Anti Obesity Day 2025: Expert Explains Why People With Normal Weight Are Developing Internal Fat

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You might look in the mirror and feel confident about your weight, only to be surprised by what's happening inside your body. Across India, a growing number of adults who appear perfectly 'normal' on the scale are quietly accumulating fat around their organs, a type of fat that doesn't show up on the outside but can silently disrupt metabolism and increase health risks. Often called 'hidden' or internal fat, it can sneak up on anyone, regardless of how lean they look, making routine health checks and lifestyle awareness more important than ever.

On this Anti Obesity day, which is observed on November 26 each year, we spoke to Dr Ashish Gautam, Senior Bariatric, Robotic and Gastrointestinal Surgeon, Max Super Speciality Hospital, Patparganj, New Delhi and Medical Director, Dr Gautam Health Care Center and Clinic, who shared insights on the same.

Visible Weight No Longer Reflects Actual Health

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India's nutrition and lifestyle profile has changed sharply in the last two decades. The National Family Health Survey round 5 (NFHS-5, 2019-21) reports that nearly one in four adults is overweight or obese. "Even more striking is the variation across the country, where the combined rate ranges from 8-50% depending on the State. The presence of so much visible obesity indicates something deeper: a broad shift in dietary quality, food access and daily habits, all of which also affect people who remain in the "normal" BMI category," said Dr Gautam.

Abdominal fat is the main concern. A study by the Indian Council of Medical Research published in The Lancet Diabetes and Endocrinology (2023) estimated that around one in three Indian adults over 20, approximately 35 crore people, have abdominal obesity. Internal fat is more metabolically active than fat under the skin. It disrupts insulin function, increases inflammation, and raises the risk of heart disease. Even individuals who appear lean can belong to this high-risk group.

BMI, therefore, misses a large segment of the population whose risks depend more on fat distribution than on total weight.

Why Does Internal Fat Build Despite Normal Weight

Poor Diet

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Diet quality has become one of the strongest drivers of hidden obesity. India is no longer calorie-deficient, but according to the State of Food Security and Nutrition in the World report (2024), around 55% of the population cannot afford a healthy diet. The same report notes that nearly 40% fall short of adequate nutrient intake. "When diets are low in protein, fibre and essential micronutrients, the body tends to store more fat around organs even without excess calorie consumption. This helps explain why two people eating similar meals can show very different metabolic outcomes," explained Dr Gautam.

The rising availability of low-cost, high-fat, high-sugar and ultra-processed foods adds to the problem. These foods are calorie-dense but nutritionally poor. Over time, they contribute to insulin fluctuations and fat storage in the abdominal region, even among people who do not gain visible weight.

Gut Bacteria

The digestive system hosts trillions of microbes, and some groups extract more energy from the same food. Even a small difference in energy extraction, when repeated over months, can shift fat storage toward the visceral region. This biological variation is one reason internal fat can grow without any apparent change on the weighing scale.

Physical Inactivity

A recent World Health Organization (WHO) assessment notes that 50% of Indians do not meet recommended physical activity levels. "Long hours of sitting reduce the body's ability to burn fat and increase the chance of fat accumulating around organs. Sleep disruption and chronic stress further influence how the body handles sugar and fat. These factors work together silently over the years," added Dr Gautam.

A Shift in Disease Patterns that is Not Fully Recognised

The sharp rise in obesity and metabolic risk among Indians, both visible and hidden, reflects long-term changes. Overweight and obesity in adults and children have doubled in the last 15 years and tripled in the last three decades, according to the World Obesity Federation.

Childhood Obesity is Another Signal

India has more than 14.4 million obese children, the second-highest number globally (GBD Obesity Collaborators, New England Journal of Medicine, 2017). These patterns indicate how early poor diet quality and inactivity begin affecting metabolic pathways, often setting the stage for adult internal fat accumulation.

"Internal fat is concerning because Indian populations have a higher tendency for central fat storage even at lower BMIs. This means metabolic risks appear earlier and with fewer visible signs. Many normal-weight adults who undergo routine screening discover high triglycerides, borderline fasting sugar or fatty liver without any change in body shape," highlighted Dr Gautam.

Rethinking How We Assess Risk

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"BMI is widely used because it is easy to measure; however, it does not capture fat distribution or muscle mass. Waist circumference, waist-to-height ratio and targeted blood tests provide far more meaningful information. Abdominal obesity, irrespective of weight category, is a better marker of metabolic strain," said Dr Gautam.

Another study by the National Family Health Survey 2019-2021 indicates that around 40% of adult women and 12% of adult men are abdominally obese. Therefore, a shift toward early screening becomes essential. Many of these metabolic changes develop quietly and are reversible in the early stages.

What Prevention Looks Like In Practical Terms

Prevention does not require dramatic interventions. Improving diet quality, especially increasing protein and fibre intake, helps stabilise blood sugar and reduce abdominal fat accumulation. Including vegetables, fruits, pulses, and whole grains helps correct nutrient deficiencies highlighted by The State of Food Security and Nutrition in the World 2024 (SOFI) and the 2024 Global Food Policy Report (GFPR).

Strength training increases muscle mass, which improves the body's use of sugar and fat. Even two short sessions a week have shown a measurable impact on visceral fat levels in multiple studies. Light movement throughout the day, consistent sleep, and basic stress management provide further support.

These are accessible steps that can slow or reverse hidden fat accumulation even when weight remains stable.

Bottomline

Dr Gautam concluded, "Hidden obesity is not a rare condition. It is becoming a common pattern in both young and middle-aged adults. Relying only on weight gives an incomplete picture. Internal fat can grow slowly for years without any outward sign. By the time symptoms appear, metabolic changes may already be advanced. Thus, routine metabolic screening, better nutrition education and early lifestyle changes can help prevent more serious conditions later in life."

Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.