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What is Morbid Obesity- Asian guidelines

Even though diet and lifestyle modification are known to be the main drivers of weight loss it is not possible for every patient to lose and maintain the weight lost. This is more commonly seen in patients with morbid obesity or severe obesity.

The word morbid obesity means that a person has excess fat content or excess weight which is extremely high compared to one’s height. As per the Indian and Asian guidelines morbid obesity is defined as Body Mass Index (BMI) > 32.5 with co-morbid conditions like Diabetes, Hypertension, Sleep Disorders like snoring, joint pain, osteoarthritis etc or BMI 37.5 or above.

What is Severe Obesity (Adiposity)?

Severe obesity may be different from Morbid Obesity but it is as harmful as morbid obesity. Severe Obesity is accumulation of excess body fat or higher body fat percentage in comparison to the bone or muscle mass which given rise to chronic life-threatening co-morbidities like Type II Diabetes, derangement of lipids and Metabolic syndrome. Indians are known to have more fat even at a lower weight compared to their American and European counterparts. Indians have a higher fat percentage even at a lower weight or BMI, hence they are called “Thin-Fat Indians” and are more prone to Type II Diabetes.

Central Obesity/ Visceral Obesity

Even severe central obesity is a type of severe obesity (high waist circumference). Normal waist circumference is maximum of 80cms in women and 90cms in men. The fat inside the abdomen, known as visceral obesity comprises fat in the liver, intestines and around and inside various organs in the abdomen. This fat is hormonally active and is responsible for various diseases like metabolic syndrome, diabetes, heart disease, liver and kidney disorders

Generally, if one has not succeeded in other attempts of weight-loss and are willing for a lifestyle change, you may be considered for weight loss surgery based on following indications:

  • Body Mass Index (BMI) >37.5kg/m2
  • Body Mass Index (BMI) >32.5kg/m2with obesity related illnesses such as diabetes, heart disease, hypertension, sleep apnoea, osteoarthritis, infertility, Polycystic Ovarian Disease (PCOD), Fatty Liver, breathlessness, urine incontinence, reflux disease, depression, lack of self esteem or confidence and any other psycho-social challenges that can interfere with the quality of life.
  • Weight 20kg or more than ideal weight with any of the co-morbid conditions mentioned above.
  • Having failed various weight loss attempts preferably with a medically supervised program.
  • Well informed and motivated person

Indications for Metabolic Surgery for Type II Diabetes for Diabetes Reversal/ Remission (sometimes termed as Diabetes Cure by some even though this terminology is not used or preferred).. American Diabetes Association, ADA Guidelines-

  • Uncontrolled Diabetes with Morbid or Severe obesity
  • Body mass Index (BMI) >30kg/m2 with uncontrolled Diabetes and progression of diabetes related conditions like frequent infections requiring intervention, Neuropathy, Sexual Dysfunction, Retinopathy, Nephropathy.
  • Body Mass Index (BMI) >27.5kg/m2 with Central Obesity, failed attempts of optimal medical treatment to control Diabetes, in consultation with a Diabetologist


BMI is reliable for those with severe or morbid obesity. However, there are some with lesser weight and BMI but higher fat percentage . These are best evaluated by a DXA scan to know the body composition, bone and muscle mass as well as regional fat mass. Such people may develop type 2 diabetes and have to be treated based on fat mass and not BMI. fallacy of BMI is seen when the muscle mass is very high as seen in body builders. Generally, females are known to have higher fat mass as compared to males even at the same BMI.