Why weight needs a seat at the table in India’s reproductive health conversation

Mallika Timblo

When it comes to reproductive health in India, there’s one metric that dominates every consultation: weight. It’s often the first thing noted, the first thing blamed, and far too often the only thing discussed. Whether it’s irregular periods, PCOS, infertility, or perimenopause, the advice rarely varies: “Just lose weight.”

But what if weight isn’t the problem? What if it’s a symptom? And what if our fixation on it is doing more harm than good?

In recent years, we’ve seen a welcome rise in conversations around women’s health in India from menstrual hygiene to fertility to mental well-being. But obesity, and more specifically its hormonal and metabolic intersections, remains quietly sidelined even as its impact becomes harder to ignore.

The latest NFHS-5 (2019–21) data shows that more than 24% of Indian women aged 15–49 are now overweight or obese, a marked rise from previous years. In urban pockets, that number climbs even higher particularly among women under 35. Sedentary lifestyles, ultra-processed diets, chronic stress, and endocrine-disrupting environmental exposures are all contributing factors. Yet India’s reproductive health programs continue to focus largely on contraception and pregnancy, often without addressing the underlying hormonal and metabolic shifts that shape both.

Working in this space, I see this every day. Women navigating fatigue, acne, irregular cycles, hair fall, mood swings only to be dismissed or shamed when weight enters the picture. Most are offered little more than superficial diet tips or a vague suggestion to “walk more,” while the root causes like insulin resistance, PCOS, thyroid dysfunction, or inflammation go unexamined.

A dangerous oversimplification, especially not in the case of hormonal conditions, where fluctuations in metabolism, insulin resistance, cortisol, thyroid function, and estrogen levels can dramatically impact weight without being caused by lifestyle alone.

And yet, women across India are being told explicitly or otherwise that their reproductive struggles are their fault. That their bodies are too much, their willpower too little. That if they just lost a few kilos, everything else would fall into place. This isn’t science. It’s bias masquerading as medicine.

Weight stigma delays diagnosis—and undermines care

Let’s be clear: weight can be an indicator of health but it is not the whole story. The issue isn’t that we shouldn’t talk about weight. The issue is how we talk about it, and what we do (or don’t do) once it’s raised.

Obesity in women of reproductive age is rarely a standalone issue. It’s intricately linked to a range of hormonal imbalances PCOS, thyroid disorders, early puberty, gestational diabetes, and more that profoundly affect reproductive outcomes. And yet, standard gynaecological care in India rarely includes structured metabolic screening or even a nuanced conversation around weight.

Women across India are being told explicitly or otherwise that their reproductive struggles are their fault. That their bodies are too much, their willpower too little. That if they just lost a few kilos, everything else would fall into place.

This isn’t science. It is a bias that is masquerading as medicine. The result? Delayed diagnoses. Misdirected treatments. And an erosion of trust between women and the healthcare system.

What needs to change

1. Integrate metabolic screening into reproductive health services

BMI, waist circumference, and basic metabolic markers like fasting insulin and lipid profiles are low-cost tools that frontline health workers can be trained to use. But more important than the metrics is the mindset. Weight should never be a source of shame or blame, it should be an entry point for understanding broader health patterns.

2. Stop separating reproductive care from hormonal care

Hormones don’t operate in silos. A woman experiencing irregular periods is just as likely to be facing a blood sugar issue as she is a fertility one. Treating only the outward symptoms without looking upstream at hormonal and metabolic signals is both inefficient and inadequate.

3. Leverage technology to create continuous, contextual care

India’s digital health landscape from telemedicine to mobile health apps to platforms like the Ayushman Bharat Digital Mission offers a huge opportunity to reimagine how women receive support. Done right, tech can help track patterns, decode symptoms, and offer real-time interventions that are culturally and biologically relevant. Crucially, it can also help remove the burden of self-blame by bringing clarity to complexity.

 A shift in mindset

We need to stop viewing weight as a moral failing, and start seeing it as one piece of a far more complex puzzle. Indian women deserve reproductive care that is informed, inclusive, and shame-free. One that recognises that hormonal health isn’t just about periods or pregnancy rather the long-term quality of life, emotional well-being, and agency.

It’s time we give weight (not as judgment), but as a clinical signal—the seat it deserves in our reproductive health frameworks. Also, it’s time we give the women carrying it the respect, clarity, and care they’ve long been denied.

Mallika Timblo is the Founder of Terrapy