New Obesity Guidelines Based on Associated Functional Psychological and Metabolic Conditions and Not BMI Alone: Dr. Shashank Shah

by Priya Jadhav

· A recent paper published in JAPI by a group of Endocrinologists, Diabetologists, Cardiologists, Gynecologists with a bariatric surgeon published new guidelines for Indian physicians.

· Patients with comorbidities and obesity showed higher mortality rates during COVID-19

Mumbai, 27th Dec 2023 - Dr. Shashank Shah, internationally acclaimed Bariatric Surgeon, and former President OSSI, (IEF), (AIAARO), along with Prof. Dr Neeta Rohit Deshpande (Endocrinologist and Obesity Physician) Co-author of a recent published paper in Journal of the Association of Physicians of India (JAPI) have submitted New obesity guidelines based on associated conditions and not BMI alone highly recommended by experts in a recently published paper in the Journal of the Association of Physicians of India (JAPI) by a group of Endocrinologists, Diabetologists, Cardiologists, Gynecologists and Bariatric surgeon. The new guidelines need immediate action and implementation by all medical experts and associations of the medical fraternity ahead of the new year 2024.

Obesity is the accumulation of excess body fat to the extent that it presents a health risk. According to a recent nationwide cross-sectional study that evaluated data from 100,531 adults in a randomized cluster sample across India, the prevalence of obesity in the country is 40.3%, with a higher incidence among women, urban populations, and individuals aged over 40 years. The highest incidence was reported in South India (46.51%) while the lowest was in East India (32.96%). It has been predicted that the prevalence of obesity will triple by 2040 among Indian adults aged 20 to 69 years.

In parallel to the increasing obesity rates, the burden of diabetes is also high and increasing globally, mainly fueled by unhealthy lifestyles. Estimates from 2019 showed that 77 million individuals had diabetes in India, and this number is expected to rise to over 134 million by 2045, with approximately 57% of these individuals remaining undiagnosed.

Internationally acclaimed Bariatric Surgeon and former President of the Obesity & Metabolic Surgery Society of India (OSSI), International Excellence Federation (IEF), and All India Association for Advancing Research in Obesity (AIAARO), Dr. Shashank Shah, stated, "At the international level, these new guidelines have already been implemented and treatment of obesity is based on associated problems. India is known as the capital of diabetes, and it is one of the youngest nations in the world. Obesity and overweight have reached pandemic proportions across the globe today, and India is no exception. This condition is the mother of all metabolic diseases, including cancer, type 2 diabetes, hypertension, etc., and mechanical disorders such as arthritis of the knees, not to mention mental disorders such as anxiety and depression. The economic burden to the individual, community, and the country can be enormous."

Body mass index (BMI) is the common measure used to define obesity. According to the guidelines, in India, a person is considered overweight when their BMI is between 23-25 kg/m2, while a person with a BMI over 25 k/m2 is considered obese. However, the Indian population is prone to developing excess fat accumulation around the waist, especially around the internal organs such as the liver and the pancreas. This can be the starting point for metabolic diseases such as diabetes, also known as visceral obesity or abdominal obesity.

Physical inactivity and aging are significantly associated with obesity in India. Abdominal obesity in women typically develops during the third and fourth decades of life. Unfortunately, the Indian population that has abdominal obesity and metabolic syndrome is at a higher risk for cardiovascular disease, irrespective of their body mass index, said Dr. Shashank.

A classic example of why this kind of grading of obesity is important, we see many patients with Diabetes with a lower weight. Let us take a 45-year-old lady, with a weight of only 67 kg, and height of 152 cm (5 feet), BMI of 30 kg/m2. She had severe diabetes, neuropathy, sleep apnea, severe joint pain, and osteoarthritis of both the knee joints limiting her daily activities because of pain. She had breathlessness, was on insulin, and her personal relationship with her husband had also got disturbed, and she was emotionally extremely depressed. If you look at her with the weight of 67Kgs and BMI of 30 kg/m2, with the present classification she does not come under a grade of severe obesity, but if you look at our present grading system, her metabolic, functional, and psychological disabilities are extremely severe so she would be called a patient with grade 3 or severe obesity and would deserve aggressive treatment, maybe in the form of metabolic and bariatric surgery. This lady underwent surgery, diabetes was resolved, pain resolved, breathlessness resolved. She started living a normal life, her functional capacity increased, her psychological confidence improved, metabolic disorders also improved. Such patients require more appropriate and more aggressive treatment, and this guideline would do justice to people, which otherwise are not considered severely obese, said Dr.Shashank.

Bariatric surgery is the last resort for those battling obesity when diet and exercise fail. In 2024, it is important to follow the updated bariatric surgery guidelines to determine eligibility for the procedure. The following people are eligible for bariatric surgery:

- BMI of over 35 kg/m2 with or without any comorbidities related to obesity

- BMI above 32.5 kg/m2 with more than one comorbidity related to obesity

- BMI of over 30 kg/m2 with more than two comorbidities related to obesity

- BMI of over 27.5 kg/m2, with uncontrolled Type 2 diabetes despite treatment

- Women with a waist circumference (WC) of over 80 cm and men with a WC of over 90 cm, who have comorbidities related to obesity.