Obesity is not only about excess weight or appearance. It often brings with it a cluster of health conditions such as diabetes, hypertension, abnormal cholesterol levels, obstructive sleep apnea, and fatty liver disease, many of which can substantially increase cardiovascular risk. Experts are increasingly concerned about the clustering of these risk factors among younger people, with patients in their 20s, 30s and early 40s showing signs of cardiometabolic risk. They emphasise that cardiovascular risk can build silently for years before a person experiences the first heart attack.
The landmark ICMR-INDIAB study, which included more than 1.13 lakh adults across India, reported a prevalence of 11.4% for diabetes, 15.3% for prediabetes, 35.5% for hypertension, 28.6% for generalised obesity and 39.5% for abdominal obesity. Dyslipidaemia was present in 81.2% of the subgroup in whom lipid parameters were assessed. When translated into population estimates for 2021, approximately 101 million Indians were estimated to have diabetes, 315 million hypertension, 254 million generalised obesity and 351 million abdominal obesity.
“Obesity rarely occurs in isolation and is often accompanied by conditions that increase cardiovascular risk. It is very common for patients seeking treatment for obesity to already have one or more of these conditions. What is more concerning is that we are increasingly seeing this clustering of risk factors in younger people – sometimes in their 20s, 30s, and early 40s. Nearly 4 in 10 Indian adults in the ICMR-INDIAB study had abdominal obesity, and this is particularly important because visceral or abdominal fat is metabolically active and closely linked to insulin resistance and other cardiovascular risk factors. The risk does not begin with the first heart attack; it can accumulate silently for years,” said Dr. Aparna Govil Bhasker, Bariatric and Metabolic Surgeon, Mumbai.
Dr. Aparna added, “The recently published joint OSSI–ESI consensus on obesity management in India also highlights this issue – Indians can have higher body fat at lower BMI and at younger ages than Western populations, contributing to earlier development of type 2 diabetes and cardiovascular disease like a heart attack. BMI, waist circumference, blood pressure, blood glucose, lipid profile, and associated conditions all need to be considered together. A patient may come to me at the age of 38 or 40 with a BMI above 35–40 kg/m². They may have tried multiple diets, lost some weight, regained it, and are now finding it increasingly difficult to manage. The detailed history and investigations can reveal elevated blood pressure, prediabetes or diabetes, high triglycerides, fatty liver and symptoms suggestive of sleep apnoea. Many patients may feel fine, but when several cardiometabolic risk factors are already present at the age of 40, we cannot afford to wait another 10 or 15 years before treating obesity. Even obstructive sleep apnoea is common among people with obesity and frequently goes undiagnosed. Patients may report loud snoring, disturbed sleep, choking episodes at night, morning headaches or excessive daytime sleepiness. So, sleep history is an important part of cardiovascular and metabolic risk assessment.”
Hypertension, diabetes and dyslipidaemia can remain completely silent, which is why regular screening is important even when a person feels well. Even breathlessness on exertion, unexplained reduction in exercise tolerance, chest discomfort or heaviness, palpitations, unusual fatigue, swelling of the feet, dizziness or breathlessness while lying down should not simply be dismissed as consequences of being overweight. These symptoms warrant appropriate medical evaluation.
“Cardiovascular risk also needs to be considered when planning metabolic or bariatric surgery. “A significant proportion of patients who come to us for metabolic or bariatric surgery already have cardiovascular risk factors such as diabetes, hypertension, dyslipidemia or obstructive sleep apnoea. Some may also have established cardiovascular disease. This does not necessarily mean that they cannot undergo surgery; it means that their risk has to be properly assessed and optimised. Depending on the patient’s age, symptoms, medical history and risk profile, preoperative evaluation may include ECG, echocardiography, cardiology assessment and further investigations when indicated. Blood pressure and diabetes need to be controlled, sleep apnoea needs to be recognised and managed accordingly,” highlighted Dr Aparna.
Dr Abhilash Mishra, Cardiologist, Zynova Shalby Hospital, Ghatkopar, Mumbai said, “Heart problems are rising at a rapid rate across the country in people of all age groups. There is not only a growing concern regarding the number on the weighing scale, but also the cardiac changes that can quietly develop alongside obesity. Obesity increases the risk of developing several heart conditions, including coronary artery disease, hypertension, and heart failure. Monthly, 4-5 patients between 30 -40 years of age who visit me are obese and already show one or more cardiovascular risk factors, such as high blood pressure, raised blood sugar, and abnormal cholesterol. Many of them do not have any obvious heart symptoms and assume that they are too young to have a cardiac problem. However, these risk factors can build up over several years and slowly affect the heart and blood vessels, raising the chances of a heart attack. Obesity should be treated as an early warning sign for heart health, not something to address only after a cardiac event. It is necessary to embrace a well-balanced lifestyle inclusive of regular exercise, a nutritious diet, weight management, and stress management. Those who are obese need to prioritise their heart health.”
Obesity is an important risk factor seen in many patients with heart disease. The concern is that excess body fat, particularly around the abdomen, can put the heart and blood vessels under stress by contributing to high blood pressure, diabetes, and abnormal cholesterol levels. These changes can gradually damage blood vessels and increase the risk of coronary artery disease, heart attack, heart failure, and irregular heart rhythms such as atrial fibrillation. In a week, 2-3 patients aged 30-40 who visit me are obese and are at risk of heart problems. Hence, recognise obesity as a modifiable cardiac risk factor and encourage people to address it early, before it translates into serious heart disease. Make sure to exercise daily, eat a balanced diet, maintain an optimum weight, and keep the heart healthy,” highlighted Dr Bipeenchandra Bhamre, a Cardiac Surgeon in Mumbai.
Metabolic and bariatric surgery is not simply a procedure to reduce body weight. Not everybody with obesity requires surgery, and not everybody requires medication. Obesity is now recognised as a chronic, progressive and relapsing disease, and treatment can include nutritional and lifestyle interventions, psychological and behavioural support, obesity management medications and metabolic/bariatric surgery. The appropriate treatment depends on the severity of obesity, waist circumference, associated diseases, previous treatment attempts and the individual’s overall health risk.
“Look at obesity as a health issue rather than only a weight issue. “Do not wait for the first heart problem to start treating obesity. The warning signs may already be present years earlier – an expanding waistline, rising blood pressure, increasing blood sugar, abnormal cholesterol, sleep apnoea, or progressively decreasing fitness. India already has an enormous burden of both obesity and cardiometabolic disease. Treating obesity earlier can help to address several cardiovascular risk factors together rather than treating each complication only after it appears. Weight loss is not merely about looking different or reaching a particular number on the weighing scale. It is about protecting health and the heart,” said Dr Aparna Govil Bhasker.