Weight
Weight management
Weight is not willpower. It is physiology, medication history, sleep, hormones and circumstance — and each of those is something we can examine.
Why the numbers are different for South Asians
The BMI thresholds most people know — 25 for overweight, 30 for obesity — were derived from European populations. South Asians carry more body fat, and more of it around the abdomen and liver, at any given BMI. The result is that a Pakistani man at a BMI of 26 can be carrying the metabolic risk of a European man at 30.
The World Health Organization therefore recommends lower action points for Asian populations: 23 kg/m² as the point where risk becomes raised, and 27.5 kg/m² as the point of high risk. Waist circumference matters at least as much, and for South Asians the thresholds are 90 cm in men and 80 cm in women.
This is not a technicality. It is the reason a great many people in Pakistan are told their weight is fine when it is already driving insulin resistance, fatty liver and blood pressure.
What weight loss actually buys you
Losing 5% of body weight measurably improves glucose, blood pressure and triglycerides. Losing 10% does considerably more, and shifts fat out of the liver. Sustained loss above roughly 15% is where remission of type 2 diabetes becomes a realistic goal rather than a hope, particularly within the first few years after diagnosis.
For a man of 90 kg, 5% is four and a half kilograms. That is a modest, reachable target, and it is worth more than an ambitious one that is abandoned in six weeks. The aim here is the weight you can still be at in two years, not the lowest number you can reach by Eid.
What we look for before talking about diet
Several treatable things cause or sustain weight gain and are routinely missed. An underactive thyroid. Polycystic ovary syndrome. Obstructive sleep apnoea, which both results from weight gain and makes further loss harder. Depression, and the medicines used to treat it. Steroids, whether prescribed or bought over the counter. Some older diabetes medicines — sulphonylureas, pioglitazone and insulin itself — cause weight gain, and there are alternatives.
So the first appointment is not a lecture about roti. It is a history, an examination and a small set of blood tests, because treating the cause is more productive than pushing harder against it.
What the plan looks like
A calorie deficit is unavoidable; how you reach it is negotiable. There is no single correct diet, and the evidence does not support one. What matters far more is whether the pattern fits your household, your budget, your work hours and your religious observance, because a plan you cannot follow in an ordinary week has an effect size of zero.
In practice that usually means working on portion size and the timing of carbohydrate rather than banning food groups, adding protein at breakfast, and finding a form of movement you will actually keep doing. Resistance work matters more than most people are told: in rapid weight loss a meaningful share of what is lost is muscle, and that is worth protecting.
Where lifestyle change alone is not enough, medication is a legitimate next step rather than an admission of failure. That is covered on its own page.
Where you sit
BMI is weight in kilograms divided by height in metres squared. The Asian column is the one that applies to you.
| Category | Asian cut-off (BMI) | International (BMI) |
|---|---|---|
| Healthy | 18.5–22.9 | 18.5–24.9 |
| Raised risk / overweight | 23.0–27.4 | 25.0–29.9 |
| High risk / obesity | 27.5 or above | 30.0 or above |
| Waist — men | 90 cm or above | 102 cm or above |
| Waist — women | 80 cm or above | 88 cm or above |
Asian cut-offs follow the WHO Expert Consultation (2004); the South Asian waist thresholds follow the International Diabetes Federation. BMI is a screening measure and nothing more — it does not distinguish muscle from fat, and in a heavily built or a very slight person the waist measurement is the more useful of the two.
Common questions
- How fast should I be losing weight?
- Roughly half a kilogram to a kilogram a week is a sensible rate on diet and activity alone. Faster than that is usually water in the first fortnight, and after that it starts costing muscle. On the injectable medicines the rate is often quicker, which is one of several reasons they need supervision rather than a WhatsApp forward.
- Will my diabetes medicines make losing weight harder?
- Some will. Insulin, sulphonylureas such as glimepiride, and pioglitazone all tend to add weight. Metformin is weight-neutral to mildly favourable, and the SGLT2 inhibitors and GLP-1 agonists cause weight loss. If weight is a priority, the regimen can often be rebuilt around that without losing glucose control — but not by stopping anything on your own.
- Is surgery an option?
- Bariatric surgery is the most effective treatment we have for severe obesity and it puts a majority of people with type 2 diabetes into remission. It is done in Lahore. It is also irreversible, requires lifelong vitamin supplementation and follow-up, and is not the right first move for most people. If it is worth considering in your case we will say so and refer you.
- I lose weight and then it comes back. What am I doing wrong?
- Probably nothing. The body defends its previous weight — appetite rises and resting energy expenditure falls after a loss, and both effects persist. This is physiology, not weakness. It is also the argument for treating obesity as a long-term condition needing long-term support, in the same way blood pressure is.
Important