The scale had little to complain about. When Manish Arora was 60 years he weighed 81.6 kg. His BMI was 25.4—hardly a number that would set off alarm bells. His waist, however, measured 106 cm. He had lived with type 2 diabetes for a decade and had already had a heart attack. After treatment, his weight fell to 70 kg, his waist shrak to 97 cm and his blood sugar markers normalised. His case, presented at the Endocrine Society’s 2024 meeting, illustrates a growing concern among Indian doctors: sometimes, the real health story is hiding around the waist.
Abdominal obesity matters particularly among Indians, who tend to accumulate more abdominal fat at lower BMIs. A national analysis of NFHS-5 data found abdominal obesity in nearly 40 per cent of Indian women and 12 per cent of men. Another study by PGIMER Chandigarh found that an increase of just 1.6 cm in waist circumference was associated with a threefold rise in diabetes risk.
“A weighing scale shows your weight, but does not indicate the precise location of your fat. As the fat surrounding the abdomen is metabolically active, this differentiation is crucial,” says Dr Pankaj Sharma, Director of Department of Robotics, Bariatric, and General Surgery, Fortis Hospital, New Delhi.
For women, waist fat is an especially useful warning signal in midlife. As oestrogen falls and muscle mass declines, fat tends to migrate towards the abdomen, even when the weighing scale barely budges. The Indian Menopause Society’s latest clinical guidelines estimate that around 40 per cent of Indian women are abdominally obese.
“During perimenopause and menopause, hormonal changes promote visceral fat accumulation while muscle mass gradually declines. This change is not simply cosmetic. It is associated with a higher risk of diabetes, heart disease, fatty liver and metabolic syndrome,”explains Dr Bimalpreet Mohan.
This is the principle behind TOFI—“thin outside, fat inside”. Which is why losing kilos is not always the right goal if muscle is disappearing alongside. Indian clinical guidance commonly uses 90 cm for men and 80 cm for women as waist thresholds that warrant attention, although cut-offs vary across individuals.
“The goal should never be just a lower number; it should be to reduce harmful visceral fat without losing muscles,” says Dr Sharma adding, lifestyle changes offer better protection against long-term metabolic disease.
Sometimes, a tape measure sees what the weighing scale cannot.
