MUMBAI, Oct. 21 -- Seeking the integration of obesity prevention and management into India's national public health programmes, experts from the Obesity and Metabolic Surgery Society of India (OSSI) and the Endocrine Society of India (ESI) have recommended Obesity Management Protocols for the nation. They have also sought support and stigma-free obesity management care, clearer food labelling, healthier school environments and the pursuit of public awareness initiatives. Mumbai and Maharashtra have a high prevalence of obesity. As per the National Family Health Survey (NFHS-6), based on data collected in 2023-24, over 45.1% of women in Mumbai city and 47.7% in Mumbai Suburban were reported to be either overweight or obese. Across urban Maharashtra, about 40.1% of women and 41.7% of men in the age group of 15 to 49 years were found to be overweight or obese. "Anyone who has a Body Mass Index (BMI) of over 30 is considered obese," explained Dr Om Lakhani, executive committee member of the Endocrine Society of India. "However, for the Indian population, we tend to be wary even if the BMI is 27, since Indians are different from the western population. In the latter, the fat content is generally subcutaneous or below the skin, which actually insulates the body. Indians generally have abdominal fat, which leads to serious health issues. Also, we tend to attract obesity-related ailments like diabetes, fatty liver and heart attacks almost a decade earlier than the western population." Dr Lakhani said that Indians also need to watch out for their waist circumference. "Men with a circumference of more than 90 cm and women of more than 80 cm should tread with caution and go in for dietary or lifestyle changes," he said. "They could also take medications only under supervision of medical experts." Other studies have also painted a grim picture. "Nearly four of every 10 Indian adults, as per the ICMR-INDIAB study, have abdominal obesity, which is particularly important, as abdominal fat is closely linked to insulin resistance and other cardiovascular risk factors," explained Dr Aparna Govil Bhasker, a bariatric and metabolic surgeon. "The risk does not begin with the first heart attack; it can accumulate silently for years." Underlining the importance of the intervention, the OSSI and the ESI have jointly developed an expert consensus on Obesity Management Protocols, in which they have recommended that the government facilitate healthcare for the obese. The charter, developed from 55 recommendations from 78 experts, calls for a broader change in how India responds to obesity. In Mumbai, the BMC has responded to it, though at the treatment level. "At the tertiary care civic hospitals level, diabetic care clinics have already been set up, which also look handle cases of obesity, since that is one of the primary sources of diabetes," said Dr Nikhil Bhagwat, head of the endocrinology department in the BMC's Nair Hospital. "Here, patients are diagnosed and medications too are prescribed depending on the scale of the issue. There are also nutritionists on board to advise and guide patients." Not surprisingly, the role of dieticians has also evolved. "Unlike earlier, when nutrition care was considered just a part of the treatment, today nutrition intervention is recognised as the first line of management for patients with obesity, diabetes, hypertension, heart ailments and other metabolic diseases," said clinical nutritionist Ruby Sound, founder director, International Association of Dietitians for Metabolic Health and Nutrition. "A dietitian plays an important role in the dietary management of these conditions, particularly obesity, helping individuals adopt sustainable, evidence-based dietary and lifestyle changes." Sound added that the BMC had taken 35 nutritionists on board at the primary healthcare level, who guide people at the city's 185 public health centres on nutrition care....