As India faces a rapidly rising burden of obesity, diabetes, fatty liver disease, and other metabolic disorders, Dr. Rakesh Kalapala, MD, DNB, FASGE, FJGES, FSGEI, has emerged as one of the country’s leading voices advocating a scientific, evidence-based, and patient-centric approach to obesity care.
At AIG Hospitals, Hyderabad, Dr. Kalapala leads the Centre for Obesity and Metabolic Therapy and the Centre for Artificial Intelligence and Innovation. His work sits at the intersection of gastroenterology, metabolic medicine, advanced endoscopy, obesity research, and healthcare innovation. Over the years, he has focused on understanding the biological drivers of obesity and developing minimally invasive treatment approaches that go beyond conventional advice around diet and exercise.
Recognized globally for his contributions to endobariatric therapies and metabolic disease management, Dr. Kalapala is associated with international scientific bodies including the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), and serves as Board Member – Endobariatrics at the American Society for Gastrointestinal Endoscopy (ASGE). These roles reflect his active contribution to shaping the evolving global conversation around non-surgical and minimally invasive therapies for obesity and metabolic disease.
Dr. Kalapala believes India is at a critical inflection point in its fight against obesity. “One of the biggest misconceptions we continue to face is that obesity is simply a consequence of poor lifestyle choices,” he says. “The science tells us otherwise. Obesity is a chronic, multi-organ metabolic disease, heavily influenced by biological pathways originating in the gut. Unless we start treating it as a disease rather than a behavioral failure, we will continue to struggle with its health and economic consequences.”
According to him, India’s obesity burden is no longer only a lifestyle concern; it is a measurable public-health and economic challenge. National data show that nearly one in four Indian adults between the ages of 15 and 49 are overweight or obese, while childhood obesity is rising steadily across urban and semi-urban populations. Beyond the obvious medical implications, the economic consequences are becoming increasingly difficult to ignore.
“The impact of obesity extends far beyond hospitals and clinics,” Dr. Kalapala explains. “It affects workforce productivity, increases absenteeism, raises healthcare expenditure, and contributes to premature mortality. Collectively, these factors create a substantial economic burden that will continue to grow if current trends remain unchecked.”
He points out that obesity-related costs do not remain confined to healthcare systems. They influence labour participation, household spending, insurance costs, and long-term economic productivity. Global analyses have shown that even modest population-level improvements in body weight can generate measurable economic benefits. Conversely, a rising obesity burden can become a drag on national competitiveness and economic growth.
At the heart of Dr. Kalapala’s approach is a simple but transformative idea: obesity should be understood through the lens of gut health and metabolic regulation.
“Obesity is not merely excess body weight,” he says. “It is a metabolically active disease that often begins in the gastrointestinal system.”
The gut plays a central role in regulating appetite, satiety, nutrient absorption, insulin sensitivity, and inflammation. Through hormones such as GLP-1, ghrelin, and peptide YY, the gastrointestinal tract constantly communicates with the brain, influencing how hungry we feel, how much we eat, and how efficiently we store energy.
As visceral fat accumulates, these regulatory systems begin to malfunction. The result is a cascade of metabolic disturbances that affect multiple organs. Fatty liver disease, now known as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), often develops alongside insulin resistance, pancreatic dysfunction, gallbladder disease, reflux disorders, and metabolic syndrome.
“In many patients, the liver, pancreas, and gut are among the earliest organs to reflect the metabolic stress of obesity,” says Dr. Kalapala. “By the time significant weight gain becomes visible, important biological changes may already be underway.”
Adding further complexity is what researchers describe as the uniquely Indian obesity phenotype. Recent genomic research led by AIG Hospitals and published in Scientific Reports suggests that Indians may be more metabolically sensitive to body fat accumulation than many other populations.
Dr. Kalapala explains that Indians frequently exhibit what is often referred to as the “thin-fat phenotype”—a combination of lower muscle mass, greater abdominal fat accumulation, and earlier insulin resistance. As a result, serious metabolic disorders such as type 2 diabetes and fatty liver disease often emerge at lower BMI thresholds than those observed in Western populations.
“Our research demonstrated that obesity risk in Indians is not uniform,” he notes. “Inherited genetic susceptibility interacts with environmental and lifestyle exposures in measurable ways. This means that a one-size-fits-all approach to obesity management is unlikely to deliver optimal outcomes.”
Another challenge that clinicians increasingly encounter is the biological resistance to long-term weight loss.
For decades, obesity treatment revolved primarily around advice to eat less and exercise more. While lifestyle modification remains essential, Dr. Kalapala believes that this message alone fails to acknowledge the powerful biological mechanisms that influence body weight.
