Abdominal obesity is an emerging public health challenge and a major contributor to the growing burden of non-communicable diseases (NCDs), particularly diabetes and cardiovascular disease. Body mass index is widely used in primary healthcare to assess obesity, but it often fails to identify individuals with excess abdominal fat who remain at high cardiometabolic risk. In low- and middle-income countries such as India, evidence to inform population-level screening strategies for abdominal obesity has been limited. This study analyzed nationally representative data from 664,646 women aged 15-49 years from the National Family Health Survey (2019-21) to examine the prevalence, determinants, spatial distribution and cardiometabolic implications of abdominal obesity. It also compares the performance of waist circumference and waist-to-hip ratio as screening measures.

The study found that nearly two in five Indian women had abdominal obesity based on waist circumference, representing an estimated 265 million women in India. Considerable geographical disparities were observed across states and districts, highlighting important opportunities for targeted public health action. Waist circumference demonstrated stronger associations with hypertension and diabetes than waist-to-hip ratio. The fair agreement between the two anthropometric indicators further indicates that they should not be used interchangeably and supports waist circumference as the preferred screening measure.

These findings have important implications for strengthening primary healthcare and NCD prevention programs. Incorporating waist circumference measurement into routine screening by frontline health workers offers a simple, low-cost and scalable approach for the early identification of high-risk women, particularly in resource-constrained settings. The district-level evidence generated by this study can also support geographically targeted interventions, efficient resource allocation and programme planning. By providing robust national evidence, this research contributes to the development of more effective screening policies and reinforces the role of primary healthcare in addressing the growing epidemic of abdominal obesity and cardiometabolic diseases in India and other low- and middle-income countries.

Priyanshu Sharma is a learning solutions and social & behaviour change lead at Vitamin Angels India with over 13 years of experience in public health, implementation science, behavioural research and health systems strengthening. He has earned his PhD from IIHMR University, Jaipur, India where his doctoral research focused on abdominal obesity among women in India. His research has been published in peer-reviewed journals and has informed evidence-based approaches for obesity screening and non-communicable disease prevention. His professional work spans maternal and child nutrition, primary healthcare, human-centered design and capacity strengthening across India.