Is India facing a hidden obesity crisis, even among people who appear to have a normal body weight?

The BRICS New Delhi Declaration has named obesity and non-communicable diseases as major global public health challenges, calling for stronger preventive healthcare and healthier living. The accompanying BRICS Mission for Healthy Lifestyle and its 2026–2029 roadmap create a timely opening to talk about a risk that rarely makes headlines in India: the possibility that a person can look perfectly healthy and still be carrying serious metabolic risk.

For a diabetologist, this is a message worth repeating often: a normal body weight does not automatically mean good metabolic health. Someone can appear slim, or fall well within a normal BMI, and still carry excess fat around the abdomen. Weight on its own says nothing about blood glucose levels, insulin sensitivity or how fat is distributed in the body. Many such individuals walk around with risk factors that stay completely undetected until a routine check-up or an unrelated symptom prompts investigation. The public conversation, then, needs to move away from appearance and weight and towards metabolic health as the real marker of wellbeing.

The mechanism behind this hidden risk is fairly well understood. Excess visceral fat, the fat that surrounds internal organs rather than sitting visibly under the skin, can drive insulin resistance, a state where the body's cells stop responding to insulin as effectively as they should. To compensate, the pancreas works harder, producing more insulin to keep blood glucose within range. Over time, in people who are already susceptible, this strain can tip into prediabetes and eventually Type 2 diabetes. Catching this process early gives people a genuine chance to change course through lifestyle changes before diabetes actually sets in.

There is also a distinctly Indian angle to this story. Genetics, body-fat distribution, dietary habits, inactivity and family history all shape diabetes risk, and Indian adults are known to develop metabolic complications at a lower BMI than people from many other ethnic backgrounds. That alone should discourage the assumption that a slim frame means low risk. What matters far more than appearance is an honest assessment of a person's overall risk profile.

Abdominal fat deserves particular attention here, since fat stored around the organs is metabolically active and contributes directly to insulin resistance and other cardiometabolic problems. A rising waist circumference can be a signal worth acting on even when total body weight looks unremarkable, interpreted, of course, against appropriate clinical and population-specific benchmarks. Abdominal obesity is a health concern in its own right, not merely a matter of body shape.

Certain groups should be especially alert to this hidden risk — those with a family history of diabetes, a growing waistline, a largely sedentary routine, high blood pressure, abnormal cholesterol, fatty liver disease, or, for women, a history of gestational diabetes. The takeaway is simple: a person doesn't need to look overweight to benefit from understanding their diabetes risk.

Identifying that risk doesn't require excessive testing for everyone — it requires the right tests for the right people. Fasting glucose or HbA1c can flag prediabetes and diabetes; waist circumference and BMI add context on body composition, and blood pressure and lipid profiles round out the cardiovascular picture, with further tests added based on symptoms and family history where a doctor sees fit.

Once identified, the response should stay firmly rooted in metabolic health rather than the scale. Regular physical activity improves insulin sensitivity even without dramatic weight loss; a balanced Indian diet built around vegetables, pulses, whole grains and sensible portions supports long-term control, and cutting back on sugary drinks and calorie-dense food helps manage risk further — alongside adequate sleep and stress management, delivered through advice that is practical and sustainable, never a crash diet.

This matters because prediabetes and insulin resistance can persist for years without obvious symptoms, and waiting for visible weight gain delays the very screening that could change the outcome. This is exactly where the BRICS healthy lifestyle initiative can make a real difference — encouraging schools, workplaces and primary healthcare centres to spread awareness that looks past appearance and towards long-term metabolic wellbeing.

As one diabetologist summed it up: some individuals carry excess abdominal fat or insulin resistance without ever appearing overweight, which is why understanding personal risk factors, building sustainable habits and undergoing timely screening matter so much that early awareness is what stands between a person and the slow, silent progression toward Type 2 diabetes and other non-communicable diseases. Normal weight, hidden risk: it may be time for India to look beyond the weighing scale.