Transforming Obesity Care: The New OSSI-ESI Guidelines
Health experts across the country are urging a fundamental transformation in obesity management in India. The Obesity and Metabolic Surgery Society of India (OSSI) and the Endocrine Society of India (ESI) recently unveiled a comprehensive joint consensus. This landmark document officially classifies obesity as a progressive, relapsing chronic disease. Consequently, the expert panel calls for an urgent shift away from the simplistic "eat less, exercise more" advice toward individualized, science-backed medical care.
Moving Beyond the 'Eat Less, Exercise More' Approach
For decades, society has treated obesity as a personal failure of discipline or willpower. However, the new joint guidelines stress that complex biological, genetic, environmental, and socioeconomic factors drive this disease. When healthcare providers focus solely on lifestyle blame, patients experience intense guilt and delay seeking medical support. Therefore, clinicians must approach obesity with the same empathy and scientific rigor applied to hypertension or type 2 diabetes.
Why BMI Alone Fails Obesity Management in India
Standard Western body mass index (BMI) cut-offs often fail Indian patients. Specifically, Indians tend to have a higher percentage of visceral body fat and lower muscle mass at lower BMI levels. As a result, metabolic complications like non-alcoholic fatty liver disease, cardiovascular disease, and diabetes develop at younger ages. Therefore, comprehensive obesity management in India requires clinicians to evaluate overall cardiometabolic risk rather than relying solely on the weighing scale.
A Multimodal Approach to Obesity Care
Nutrition and physical activity remain foundational components of long-term care. However, the consensus highlights that one rigid therapeutic ladder does not fit all individuals. Depending on disease severity and staging, doctors should personalize treatment plans promptly. Clinicians have multiple effective tools available, including behavioral therapy, targeted pharmacotherapy, endoscopic procedures, and metabolic surgery. Ultimately, these options complement each other at different stages of the disease to prevent irreversible complications.
Frequently Asked Questions
Q1: Why is obesity officially classified as a chronic disease in India?
Obesity involves complex neuroendocrine dysregulation, genetic predisposition, and metabolic alterations that make long-term weight maintenance biologically challenging without medical care.
Q2: Why do Indian guidelines use lower BMI thresholds for interventions?
Indians exhibit a distinct thin-fat phenotype, accumulating higher visceral adiposity and facing elevated risks of cardiovascular and metabolic disorders at comparatively lower body weights.
Q3: What treatment options do the OSSI-ESI consensus guidelines recommend?
The guidelines recommend a flexible, personalized strategy that combines medical nutrition therapy, anti-obesity medications, psychological support, endoscopic therapies, and metabolic and bariatric surgery.
References
- Experts say obesity a chronic disease, call for shift beyond 'eat less, exercisemore' approach - ETHealthworld
- Expert Consensus on Obesity Management Protocols – A Joint Position Statement by Obesity and Metabolic Surgery Society of India (OSSI) and Endocrine Society of India (ESI). Obesity Surgery, 2026.
- ESI Clinical Practice Guidelines for the Evaluation and Management of Obesity in India – An Update (2025). Indian Journal of Endocrinology and Metabolism.
