Key takeaways
- The standard WHO BMI cut-offs (25 overweight, 30 obese) were based largely on European populations.
- A 2004 WHO expert consultation found that risk begins between BMI 22 and 25 in different Asian groups.
- Indian guidelines use BMI 23 and above as excess weight, and waist of 90 cm (men) or 80 cm (women) as abdominal obesity.
- A waist more than half your height is a simple warning sign that NICE also uses.
- BMI is a screening tool. Waist, blood tests and family history complete the picture.
Where did the usual BMI numbers come from?
People often show me an app that says their BMI is "normal" and ask why I am still talking about their weight. Fair question. Let me explain where the numbers come from.
Body mass index is weight in kilograms divided by height in metres squared. The familiar categories (18.5 to 24.9 normal, 25 to 29.9 overweight, 30 and above obese) were set using data mostly from European and North American populations. Not from us.
In 2004, a WHO expert consultation published in The Lancet looked at Asian data and found that Asian populations have a different relationship between BMI, body fat and health risk. The level at which risk rose varied from 22 to 25 kg/m² across Asian groups. The WHO kept the international categories but added public health "action points" at 23, 27.5, 32.5 and 37.5 kg/m², and left countries to decide how to use them.
Why do Indians carry more risk at the same BMI?
See, what happens is, the scale only tells you how heavy you are. It does not tell you what that weight is made of, or where it sits. Two findings explain most of it:
- More fat for the same weight. A review by Misra and Shrivastava in Nutrients (2013) reports that South Asians have higher body fat at a given BMI than white Caucasians. In one Singapore study, Asian Indians had a BMI about 3 points lower than white Caucasians at the same body fat percentage.
- Fat in the wrong places. The same review describes greater truncal and intra-abdominal fat in South Asians, with more fat deposited in the liver and muscles, and links this to higher insulin resistance and abnormal cholesterol at lower BMI values.
The illustration I like is the "Y-Y paradox", described by Prof. Chittaranjan Yajnik and Prof. John Yudkin in The Lancet in 2004 and summarised in the Endotext chapter on thin-fat obesity. Two doctors with a similar BMI of about 22.3, one Indian and one Caucasian, had body fat of 21.2% and 9.1% respectively. Same BMI, very different bodies. I have written more about this in thin outside, fat inside.
So what are the Indian cut-offs?
The 2009 Indian consensus guideline, summarised by Misra and Shrivastava, set these numbers. The India Obesity Commission's 2025 revision keeps the BMI 23 and waist thresholds:
| Measure | International | Asian Indian |
|---|---|---|
| Normal BMI | 18.5 to 24.9 | 18.5 to 22.9 |
| Overweight / excess weight | 25 to 29.9 | 23 to 24.9 |
| Obesity | 30 and above | 25 and above |
| Waist, men (abdominal obesity) | Above 102 cm | 90 cm or more |
| Waist, women (abdominal obesity) | Above 88 cm | 80 cm or more |
| Waist-to-height ratio | Above 0.5 (NICE) | Above 0.5 |
The 2025 revision goes a step further, and I think rightly. It drops the idea that BMI alone defines obesity. Instead it combines BMI above 23 with abdominal fat and the presence or absence of health effects (Stage 1 or Stage 2). If you want to know what that means for treatment, read who is eligible for medical weight loss.
The UK's NICE also recommends lower BMI thresholds for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background. So this is not an Indian quirk. It is how the evidence reads.
How can you check yourself at home?
You need a tape measure and two minutes. No app, no gadget.
- BMI. Weight (kg) divided by height (m) squared. For example, 70 kg at 1.65 m gives 70 ÷ 2.72 = about 25.7. Internationally that is "overweight". In Indian terms, it is already in the obesity range.
- Waist. Stand relaxed, breathe out gently, and measure around your middle midway between the lowest rib and the top of the hip bone, usually around the navel. Do not suck in. The tape is not your mother-in-law; there is nobody to impress.
- Waist-to-height ratio. Divide waist by height in the same units. A 165 cm person should aim to keep their waist under 82.5 cm. Above 0.5 means higher risk.
