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Why Is Excess Belly Fat A Health Concern, Even In People Who Appear To Have A Normal Body Weight?

India is facing a significant metabolic health challenge, with millions of people living with diabetes or prediabetes. The ICMR-INDIAB study estimated that 101 million Indians have diabetes and 136 million have prediabetes. 

What is particularly concerning is that many people at risk may not appear overweight. They may have a normal Body Mass Index (<span>BMI</span>) but carry excess body fat, particularly around the abdomen, putting them at risk of <a href="https://www.healthandme.com/health-wellness/what-is-diabetes-insipidus-the-condition-that-causes-frequent-urination-article-151119660" data-type="tilCustomLink">metabolic disorders</a>.

<h2>The ‘Thin-Fat Indian’ Phenotype: What Does It Mean?</h2>

This is especially relevant to Indians because of differences in body composition and a greater susceptibility to metabolic complications at relatively lower body weights. Research suggests that Asian Indians tend to have a higher body fat percentage, greater abdominal fat accumulation and relatively lower skeletal muscle mass than several other populations with a similar BMI. 

This pattern is commonly described as the ‘thin-fat Indian phenotype’, also known as TOFI, or ‘<span>Thin Outside</span>, Fat Inside’. Genetic predisposition, early-life nutritional influences, physical inactivity and dietary habits can all contribute to this phenomenon. As a result, a person who appears slim may still have excess body fat, reduced muscle mass and an increased risk of metabolic disease.

Also read: <a href="https://www.healthandme.com/fitness/short-bursts-of-squats-may-build-strength-as-effectively-as-longer-gym-sessions-study-finds-article-156436022" data-type="tilCustomLink">Exercise Snacking: Short Bursts Of Squats May Build Strength As Effectively As Longer Gym Sessions, Study Finds</a>

<h2>Why BMI Alone Cannot Reveal Excess Body Fat</h2>

BMI is a useful screening tool, but it measures weight in relation to height and cannot distinguish between fat and muscle. Body fat percentage offers additional information by indicating the proportion of body weight made up of fat. According to clinical guidelines from the Endocrine Society of India, body fat levels exceeding approximately 25% in men and 30% in women may be considered excessive in Indian adults when measured using Dual-Energy X-ray Absorptiometry (DXA). 

However, these thresholds should be interpreted alongside age, fat distribution, muscle mass and other metabolic parameters. A normal BMI alone cannot rule out excess body fat or an underlying metabolic risk.

<h2>Visceral Fat: How <span rel="noindex">Belly Fat</span> Affects Metabolic Health</h2>

The location of fat accumulation is equally important. Subcutaneous fat lies beneath the skin, while visceral fat accumulates deep within the abdomen, surrounding internal organs. Excess visceral fat can release free fatty acids and inflammatory substances that contribute to insulin resistance, abnormal cholesterol metabolism and chronic low-grade inflammation. 

Over time, these changes can increase the risk of <a href="https://www.healthandme.com/health-news/godzilla-drug-retatrutide-reverses-sleep-apnea-in-1-in-4-diabetes-patients-article-156425113" data-type="tilCustomLink">type 2 diabetes</a>, metabolic dysfunction-associated steatotic liver disease, hypertension and cardiovascular disease. In Indian adults, a waist circumference of 90 cm or more in men and 80 cm or more in women indicates increased abdominal adiposity and warrants further metabolic risk assessment.

Also read: <a href="https://www.healthandme.com/fitness/the-changing-obesity-treatment-landscape-where-does-bariatric-surgery-fit-in-the-age-of-weight-loss-drugs-article-156394196" data-type="tilCustomLink">The Changing Obesity Treatment Landscape: Where Does Bariatric Surgery Fit in the Age of Weight-Loss Drugs?</a>

<h2>Can Dietary Changes Help Reduce Metabolic Risk?</h2>

Addressing this risk requires a shift in how we approach everyday nutrition and physical activity. Traditional Indian meals can sometimes be disproportionately high in carbohydrates, with rice, rotis and potatoes taking up much of the plate while protein-rich foods receive less attention. 

Including adequate protein through dal, pulses, dairy, paneer, soy, eggs, fish or lean meat can help preserve muscle mass and support metabolic health. Carbohydrates do not need to be eliminated; instead, the focus should be on balanced portions, fibre-rich foods and overall dietary quality.

<h2>Resistance Training For Metabolic Health</h2>

Physical activity is equally important, particularly resistance training, which helps maintain skeletal muscle and supports glucose metabolism and <a href="https://www.healthandme.com/health-wellness/leading-gastroenterologist-padma-bhushan-dr-s-k-sarin-shares-dos-donts-for-healthy-liver-at-times-health-summit-2026-article-156421077" data-type="tilCustomLink">insulin sensitivity</a>. 

While walking and other aerobic activities are beneficial, adults should also incorporate muscle-strengthening exercises at least twice a week. A combination of aerobic exercise and resistance training can help improve body composition and reduce metabolic risk.

<h2>Festive Eating And Metabolic Health</h2>

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Festive seasons and weddings often involve frequent consumption of sweets, fried foods and calorie-dense meals. Occasional indulgence is not the primary concern; rather, repeated overeating combined with reduced physical activity can affect long-term metabolic health. Mindful portions, balanced meals and regular exercise can help people enjoy celebrations without consistently compromising their health.

