High body fat in apparently lean individuals is a commonly described phenotype in individuals of Asian descent, but very limited consolidated scientific literature is available on this topic. This phenotype is known as ‘normal-weight obesity’ and may explain the large disparity between the prevalence of obesity (as measured by BMI) and diabetes that occurs in these individuals. Routine use of obesity indicators that best predict body fat content would help to identify these individuals in clinical practice. In this debate, we would like to highlight that even though fat and BMI have a good correlation, as suggested by Kryst et al. (2019), clinicians, public health researchers and policymakers should consider the use of these indicators in conjunction with each other rather than individually. Future research is needed on pathogenic mechanisms, diagnostic modalities and therapeutic options in these individuals which will help to further characterize and manage these patients appropriately.

The ethnicity of the studied group is one of the key characteristics that should be taken into consideration when analysing the problem of overweight and obesity. It is especially crucial in populations of countries such as India, where the proportion of the fat to lean mass and general adiposity are significantly different from those observed among Europeans. This can cause a higher risk of various metabolic-related diseases to appear at relatively lower absolute adiposity. Therefore, there is a need for further research regarding the issues of body mass and composition in Indian populations, to obtain additional information as well as to develop ethnically specific cut-off points.

Obesity indicators are useful clinical tools in the measurement of obesity, but it is important for clinicians to appropriately interpret their values in individuals with different ethnicities. Future research is needed to identify optimal cut-offs that can predict the occurrence of cardio-metabolic comorbidities in individuals of different ethnic descent. Assessment of more recently developed indicators like the Edmonton Obesity Staging System and visceral adipose tissue are able to appropriately identify metabolically at-risk individuals.