That is very important to understand: a normal BMI with a large waist is not reassuring. Many Indians in Mumbai offices have a BMI of 23 to 24 and a waist over 90 cm, and they are the people who are surprised by a prediabetes report.
Does this mean everyone with a BMI of 23 needs treatment?
No. These cut-offs are for screening and risk, not automatic treatment. I would not hand anyone medicine because of one number.
A BMI of 24 with a normal waist, normal sugar, blood pressure and cholesterol, and an active lifestyle may simply need sensible habits and periodic checks. The same BMI with a 95 cm waist, prediabetes and fatty liver deserves a proper medical conversation. Same number, different person, different plan.
And this is not a small problem. The ICMR-INDIAB study, published in The Lancet Diabetes & Endocrinology in 2023, estimated generalised obesity in 28.6% and abdominal obesity in 39.5% of Indian adults, alongside 101 million people with diabetes and 136 million with prediabetes.
What should you do with your numbers?
This is roughly what I tell people once they have measured themselves:
- BMI under 23 and waist below the cut-off: keep going, recheck yearly.
- BMI 23 to 24.9 or waist above the cut-off: get fasting sugar or HbA1c, lipids, blood pressure and liver function checked, and build activity and protein habits.
- BMI 25 or more with a large waist, or any weight-related condition: speak to a doctor about a structured plan, which may or may not include medicine.
What you do with that is your call. I just want you to make the decision with the right numbers in front of you.
How I approach this at Dr Tvacha
In The Endgame Weight Programme, I use Indian thresholds, waist and blood tests together, not BMI alone, to decide whether medicine is appropriate for you. The Rs 499 video eligibility consult is available across India, and if medicine is not the right step for you, I will tell you so plainly.
Frequently asked questions
What is a normal BMI for Indians?
For Indian adults, I use 18.5 to 22.9 kg/m² as normal, which is what our guidelines say. A BMI of 23 to 24.9 means excess weight, and 25 or above is classified as obesity in the Asian Indian consensus. The numbers are lower because, at the same BMI, Indians carry more body fat and more metabolic risk than European populations.
What waist size is risky for Indian men and women?
Indian guidelines define abdominal obesity as a waist of 90 cm or more in men and 80 cm or more in women. A simpler check I like: if your waist is more than half your height, a ratio above 0.5, take it as a warning sign. Measure at the level of your navel, standing relaxed, without sucking in.
Is BMI accurate for Indians at all?
BMI is useful and cheap, and the 2025 Indian revision supports using it for screening. But basically it cannot separate fat from muscle or tell you where the fat sits. That is why I never use it alone. Indian guidelines combine BMI with waist circumference or waist-to-height ratio, and with tests for sugar, blood pressure and cholesterol.
Do these cut-offs apply to Indians living abroad?
Yes. The higher risk at a lower BMI comes from body composition and fat distribution, and those do not change when you change your passport. The UK's NICE recommends lower BMI thresholds for people of South Asian family background, and similar approaches are used elsewhere. If you live abroad, use the Asian cut-offs and your waist for self-checks.
Are children assessed the same way?
No. Children and teenagers are assessed with age- and sex-specific growth charts, not adult BMI cut-offs. If you are worried about your child's weight, a paediatrician can plot their measurements on the right charts and advise you on next steps. What I have written here applies to adults only.
Written by
Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.
Sources
- Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies (WHO Expert Consultation, Lancet 2004)
- Obesity and Dyslipidemia in South Asians (Nutrients, 2013)
- Revised definition of obesity in Asian Indians living in India (Diabetes & Metabolic Syndrome, 2025)
- Keep the size of your waist to less than half of your height, NICE recommends
- Thin-fat obesity: the tropical phenotype of obesity (Endotext)
- Lessons learnt from the ICMR-INDIAB study (National Medical Journal of India)
This article is for general education and does not replace a consultation. Medicines and treatments are prescribed only after a doctor's assessment. Last reviewed 25 October 2026.