Rising obesity among Indian women calls for science-based, community and lifecycle-oriented care, study finds

A study published in the Indian Journal of Obstetrics and Gynecology Research, supported by the Indian Society of Assisted Reproduction, highlighted an urgent public health concern posed by the rising prevalence of obesity among Indian women in their reproductive year. According to the findings, nearly 50% of Indian women aged 35–49 are living with obesity, with even younger women aged 18–30 increasingly at risk. The health implications of this trend extend from menarche to menopause –spanning complications in fertility, pregnancy, and long-term metabolic health.

Early intervention and integrating obesity care across health system

Experts in reproductive health and endocrinology say the findings should serve as a wake-up call to rethink India’s public health strategies and embed obesity care into all layers of the healthcare system.

Addressing obesity in the reproductive years is not just about improving fertility — it’s about preventing lifelong complications,” said Nanditha Palshetkar, medical director at Bloom IVF Lilavati Hospital and former president of The Federation of Obstetric and Gynecological Societies of India (FOGSI). Dr. Palshetkar emphasised the importance of early recognition and education. “If we manage obesity early, ideally before conception, we can significantly improve outcomes for both mother and child,” she said.

“We must start recognising obesity as a disease,”Dr. Palshetkar said, “It’s often the underlying cause of comorbidities like high cholesterol and fatty liver. Unfortunately, there’s a widespread perception that simply ‘eating well’ at home ensures good health — which can be misleading. There’s a serious lack of awareness.

Piya Ballani Thakkar, consultant endocrinologist with a specialisation in diabetes and metabolic disorders, stressed the urgent need to integrate obesity screening and counselling into existing national programmes like –Reproductive, Maternal, Newborn, Child and Adolescent Health(RMNCH+A) , which focus on women of reproductive age, children, and adolescents. She called for the expansion of dietitian-led services at the primary care level and use of vernacular media in breaking down the science and disease burden.

“In rural areas, ASHA workers can play a vital role. In areas where ASHAs are absent, local NGOs can help. These systems already exist, we just need to incorporate BMI checks, counselling, and awareness about obesity into ongoing programmes like POSHAN — nutrition mission, anaemia campaigns, and even HIV or TB outreach,” she added.

Need for early screening and lifecycle approach

The study reports that 33.5% of urban women and 19.7% of rural women are affected by obesity — largely driven by lifestyle shifts, sedentary jobs, and high-carb diets. The problem is compounded by poor dietary patterns and reduced physical activity, fueling a rise in conditions like gestational diabetes, PCOS, and even increased miscarriage risk in women with a BMI over 30 kg/m².

Dr. Ballani emphasised the need for a lifecycle approach to obesity management in women. “We have to tackle obesity differently across stages. For women trying to conceive, lifestyle modifications are key, and any anti-obesity medications must be stopped prior to pregnancy. During pregnancy, weight gain needs to be closely monitored based on BMI. Postpartum, structured programmes for weight loss, including breastfeeding encouragement and, if necessary, later reintroduction of medications, are essential,”she said

She also noted the need for longitudinal birth cohort studies linking maternal BMI to child health outcomes, and suggested that NFHS data should include pre-pregnancy BMI, waist circumference, and granular lifestyle indicators to better inform policy.

She also underlined the unique challenges of peri-menopausal and post-menopausal women, pointing to the need to monitor muscle mass, bone health, and screen for metabolic disorders before initiating weight loss interventions.

Stepwise treatment model proposed by study

The study proposes a stepwise treatment algorithm designed specifically for Indian women, enabling gynaecologists to assess and treat obesity with culturally relevant approaches. The doctors agree that small, sustainable lifestyle changes– a high-fiber, low-glycemic diet, moderate daily exercise, and community support– remain the foundation of treatment. In select cases, medication and bariatric surgery may be necessary.

Dr. Palshetkar also noted culturally sensitive physical activity programmes like Garba, Bhangra, and Lezim in schools and community groups, especially in villages. “Children often dislike traditional physical education. But if you bring in dance forms they enjoy, they’re more likely to stay active. These interventions need to be fun, inclusive, and culturally rooted,”she said.

On clinical guidelines, Dr. Ballani recommended that stepwise obstetrician-gynecologist (OBGYN) algorithms and BMI-specific weight gain targets be translated into simple, actionable checklists for frontline providers. She emphasised that while lifestyle interventions should be the foundation, pharmacological and surgical treatments must be individualised, reserved for severe cases, and coordinated with endocrinology and OBGYN teams.

Call for improved obesity care

The broader goal, Dr. Palshetkar stressed, is to recognise obesity as a disease, a shift that could push governments to act. “Just like the World Health Organisation’s (WHO) classification of infertility helped raise awareness and mobilise resources, declaring obesity as a disease will help integrate it into public policy and healthcare. Pre-conception counselling must include guidance on achieving a healthy BMI. Telling a woman to take folic acid is good, but if her BMI is over 30, we’re missing a key risk factor,” she said.

However, recognising obesity purely through a clinical lens isn’t enough. Experts stress that stigma, weight bias, and sizeism remain major barriers to understanding and treating obesity effectively. These social attitudes often prevent individuals from seeking help and can even shape how healthcare providers respond to patients, leading to delayed or inadequate care.

As India continues to battle non-communicable diseases like diabetes and cardiovascular disorders, experts say that a more compassionate, science-based understanding of women’s health — free from judgment– could serve as a powerful preventive approach.

“We have observed that children born to mothers living with obesity have a higher risk of developing obesity themselves,” said Dr. Palshetkar. “To break this cycle, interventions must begin even before conception.