This guide explains both frameworks for physicians, endocrinologists and dietitians, compares them side by side, and shows where body composition testing fits. For the older BMI-based classes (WHO 2004 Asian cut-offs and the 2009 Indian BMI thresholds), see our post on stages of obesity in India<\/a>.<\/p>\n BMI cannot tell fat from muscle, and it says nothing about where fat sits. The Lancet Commission<\/a> notes that BMI-based measures can both underestimate and overestimate adiposity, and that BMI can underestimate fat mass in older adults, in people who have lost muscle, and in some ethnic groups including Asian populations. For India this is a familiar problem: patients with an unremarkable BMI and high body fat, described in our post on thin-fat syndrome<\/a>.<\/p>\n The Commission (Rubino et al., Lancet Diabetes & Endocrinology, published online 14 January 2025) brought together 58 experts from multiple specialties and countries, including people with lived experience of obesity. Its full text<\/a> reports that its recommendations were endorsed by 76 organisations worldwide.<\/p>\n The Commission recommends that BMI be used only as a surrogate of risk at population level, for epidemiology or for screening, not as an individual measure of health. Excess adiposity should be confirmed by one of:<\/p>\n Cut-offs must be appropriate to age, gender and ethnicity. Above a BMI of 40, excess adiposity can be assumed. The Commission adds that for people whose BMI is near but below the obesity cut-off, direct fat measurement, where available, helps avoid underdiagnosis.<\/p>\n Clinical obesity requires evidence of reduced organ or tissue function due to obesity, substantial age-adjusted limitation of daily activities, or both. The Commission lists 18 diagnostic criteria for adults (and 13 for children and adolescents). The adult criteria include:<\/p>\n Each criterion assumes that other obvious causes have been excluded.<\/p>\n The revised definition of obesity in Asian Indians living in India<\/a> (Misra et al., Diabetes & Metabolic Syndrome, January 2025) replaced the 2009 guidance, which relied on BMI alone. It came from a five-round Delphi process; 118 Indian experts, including physicians, surgeons, physiotherapists and nutritionists, were invited. The lead author was also a Lancet commissioner, and the paper describes the two efforts as aligned.<\/p>\n The full paper<\/a> lists:<\/p>\nWhy BMI Alone Stopped Being Enough<\/h2>\n
The Lancet Commission: Clinical vs Preclinical Obesity<\/h2>\n
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Step one: confirm excess adiposity<\/h3>\n
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Step two: assess for clinical obesity<\/h3>\n
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India’s 2025 Revised Definition: Stage 1 and Stage 2<\/h2>\n
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The cut-offs in the Indian paper<\/h3>\n
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