm in men or 80 cm in women signals central obesity regardless of BMI.
- A 5–10% weight reduction improves sugar, liver and lipid markers measurably.
- Untreated sleep apnoea undermines weight loss — treat it first if you snore heavily.
A note on medical advice
This article is general health education written and reviewed by the Preventive Health Check Team at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
ObesityWeightMetabolic healthPrevention
