Obesity Among Indian Women a Growing Crisis, Experts Warn of Risks to Fertility and Pregnancy
Nearly one in two Indian women aged 35–49 is now overweight or obese, raising alarms among health professionals about the impact of rising obesity on fertility and pregnancy outcomes. According to a new consensus statement published in the Indian Journal of Obstetrics and Gynecology Research, the obesity epidemic in India is now striking women earlier in life and worsening with age.
The paper, led by Dr. Nandita Palshetkar of Mumbai’s Lilavati Hospital along with 11 other medical experts across India, represents a landmark call for action. Published under the Indian Society of Assisted Reproduction (ISAR), it draws insights from over 75 studies, including national surveys and international data, to offer a roadmap for assessing and managing obesity among Indian women—especially those planning a pregnancy.
Obesity Starting Early, Worsening With Age
The data reveal a disturbing trend: obesity is no longer confined to older, urban, or affluent populations. In fact, the National Family Health Survey-5 (2019–21) found that 33.2% of urban women and 19.7% of rural women in India were overweight or obese, defined as having a Body Mass Index (BMI) of over 25 kg/m².
More alarmingly, in the reproductive age group of 35–49 years, nearly 49% of women were found to be overweight or obese. Among younger women aged 18–30, another large-scale study showed that over 52.4% were already classified as obese.
“The trends are very clear. Obesity is increasing and affecting younger women, including those planning pregnancies. We need urgent action, at both the clinical and public health levels,” the report states.
Serious Health Risks Across Life Stages
Obesity in women leads to a wide range of health issues—many of which are unique to the female reproductive system. Some of the key risks associated with obesity in women include:
- Irregular periods and infertility
- Polycystic Ovary Syndrome (PCOS)
- Gestational diabetes and hypertension during pregnancy
- Increased risk of miscarriages and stillbirths
- Higher likelihood of C-sections and birth complications
- Urinary incontinence and uterine fibroids
Additionally, obesity worsens common chronic conditions such as depression, metabolic syndrome, and cardiovascular disease, particularly in post-menopausal women.
Importance of Early Management
The expert panel recommends that gynecologists and primary care physicians screen all women for BMI, waist circumference, and lifestyle factors, especially if they are planning to conceive.
“By managing obesity early, ideally before conception, we can significantly improve fertility outcomes and reduce risks during pregnancy. Our aim is to help women make small, sustainable lifestyle changes, which can go a long way in protecting maternal, fetal and child health,” said Dr. Palshetkar.
The report emphasizes that even a modest weight loss—just 5–10% of body weight—can have a significant positive effect. For women with PCOS, this can lead to better menstrual regularity, improved ovulation, increased live birth rates, and reduced risk of miscarriage.
Weight loss can also improve overall health outcomes, including mobility, mental well-being, and quality of life.
Treatment Recommendations: From Lifestyle to Medications
The first line of treatment should always be lifestyle modification, the paper stresses. Recommended changes include:
- Reducing sugar, processed food, and saturated fats
- Increasing intake of fiber, fruits, and lean protein
- Engaging in at least 150 minutes of moderate exercise per week
- Practicing portion control, mindfulness, and good sleep hygiene
Cognitive Behavioural Therapy (CBT) can also be helpful, particularly for women struggling with emotional or binge eating.
For women with a BMI over 27 and a related health condition, or BMI over 30, medications may be considered. Currently, Orlistat is available in India. Another drug, Semaglutide (2.4 mg), which has shown significant weight loss and hormonal benefits in global studies, has been approved but is not yet available in India. Importantly, these medications are not advised during pregnancy or breastfeeding.
Bariatric Surgery: A Last Resort for Some
For women with a BMI above 35 or those suffering from obesity-related health complications, bariatric surgery may be considered. The surgery has shown effectiveness in improving fertility, hormone levels, and reducing pregnancy risks. However, conception should be postponed for at least 12 months after the procedure to ensure safety.
Pregnancy and Postpartum Guidelines
For pregnant women, doctors strongly advise against the use of weight-loss medications. Instead, diet and physical activity should be the cornerstone of management. Weight gain during pregnancy should be monitored closely based on pre-pregnancy BMI, and postpartum weight loss should follow a structured plan aiming at a reduction of 0.5 kg per week.
“Breastfeeding should be encouraged as it supports weight loss and child health. Anti-obesity medications can be reintroduced only after breastfeeding has completely ceased,” said Dr. Piya Ballani Thakkar, co-author and endocrinologist at Bombay Hospital.
The report also provides trimester-specific weight gain recommendations and encourages screening for bone health and metabolic disorders among perimenopausal and postmenopausal women before starting any weight management program.
A Call to Action
Experts say the issue goes beyond aesthetics—it is a serious medical and public health problem. The ISAR-led recommendations aim to equip doctors with standardized protocols to screen, counsel, and treat obesity in Indian women more effectively.
“Obesity in Indian women is now a silent epidemic with far-reaching consequences. The time to act is now,” the report concludes.
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