You May Look Slim, But Are You Healthy? Inside India’s Hidden Obesity Epidemic
‘You look so slim!’, in India, it’s one of the biggest compliments one can receive, often seen as the ultimate marker of good health. But Dr Shashank R. Joshi, Endocrinologist, Lilavati Hospital and Padma Shri Awardee, warns that this assumption is dangerously outdated. “We’ve been taught to see health through the lens of the weighing scale and the mirror," says Dr Joshi. “But what if the scale is lying? What if our bodies are telling a completely different, and far more dangerous, story?"
According to Dr Joshi, India is now facing a silent epidemic where millions who appear to have a “normal weight" are actually carrying harmful amounts of hidden internal fat, pushing them toward chronic diseases like type 2 diabetes far earlier than expected.
The “Thin-Fat" Indian Paradox
This deceptive pattern stems from what Dr. Joshi and other researchers describe as the Asian Indian Phenotype. “Our research and new guidelines on obesity in Asian Indians confirm what doctors have long observed Indians are built differently," explains Dr Joshi.
Even at the same Body Mass Index (BMI) as other ethnicities, Indians have significantly higher total body fat. More importantly, Dr. Joshi emphasizes that “it’s not just how much fat we carry, but where we store it." Indians are genetically predisposed to accumulating fat deep inside the abdomen, wrapped around organs like the liver and pancreas. This visceral fat behaves like a toxic organ by constantly releasing inflammatory chemicals.
“This is why a person can look slim on the outside while carrying a dangerous amount of fat internally," says Dr Joshi.
From Hidden Fat to Open Disease
This internal fat is directly linked to what Dr. Joshi calls India’s “diabesity crisis." Visceral fat triggers inflammation and insulin resistance, forcing the pancreas to overwork until it ultimately gives up leading first to prediabetes, then to early-onset type 2 diabetes.
Dr Joshi points out that this explains why Indians develop diabetes at shockingly low BMIs. “Stage 1 obesity for Asian Indians begins at a BMI of 23 kg/m²," he stresses, a number still considered healthy internationally. Many of Dr. Joshi’s patients with type 2 diabetes do not look overweight at all. “This is the ‘thin-fat’ Indian, normal on the outside, metabolically unhealthy on the inside."
Why the Waistline Matters More
“If the scale is misleading, we must look beyond it," says Dr Joshi. To address this public health emergency, Indian medical experts including Dr. Joshi have created new, India-specific guidelines:
BMI ≥ 23 kg/m² is the risk threshold for Asian Indians.
Waist circumference matters more:
≥ 90 cm for men
≥ 80 cm for women
Stage 1 obesity: BMI ≥ 23 kg/m² with no complications
Stage 2 obesity: BMI ≥ 23 kg/m² plus diabetes, hypertension, or symptoms
“This shifts the focus from weight to metabolic health," explains Dr Joshi.
Managing the Invisible Obesity
This new understanding requires a long-term, integrated strategy, one that Dr. Shashank R. Joshi strongly advocates. He emphasizes lifestyle as the foundation but acknowledges that modern medicine now offers powerful tools.
For those with Stage 2 obesity, Dr. Joshi explains that GLP-1 receptor agonists can target hunger signals, improve insulin sensitivity, and lead to significant weight loss but always under strict endocrinology supervision.
“It’s time to stop judging health by appearance," urges Dr Joshi. “An expanding waistline, even with normal weight, is a critical warning sign."
The Real Health Mantra
According to Dr. Joshi, true metabolic health needs sustained lifestyle habits:
Eating slowly
Eating less and on time
Choosing the right foods
Strength training or yoga
Mindfulness meditation
Adequate sleep
And, as he says, “doing everything with a smile."
“Even if you look slim," concludes Dr Joshi, “your body may be hiding a serious internal risk. The real measure of health isn’t in the mirror, it’s in a simple measuring tape."