The new norm has reinforced the views of two senior doctors in Pune, one who backs surgery, and the other who believes in treating the cause through maternal nutrition. But both have been emphasizing on body adiposity as a true measure than merely calculating body fat based on height and weight (BMI) for more than two decades now.
The guidelines, perhaps the first-of-its-kind, were developed over three and a half years by a committee of 62 professionals. The document advocates approaching obesity as a complex chronic disease rather than an issue of weight loss. They were released in the Canadian Medical Association Journal on August 4.
“Asians are more prone to develop obesity, insulin resistance, and related complications even at lesser BMI than Caucasians,” Pune-based senior bariatric surgeon Shashank Shah. He is the director of Laparo-Obeso Centre, an centre of excellence for metabolic and bariatric surgery in Pune.
In 2006, Shah had proposed that bariatric surgery may be a better treatment option for diabetes than medical therapy and lifestyle management alone. His study caught the attention of researchers in America and Europe, prompting them to undertake similar studies on their population. “When I would perform surgery for treating diabetes among patients with low BMI but high body fat, it was looked at rather skeptically,” Shah said.
When the American Diabetes Association included metabolic surgery as an option for treating type II diabetes in the treatment guidelines in 2017, it changed the method to treat diabetes worldwide.
Senior diabetologist Chittaranjan Yajnik from Pune has been championing the cause of controlling adiposity and diabetes through the mother’s nutrition way before the child is conceived. “An Indian baby weighing 2.7 kg has more body fat than a British baby weighing 3.5 kg,” Yajnik said. His study spanning three generations shows that improved nutrition in mothers can help prevent obesity and diabetes in future generations.
Controlling fetal adiposity may be the only solution to the vicious intergenerational cycle of obesity and diabetes, Yajnik, who heads the diabetology department at KEM Hospital in Rasta Peth, said.
Both Pune doctors’ views have been justified in the Canadian Clinical Practice Guidelines for Obesity Management in Adults which focused on improving health and well-being rather than falling numbers on the scale. “The time for simplistic measures of calculating obesity based on BMI is over. Now India must incorporate this new definition in policy and practice,” Shah said.