Obesity has overtaken every other health threat to become the biggest avoidable burden of the century, according to a new Lancet commission, which ranks excess weight above climate change, pandemics and antimicrobial resistance in terms of years of healthy life lost that could have been prevented.
The Lancet Commission on 21st Century Global Threats to Health estimates that it could account for 23.1 billion cumulative amenable disability-adjusted life years (DALYs) between 2025 and 2100, a toll that exceeds projected health losses from the other major global threats, ETHealthworld reported on October 12, 2026.
For India, where waistlines have expanded rapidly alongside urbanisation and changing diets, the warning lands with particular force. Health experts say the country’s expanding waistline hides metabolic dangers that conventional measures such as body mass index (BMI) often fail to capture, leaving millions at risk of diabetes and heart disease even at lower body weights.
Obesity and the thin-fat problem in India
According to ETHealthworld, Mumbai-based diabetologist Dr Rajiv Kovil has cautioned that Indians can carry excess visceral fat, reduced muscle mass and metabolic complications at comparatively lower BMI levels. “Relying solely on BMI can be dangerously deceptive in Indian populations,” he said, noting that many South Asians carry higher proportions of visceral abdominal fat and lower muscle mass at lower body weights.
That profile, sometimes described as the “thin-fat Indian” phenotype, means an individual may not look visibly overweight yet already carry severe metabolic inflammation, insulin resistance and cardiovascular risk. Dr Anoop Misra, chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences, has echoed the concern, calling for early metabolic screening, improved urban environments and equitable healthcare access, according to Health and Family magazine.
Medical societies in the region now recommend lower BMI thresholds for Indians, often treating a BMI above 23 as overweight and above 25 as obese, alongside waist-to-hip measurements to detect hidden risks before organ damage develops.
Obesity projections: 440 million Indians at risk by 2050
The numbers behind India’s obesity epidemic are stark. Data from the National Family Health Survey-5 (2019-21) shows that nearly one in four Indian adults is obese, with prevalence rising rapidly. The World Obesity Federation reports that India has one of the steepest annual increases in childhood excess weight, with rates doubling in the last 15 years and tripling over three decades, according to Daily Current Affairs analysis.
A Lancet study projects that by 2050 India could have over 440 million obese and overweight individuals, making it the second most affected nation after China. In 2021, more than 180 million Indian adults were already classified as overweight or obese, with women affected more than men, Medicircle reported.
The links with infection are also emerging. A Lancet study published in February 2026 found that adults with obesity face nearly a 70 per cent higher risk of severe infection outcomes, and modelled data suggests about one in every 26 infectious disease deaths in India in 2023 was linked to excess weight, the Free Press Journal reported.
What the Lancet wants done about obesity
The commission attributes the crisis not to individual choices alone but to environments: unhealthy food systems, sedentary routines, aggressive marketing of processed foods and limited opportunities for physical activity. The World Health Organization estimates that higher-than-optimal BMI contributed to 3.7 million deaths worldwide in 2023, and lists excess weight as a major driver of type 2 diabetes, cardiovascular disease and several cancers.
In India, the State of Food Security and Nutrition in the World 2024 report found that 55 per cent of Indians cannot afford a healthy diet and 40 per cent lack adequate nutrient intake, while the WHO reports that 50 per cent of Indians fail to meet recommended physical activity levels. Weight-related healthcare costs in India were estimated at 28.95 billion dollars in 2019, or 1.02 per cent of GDP, and could rise to Rs 4,700 per capita by 2030 if no interventions are made.
The Lancet has also proposed redefining obesity in India under a new framework, setting Stage 1 and Stage 2 obesity at BMI above 23, with physicians assessing waist circumference and waist-to-height ratio rather than relying on BMI alone. The message, experts say, is that India’s response must shift from personal blame to systemic action on food, cities and screening.