“When obesity becomes established, the body actively works to maintain that higher weight,” he explains. “Appetite-regulating hormones change, hunger signals increase, satiety signals weaken, and metabolic rate often slows. The result is that many individuals are fighting powerful physiological forces, not simply a lack of motivation.”
Modern lifestyles further compound the problem. Sedentary occupations, ultra-processed food environments, chronic stress, sleep disruption, and reduced physical activity all contribute to metabolic resistance and make sustainable weight loss increasingly difficult.
This evolving understanding of obesity biology has led to the emergence of advanced metabolic therapies that target the underlying mechanisms of weight regulation rather than relying solely on behavioural interventions.
“Modern metabolic therapies essentially help reset the body’s weight-regulation system,” says Dr. Kalapala. “Instead of asking patients to constantly battle hunger, we work with the biological pathways that control appetite and satiety.”
Many of these therapies mimic naturally occurring gut hormones that communicate with the brain. By enhancing feelings of fullness and reducing hunger, they enable patients to achieve clinically meaningful and sustainable weight reduction. However, Dr. Kalapala emphasizes that these therapies work best when integrated into structured, long-term care pathways involving nutrition, physical activity, behavioural support, and metabolic monitoring.
Among the most exciting developments in the field are endobariatric therapies—minimally invasive, incisionless procedures that bridge the treatment gap between lifestyle modification, pharmacotherapy, and bariatric surgery.
One such intervention is the Intragastric Balloon (IGB), which occupies space within the stomach and promotes early satiety. By reducing effective stomach capacity and slowing gastric emptying, patients often experience significant additional weight loss compared to lifestyle interventions alone.
Another increasingly important option is Endoscopic Sleeve Gastroplasty (ESG). Performed entirely through an endoscope, ESG reshapes the stomach into a narrower sleeve-like structure without requiring external incisions. Multiple studies have reported approximately 15–17 percent total body weight loss at one year, making it a compelling alternative for selected patients seeking substantial weight reduction without surgery.
Dr. Kalapala has been closely involved in advancing the clinical understanding and adoption of such endoscopic bariatric and metabolic therapies. His work focuses not only on weight loss, but on improving the broader metabolic consequences of obesity, including fatty liver disease, diabetes risk, reflux symptoms, and long-term cardiometabolic health.
He is particularly interested in therapies that target intestinal signalling rather than simply reducing stomach volume.
Duodenal Mucosal Resurfacing (DMR), for example, focuses on the duodenum—the first segment of the small intestine. By resurfacing the intestinal lining, DMR appears to recalibrate metabolic and hormonal pathways involved in glucose regulation and insulin sensitivity.
Similarly, the Duodenal–Jejunal Bypass Liner (DJBL) temporarily alters how nutrients interact with the upper small intestine, creating metabolic effects that extend beyond calorie restriction alone.
“These therapies reinforce an important concept,” says Dr. Kalapala. “Obesity is not only about how much food enters the body. It is also about how the gut processes and signals that information to the rest of the metabolic system.”
Looking ahead, Dr. Kalapala believes the future of obesity care lies in personalization. Advances in genomics, artificial intelligence, metabolic profiling, and endoscopic therapy are making it increasingly possible to identify high-risk individuals early and tailor interventions according to their biological profile.
At AIG Hospitals, this approach is already reflected in the way obesity care is being developed as a multidisciplinary and technology-enabled program—combining gastroenterology, endocrinology, hepatology, nutrition, endoscopic therapy, data science, and long-term follow-up. According to Dr. Kalapala, the goal is not just to reduce weight, but to reduce disease burden.
“The future of obesity management is precision medicine,” he says. “Understanding individual risk, intervening early, and selecting evidence-based therapies can dramatically improve long-term outcomes.”
For India, he argues, the stakes extend beyond individual health. Obesity is increasingly influencing healthcare costs, workforce productivity, and economic resilience. Addressing it effectively will require coordinated efforts across healthcare systems, policymakers, researchers, industry, and communities.
“Obesity is not simply a personal health issue,” Dr. Kalapala concludes. “It is a national challenge with implications for our healthcare system, our economy, and future generations. The sooner we recognize it as a chronic metabolic disease and act accordingly, the better positioned we will be to reverse its growing impact.”
In Dr. Kalapala’s view, the gut is no longer just a digestive organ; it is central to the country’s metabolic future. For India to address obesity meaningfully, the conversation must move from blame to biology, from short-term weight loss to long-term metabolic health, and from fragmented care to integrated, evidence-driven treatment pathways.
