- A global group of experts has suggested a new approach to diagnosing and treating obesity.
- Instead of relying only on body mass index (BMI), which has some limitations, the new framework introduces improved ways to identify and understand obesity, for example, by separating early signs of obesity (pre-clinical) from more advanced cases (clinical).
- This approach seeks not only to improve outcomes for over one billion people living with obesity worldwide but also to reduce stigma, optimise healthcare resources and ensure fair access to effective treatments.
Recent research, published in
This method incorporates additional measures of excess body fat alongside body mass index (BMI), as well as objective signs and symptoms of individual health issues.
The new framework aims to improve how obesity is defined and diagnosed.
It also tackles the problems with traditional methods, which have often made it harder for people with obesity to get the care and support they need.
By providing a clear and evidence-based method to diagnose obesity, the experts also hope to settle the debate about whether obesity should be considered a disease.
Researchers emphasized that viewing obesity as either always a disease or never a disease is an overly simplistic approach, as evidence suggests a more complex reality.
They noted that while some individuals with obesity maintain normal organ function and overall Health, others experience significant signs and symptoms of illness.
The researchers cautioned that considering obesity solely as a risk factor, rather than a disease, may prevent individuals who are unwell due to obesity from accessing timely care.
On the other hand, labelling obesity as a disease for everyone could result in overdiagnosis, unnecessary treatments and high costs for both people and society.
The new framework takes a fresh approach by understanding that obesity is a complex condition and promoting care that is personalised for each individual.
For people who show clear signs of obesity, it recommends timely and effective treatments, similar to how other long-term Health conditions are managed.
For people at risk of obesity but not yet showing active illness (preclinical obesity), the focus would be on reducing risks and preventing the condition from progressing.
With over 1 billion people worldwide estimated to be living with obesity, the Commission’s proposal offers health systems a chance to adopt a universal, clinically meaningful definition of obesity along with a more precise diagnostic method.
The current ways of diagnosing obesity are seen as outdated and not very effective. Doctors and policymakers often disagree on how well these methods work.
That is because these methods can cause errors, such as incorrectly measuring body fat or misdiagnosing health issues related to obesity.
A big part of the problem is relying too much on body mass index (BMI), which is often used to define obesity as a BMI over 30 kilograms per square meter (kg/m²) for people of European descent.
Many countries also apply specific BMI thresholds to account for ethnic differences in obesity-related risk.
While BMI can help identify individuals at higher risk of health problems, the Commission emphasizes that it is not a direct measure of body fat.
BMI fails to account for fat distribution and provides no insight into an individual’s overall health or the presence of illness.
The researchers highlighted that the Health risks associated with excess fat depend on where it is stored in the body.
Fat accumulation around the waist or within organs like the liver, heart or muscles poses a greater health risk compared to fat stored beneath the skin in areas such as the arms or legs.
The experts highlighted that some people with too much body fat might not have a BMI high enough to be considered obese, causing their health problems to be missed.
On the flip side, some people with a high BMI and significant body fat might still have healthy organs and no signs of illness.
This shows the need for a better way to diagnose obesity. While BMI can be helpful as a first step, the experts suggest it’s not enough on its own.
Mir Ali, MD, board certified general surgeon, bariatric surgeon and medical director of Memorial Care Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, not involved in this research, agreed.
Ali told Medical News Today that this is “a well-written paper” and “addresses the need to establish better guidelines for the diagnosis and treatment of obesity.”
“The implications are: BMI is currently the widely used measure of obesity; however, it is flawed and sometimes a person who needs treatment for obesity, may not get the optimal treatment due to BMI criteria alone. Adopting more clinically relevant criteria for the diagnosis and treatment of obesity will allow for treatment of a larger group of patients. Unfortunately, changing long standing parameters will take some time.”
– Mir Ali, MD
Accordingly, the researchers have introduced a new framework for diagnosing obesity, distinguishing between clinical obesity and preclinical obesity.
Clinical obesity is a chronic disease where excess body fat impairs organ function or daily activities. Researchers identified diagnostic criteria, including breathlessness, heart failure, joint pain and organ dysfunctions, with separate measures for adults and children.
Preclinical obesityrefers to excess body fat without current health issues but with increased risks of conditions like type 2 diabetes, heart disease, and certain cancers. Early interventions can mitigate these risks.
This framework, endorsed globally, aims to improve obesity diagnosis and management, promoting more effective and tailored healthcare strategies.
Mark A. Anton, MD, FACS, medical director at Slimz Weightloss, who was also not involved in this research, found “the exploration of alternative metrics to BMI for assessing obesity particularly valuable.”
“BMI has limitations, as it doesn’t account for muscle mass, bone density, or distribution of fat. The research suggests a more comprehensive approach, considering factors like metabolic Health and body composition, which could lead to more personalized and effective treatment plans for patients.”
– Mark A. Anton, MD, FACS
For people with clinical obesity, the Commission experts recommend treatments that focus on improving how the body works, rather than just trying to reduce weight.
These treatments could include lifestyle changes, medications, or surgery, depending on what’s best for the individual.
For individuals with preclinical obesity, care should prioritize risk reduction through counselling, monitoring or proactive interventions based on risk levels.
This evidence-based framework, developed by 56 experts in collaboration with individuals living with obesity, also addresses the societal impact of obesity and the harmful effects of weight stigma.
To reduce stigma, the Commission calls for better training for healthcare professionals and policymakers, along with a shift in how obesity is understood and discussed.
In conclusion, Anton highlighted that, “by adopting a broader set of criteria, Healthcare providers can offer more tailored advice and interventions, ultimately improving patient outcomes and reducing the stigma often associated with obesity.”
