Why Indians can be fit but fat: Hidden hormonal risks behind belly fat

When this communication becomes strained, metabolic disease can emerge quietly, even in people who appear outwardly healthy.

When belly fat messes up hunger hormones
Inside the body, ghrelin acts as the hunger signal, rising before meals and encouraging food intake. Modern life, with irregular sleep and high stress, tends to keep ghrelin elevated for longer than ideal, nudging the body toward constant eating and reduced insulin sensitivity. Leptin, the hormone meant to signal satiety, often becomes less effective when body fat is high. This leptin resistance is particularly common among Indians because our fat distribution is more central and visceral. This type of fat produces inflammatory molecules that disrupt hormonal balance and increase the risk of insulin resistance.

At the same time, gut-derived hormones known as incretins, mainly GLP 1 and GIP, help the pancreas release insulin in a glucose dependent manner. They also promote satiety and slow intestinal movement. In the early phases of metabolic dysfunction, this incretin response weakens. The result is delayed insulin release and higher post meal glucose spikes, often occurring long before blood tests become abnormal. Insulin itself, the central regulator, tries to compensate for these disturbances but prolonged strain leads to hyperinsulinemia and eventually insulin resistance.

Physically active but still at risk
This complex hormonal interplay explains why someone can be physically active yet still at risk. Many individuals who train regularly and appear fit carry significant visceral or ectopic fat, particularly around the liver and pancreas. This fat is metabolically active. It communicates constantly with the immune and endocrine systems, influencing appetite, glucose control and inflammatory responses. As a result, the body may transition from a seemingly healthy state to metabolic disease more quickly than expected.

For these reasons, the “fit and fat” idea is not inherently wrong, but it is incomplete. Fitness undeniably protects health. It improves cardiovascular function, enhances mood, reduces inflammation and builds resilience. But fitness alone cannot fully counteract the biological effects of excess visceral fat. For the Indian population, this becomes even more relevant because our bodies tend to store hormonally active fat much earlier in life.

Moving forward, shift your focus from weight or appearance to underlying metabolic health. Achieving this does not require extreme diets or rigid targets. It requires a balanced strategy that includes maintaining healthy body composition with adequate muscle mass, reducing visceral fat, supporting consistent sleep and adopting regular physical activity across the day rather than relying solely on intense workouts. These habits help stabilise the hormonal pathways that influence hunger, satiety and insulin function.

(Dr Abhijit Bhograj is Consultant, Endocrinologist Diabetes and Thyroid, Manipal Hospital, Bengaluru)