Air India recent – Air India’s recent announcement, indicating possible pay cuts or even de-rostering for crew members with high body mass index (BMI), may, at first glance, appear to be a prudent and well-intentioned step towards ensuring fitness and operational safety. After all, aviation is a profession where physical fitness is essential. Still, the timing of this decision – coinciding with the week when the anti-obesity drug, semaglutide, went off patent and about 40 products entered the Indian market – signals something deeper.

India today faces an increasing burden of obesity and its associated metabolic conditions such as diabetes, hypertension, fatty liver disease and dyslipidemia. Nearly a quarter of Indians are overweight or obese.

One in 10 adults suffers from diabetes, one in three suffers from high blood pressure, and a large portion suffer from fatty liver disease. What is even more worrying is that obesity is increasing rapidly in children. The reasons, which are neither unclear nor debatable, include the proliferation of ultra-processed or foods with high fat, salt and sugar content, and increasingly sedentary lifestyles due to urban work patterns, shrinking open spaces, chronic stress, alcohol consumption and inadequate sleep.

This is a genetic predisposition in Indians and South Asians towards excess body fat despite appearing lean – the so-called “thin-fat” phenotype.