Experts call for shift from 'Eat Less, Exercise More' in new obesity consensus

Health experts have described obesity as a chronic disease and called for a shift away from the traditional “eat less, exercise more” approach, urging treatment to be tailored to an individual’s health needs and disease severity.

The Obesity and Metabolic Surgery Society of India (OSSI) and the Endocrine Society of India (ESI) have jointly prepared an expert document that sets out recommended approaches to managing obesity, stressing that many factors contributing to it may be beyond a person’s control.

“Obesity is a chronic disease that requires timely recognition, scientific treatment and long-term care. This joint consensus provides a unified, India-specific framework that can help move the conversation away from blame and towards evidence-based medical care,” OSSI president Dr K S Kular said.

The consensus highlights that obesity is influenced by a complex interplay of genetic, metabolic, endocrine, environmental, psychological, socioeconomic and lifestyle factors.

“People living with obesity are often made to feel that their weight is simply the result of poor eating habits or lack of willpower. This creates guilt, shame and hesitation in seeking medical help,” said Dr Aparna Govil Bhasker, bariatric and metabolic surgeon from MetaHeal.

Obesity deserves the same scientific, compassionate and long-term approach as any other chronic disease, she said, adding that the focus should be on improving health, not blaming the individual.

 

The recommendations emphasise that BMI, or body weight, alone should not determine treatment, as Indians tend to have higher body fat and develop metabolic complications such as type 2 diabetes and cardiovascular disease at comparatively lower BMI levels and younger ages than Western populations.

“India needs an approach to obesity that reflects the unique metabolic risks of our population. Assessment must look beyond weight alone and consider the overall health of the individual,” ESI president Dr Kaushik Pandit said.

Healthy eating, physical activity and other lifestyle measures remain central to obesity management, but the consensus stresses that one size does not fit all.

Depending on disease severity and individual needs, treatment may also include psychological support, obesity management medications, endoscopic therapies and metabolic and bariatric surgery, as per the recommendations.

“The consensus moves away from a rigid treatment ladder. Treatment should be personalised and can evolve as the patient’s health needs change,” said Dr KVS Hari Kumar, honorary secretary of ESI.

“Obesity is a progressive and relapsing disease, and delaying appropriate treatment can allow both the disease and its associated complications to advance,” former OSSI president Dr Randeep Wadhawan said.

The consensus emphasises the need for timely, individualised treatment, urging clinicians to offer effective medical, endoscopic or surgical interventions before patients develop severe complications.

Beyond individual treatment, the experts call for a broader change in how India responds to obesity.

“Lifestyle measures, medications, endoscopic therapies and metabolic and bariatric surgery should not be seen as competing treatments. They are different tools that can be used at different stages of the same disease,” said Dr Sarfaraz Baig, bariatric and metabolic surgeon from Kolkata. 

The consensus supports stigma-free care, equitable access to treatment and integration of obesity prevention and management into national health programmes.

It also called for population-level measures including clearer food labelling, healthier school environments and public awareness initiatives.