Commentary: Is the concern regarding overweight/obesity in India overstated?

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Abstract
The association between body mass index (BMI) and mortality continues to defy easy characterization. In this issue, Sauvaget and colleagues 1 report elevated BMI to be unrelated to mortality risk in a rural Indian population. In fact, their results could be interpreted to suggest that overweight Asian-Indians have reduced mortality. At the same time, underweight (BMI <18.5 kg/m 2) was associated with increased risk. Given the attention paid to excess weight as a public health problem worldwide, the lack of association between elevated BMI and mortality may seem surprising. Studies in both Asia and the West have been mixed regarding the relation between mildly excessive BMI and mortality 2-4. Little data exist regarding the body mass-mortality relationship in India, although BMI was reported to be unrelated to mortality in an urban cohort, 5 similar to the findings in this issue. India is undergoing an epidemiologic transition in which chronic conditions replace communicable disease as major causes of morbidity and death. 6 In Kerala, the state in which this study took place, life expectancy approaches that of many Western industrialized nations (for example, in 2000, life expectancy at birth is 74.6 years in Kerala, 7 compared with 77 years in the US). 8 Indeed, data on the patterns of deaths in Kerala increasingly mirror those in the US. 9 Is the emerging concern regarding overweight and obesity in India overstated? To the contrary, evidence indicates that adiposity is increasing in India, that it is associated with cardio-metabolic risk factors, diabetes and cardiovascular disease, 10,11 and that mortality from these conditions is increasing. 12 Diabetes is a particular concern, both as a risk factor for cardiovascular disease and for the high human and economic cost of microvascular disease complications. While this study is

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