Ultimately, the weighing scale tells only part of the story. BMI, waist circumference, body fat percentage, muscle mass and metabolic markers such as blood glucose and cholesterol should be considered together to obtain a more complete picture of health. India's fight against diabetes must go beyond weight loss and focus on improving body composition, preserving muscle and reducing excess fat. Looking thin does not necessarily mean being metabolically healthy, and recognising this distinction is an important step towards preventing diabetes and other metabolic disorders.

<strong><em>By Dr. Aparna Govil Bhasker, Consultant Bariatric and <span rel="noindex">Metabolic Surgeon</span>, Saifee Hospital, Mumbai</em></strong>

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India is facing a significant metabolic health challenge, with millions of people living with diabetes or prediabetes. The ICMR-INDIAB study estimated that 101 million Indians have diabetes and 136 million have prediabetes. What is particularly concerning is that many people at risk may not appear overweight. They may have a normal Body Mass Index (BMI) but carry excess body fat, particularly around the abdomen, putting them at risk of metabolic disorders.The ‘Thin-Fat Indian’ Phenotype: What Does It Mean?This is especially relevant to Indians because of differences in body composition and a greater susceptibility to metabolic complications at relatively lower body weights. Research suggests that Asian Indians tend to have a higher body fat percentage, greater abdominal fat accumulation and relatively lower skeletal muscle mass than several other populations with a similar BMI. This pattern is commonly described as the ‘thin-fat Indian phenotype’, also known as TOFI, or ‘Thin Outside, Fat Inside’. Genetic predisposition, early-life nutritional influences, physical inactivity and dietary habits can all contribute to this phenomenon. As a result, a person who appears slim may still have excess body fat, reduced muscle mass and an increased risk of metabolic disease.Also read: Exercise Snacking: Short Bursts Of Squats May Build Strength As Effectively As Longer Gym Sessions, Study FindsWhy BMI Alone Cannot Reveal Excess Body FatBMI is a useful screening tool, but it measures weight in relation to height and cannot distinguish between fat and muscle. Body fat percentage offers additional information by indicating the proportion of body weight made up of fat. According to clinical guidelines from the Endocrine Society of India, body fat levels exceeding approximately 25% in men and 30% in women may be considered excessive in Indian adults when measured using Dual-Energy X-ray Absorptiometry (DXA). However, these thresholds should be interpreted alongside age, fat distribution, muscle mass and other metabolic parameters. A normal BMI alone cannot rule out excess body fat or an underlying metabolic risk.Visceral Fat: How Belly Fat Affects Metabolic HealthThe location of fat accumulation is equally important. Subcutaneous fat lies beneath the skin, while visceral fat accumulates deep within the abdomen, surrounding internal organs. Excess visceral fat can release free fatty acids and inflammatory substances that contribute to insulin resistance, abnormal cholesterol metabolism and chronic low-grade inflammation. Over time, these changes can increase the risk of type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, hypertension and cardiovascular disease. In Indian adults, a waist circumference of 90 cm or more in men and 80 cm or more in women indicates increased abdominal adiposity and warrants further metabolic risk assessment.Also read: The Changing Obesity Treatment Landscape: Where Does Bariatric Surgery Fit in the Age of Weight-Loss Drugs?Can Dietary Changes Help Reduce Metabolic Risk?Addressing this risk requires a shift in how we approach everyday nutrition and physical activity. Traditional Indian meals can sometimes be disproportionately high in carbohydrates, with rice, rotis and potatoes taking up much of the plate while protein-rich foods receive less attention. Including adequate protein through dal, pulses, dairy, paneer, soy, eggs, fish or lean meat can help preserve muscle mass and support metabolic health. Carbohydrates do not need to be eliminated; instead, the focus should be on balanced portions, fibre-rich foods and overall dietary quality.Resistance Training For Metabolic HealthPhysical activity is equally important, particularly resistance training, which helps maintain skeletal muscle and supports glucose metabolism and insulin sensitivity. While walking and other aerobic activities are beneficial, adults should also incorporate muscle-strengthening exercises at least twice a week. A combination of aerobic exercise and resistance training can help improve body composition and reduce metabolic risk.Festive Eating And Metabolic Health   Festive seasons and weddings often involve frequent consumption of sweets, fried foods and calorie-dense meals. Occasional indulgence is not the primary concern; rather, repeated overeating combined with reduced physical activity can affect long-term metabolic health. Mindful portions, balanced meals and regular exercise can help people enjoy celebrations without consistently compromising their health.Ultimately, the weighing scale tells only part of the story. BMI, waist circumference, body fat percentage, muscle mass and metabolic markers such as blood glucose and cholesterol should be considered together to obtain a more complete picture of health. India's fight against diabetes must go beyond weight loss and focus on improving body composition, preserving muscle and reducing excess fat. Looking thin does not necessarily mean being metabolically healthy, and recognising this distinction is an important step towards preventing diabetes and other metabolic disorders.By Dr. Aparna Govil Bhasker, Consultant Bariatric and Metabolic Surgeon, Saifee Hospital, Mumbai

why is excess belly fat a health concern, even in people who appear to have a normal body weight?

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Why Is Excess Belly Fat A Health Concern, Even In People Who Appear To Have A Normal Body Weight?

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Why Is Excess Belly Fat A Health Concern, Even In People Who Appear To Have A Normal Body Weight?

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Big Lancet Report: Heat-Related Deaths Rise 36% Since Paris Climate Agreement, Global Warming Blamed